13 year old behavior/depression

[walynut]

My 13 year old son that is putting us at our wits end. At a  young age he was diagnosed w/ ADHD. When the meds are balanced Ridalin, Concerta ect, he is tolerable for about six months, c’s in school, minor sibling fighting, respectful. Now that he turned thirteen, he started the school year off w/ a bang, B honor roll, playing basketball, no real issues, best I have seen. This qtr were looking at all D’s and F’s. He fails to bring home work home because he feels we are yelling at him when we try to help him. To address this issue we went back to the psych and put him on a low dose of blood pressure med that as he said studies had shown to help with the ADHD. Depression! He has the attitude that everyone is always yelling at him, even though we are just trying to talk to him. Crying has started again, if he doesn’t get his way, he goes to his room and throw a fit for an hour and then begin the silent treatment. This morning before school, he called his mother and said that he hated school, hated the town we lived in, hated his teachers and said he should just go jump off the roof. We contacted the counselor at school for two reasons,since we were both at work, to ensure he did get to school, and he did, and also for him to chat with him. The school counselor said that he did not feel that he was going to hurt himself but he was depressed because 1; He had been wanting to go to Space Camp but he had to maintain a 2.9 GPA to qualify, and he had some notion in his head that he was going to go to his Grandpa’s house for the summer in MT and we said no. The counselor mentioned it seemed he was more content to wollar in his depressed state than to press on and get over it.Good stuff, He is awesome when out in public!!! He holds doors opens for ladies, he will work for anyone that needs help offers anything to anybody. I actually have no concerns turning him loose in our small town because he is capable of doing the right thing when were not around and he does. Please help!

[Rebecca Resnik, PsyD]

Hello,
    your poor son sounds so miserable, and there is no one as skilled in spreading the misery around like a 13 year old. My first concern is that your son has expressed suicidal ideation that includes a somewhat lethal plan for how he might go about harming himself. I am sure your guidance counselor means well, but I would get him to either a psychiatrist or psychologist as soon as possible for a formal risk assessment. Guidance counselors may have brief training in risk assessment, but I would not want to take chances with your son's safety. Young adolescents are very impulsive, and of course if your son has ADHD, he is more impulsive than most. Self-harm is often a very impulsive act that can be deterred just by making sure the person does not have access to a quick and easy way of harming themselves. Take some time to assess how safe your home is (lock up firearms etc.).

    You are correct that 13 year olds tend towards emotional highs and lows that can seem incomprehensible, but most are not having this degree of difficulty. I am not sure from your email if your son has had a formal diagnosis of depression, but his symptoms are very consistent with depression in early adolescence. Many children with depression do not act pervasively sad, but are irritable and short tempered. The guidance counselor's advice to him and to you that he should just 'get over it' could work in the long run (everybody matures eventually, and depressions do typically resolve) but that could leave your family and your son struggling with this for months. I don' t see that as being in anyone's best interest when medications and therapy can significantly reduce the length and severity of depressions and improve life at home. If you can get him professional help by all means do so.

I would recommend you find a psychiatrist who specializes in adolescents who can coordinate his medications. Psychiatrists can often provide better service than general practitioners because they specialize in psychotropic medications and the interactions between them. I would strongly recommend you meet with a clinical psychologist (one with a license and a doctoral degree) and ask about having a formal evaluation if needed. A psychologist will be very helpful in teaching your son some better ways to cope with these feelings instead of tantrums and the 'silent treatment' Sounds like your son is trying so hard to let you know how bad he feels that these behaviors are likely to continue until he feels relief.

The psychologist can also assist you and your spouse in managing his behavior. Psychologists are experts in assessment (testing) as well as behavior modification. Your son will be happier if he knows that his parents can help him stay in control through methods that are fair and positive. I recommend finding a psychologist who will see your son and work with you and your spouse. Parent management training and Parent Effectiveness Training are both excellent methods of helping get back peace in the household. While you are waiting for your appointment, here's some resources:
The Kazdin Method for Parenting the Defiant Child by Alan Kazdin
How to Talk so Teens Will Listen and Listen so Teens will Talk by Adele Faber
Dr. Larry Silver's Guide to Parents of Children with ADHD by Larry Silver
Children and Adults with ADHD www.chadd.org
Cope Care Deal www.copecaredeal.org (a site for adolescents struggling with mental health issues)

Best Wishes
Rebecca Resnik
Disclaimer: This post was written for informational purposes only. It is never intended to replace face to face psychological or psychiatric care. This post is not intended to create a patient clinician relationship, nor to give or rule out a diagnosis.

[walynut]

I guess my overall questions is should we be looking for another diagnosis other than ADHD. Should we be looking at adding a anti depresent medication, and of course the golden question with no real answer, what part of this behavior is just a 13 year old boy? Thanks in advance for your help!!!

[Sally44]

Hi, I'm just a parent, not a professional.  Your son is going through puberty, so he will have all the hormal highs and lows that are typical of his age, and his diagnosis on top.  I don't think you necessarily need to get another diagnosis, unless you feel it will get your son access to things he cannot get without a diagnosis.  Having ADHD means that he is impulsive and his probably has anxiety.  He is intelligent enough to be self aware that he has difficulties and that in itself can lead to low self esteem and depression.
Take the above advice and see if the professionals think he needs medication for depression.  
It can be hard sometimes for parents to get a balance with school work because they want their child to do well.  But if that means he is being pushed beyond what he can cope with, then unfortunately you do have to drop the pressure.  And you need to be very aware of what is going on in school because he may not be being supported to the level that he needs.
If he is struggling with school, that means he is having to face that situation and endure it day after day.  If he is having problems with friendships he is having to endure being on his own every day.  So start digging deeper into what the school can and should provide for your son so that he is happier and supported during lessons and during playtimes and dinnertimes.
I have a son on the autistic spectrum, and for a long time I tried to keep him at the same academic level as his peers.  But he wasn't happy and neither was I.  It was hard work, and at the end of the day I want my son to be happy in himself and I want him to want to learn and not be totally negative about school and learning.  There are more important things in life.  There are life skills, and hobbies and interests, and friendships and family etc.  
If he really wants to go and visit his grandfather, could that not be arranged over a long weekend.  Ask your son for 5 things he would like to do, and make sure he does one of them on a regular basis.  Get him involved with interests he is good at or join clubs he is interested in.  Get some positive things happening in his life.