At the end of our ropes
I’m here to ask the community for help. I know we’re a neurodiverse bunch, so I’ve got good hopes somebody can relate to this.
My son is currently 16 and has always struggled with basic tasks. He’s gone through many tests and trainings when he was elementary school, but executive functions remain a challenge. From previous tests, we know he has an IQ of over 145. Back when he was tested, the psychologist advised to change his school curriculum to get him more engaged. This has partially worked: he’s been having more fun at school and has had some really cool academical achievements. But his struggle with basic day to day tasks and school work remains the same, and keeping focus is by far the most problematic part of it.
With going to middle school came owning a phone and iPad. From day one, these do get his full attention. Me and my son are much alike when it comes to obsessive behavior, so I sometimes feel like I’m looking in the mirror when I see him with his phone. I too can lose myself in a game and binge it in a weekend. But for me, it isn’t 24/7. I can turn it off when it needs to be off. So I’ve always been strict with rules about screen time for him, but these rules have gone out the window in the last 2 years. There has been lying, sneaking and hiding to increase screen time. It has had a negative effect on our family and it’s draining to have to deal with this daily. I think that’s why we’ve somewhat given up on it, it was impossible to keep in check.
In the past 3 years, he has started to really experience the negative impact of his challenges. We’ve attempted to help him plan his days, to plan his school work, to do chores in the house. But nothing seems to stick and he gets frustrated with himself and it is affecting his mood. In an attempt to find out more about what is causing his difficulties with basic tasks, we’ve asked a psychologist to look into AD(H)D. After an assessment, they’ve now come back with their findings. According to them, it cannot be AD(H)D because he can focus on things he likes (a board game was their example). Their rationale is that people with ADHD cannot focus on any task, even if they like them. They are saying it is his IQ, that he’s too bored to focus on basic tasks. According to them, he should force himself to do menial tasks and that we should be there to enforce this with rules and praise. Like we haven’t tried this already without any results. To say that I’m disappointed and furious about this outcome, is an understatement. It leaves us dead in the water and this makes me feel hopeless.
I’m hoping to gain some insights by reading your comments. This attempt might point us in a new direction, because I’m fine if it is something entirely different than ADHD. I just really want him to feel better.
Teacher here.
Other Possibilities
Other people here have thoroughly covered the ADHD aspect (and they're right), so I want to add some other possibilites.
Difficulties with executive functioning can also be symptomatic of autism, depression, and anxiety (among others).
Students with autism can have trouble working on non-preferred tasks, and can struggle to manage the various demands of having lots of different tasks allotted to them (e.g. homework, chores, hygiene, etc.).
Depression can manifest as executive dysfunction in that the student is aware of what they need to do but they are unable to bring themselves to do it. I think of it like a car. I can sit in the driver's seat, and know where I need to go, but if there's no gas in the tank, it's simply not going to happen. Depression can rob kids of "the gas in their tanks."
Anxiety, meanwhile, can inhibit task completion for a number of different reasons. A student who is anxious about potential failure might realize that they can control the situation by refusing to do something. In this way, they deliberately induce the failure, and it's reflective of their refusal to do a task rather than their inability to do a task. Contrastingly, someone with anxiety might get overwhelmed by the demands put on them which compromises their ability to act. They want to act, in fact, they would like nothing more than to be able to do that, but the anxiety effectively paralyzes them into inaction.
These are not the only potential outcomes under those different umbrellas, and those are not the only umbrellas under which executive dysfunction lives. I mention them though to expand the possibility base for what your child is experiencing. It's also possible that it's none of these things and is just a unique, individual struggle for him in particular. Labeling the problem can be helpful psychologically and in terms of accessing treatment, but it's less important that you identify "what" is "causing" his behavior and more important that you help him through this challenge.
Helping Him
I'll start off with the idea that it can be difficult to do this as a parent. Not only does it require a lot of effort and patience and frustration on your part, but also kids his age frequently mask or hide their true feelings. Sometimes this is done out of a functional desire to get what they want; other times it's a product of shame.
It's very possible that he's aware of his own limitations, especially if he compares himself to his peers, and that's a blow to his self-esteem. Few people like to share their deepest insecurities with others -- especially not teenage boys, and especially not with their parents. Parental attention to a source of shame can often be a force multiplier on the feeling, even if it's entirely well-intended.
I'm not a parent, so take what I have to say with a grain of salt, but I am a teacher who has, at this point in my career, worked with hundreds of students with executive functioning difficulties, so I do have a good amount of experience in this area.
I recommend positioning yourself as his ally trying to tackle a problem together rather than anything in opposition to him. If he's already lying and hiding things, then he might already feel that you're an obstacle to what he wants rather than a support system for him.
What this means is lots of messaging about supporting him and trying out different solutions. It's not enough to just say something once -- he needs to consistently know that you're rooting for him and there to help him. Lead with love and patience -- even when it's hard.
Strategies
Up to this point, a lot of this topic has been theoretical and living in the abstract realm. You might be wondering: what can I do right now to help?
Here are a bunch of different things in my toolbox that I use to help kids with executive dysfunction. No single one is a guarantee, and not every one works with every child. Many kids end up using a combination of these. Consider the following a non-exhaustive menu of things to try, with the goal always to be finding what works for your son specifically.
Noise: Some students work better with background noise. Use some good headphones and have him try out working with background music. For some, music will become its own distraction, so for them I recommend soundscapes. soundescape.io is a great background noise site that lets you construct your own soundscape using different sources.
Standing Desk: Some students work better at a standing desk, as it allows them to be more active, swaying or shifting their weight or whatnot.
Designated Workspace: Some students do well having a designated workspace in the home. This could be a standing desk like above, or a comfy alcove with plush pillows, or a corner desk, etc. I recommend trying to make it a single-use space if at all possible -- the "get things done" space. They go there to work and then leave to relax or do other things. No TV screens, they don't bring their phone, etc. Given that most students use Chromebooks for a lot of assignments, I recommend making it in a public area in the home, rather than in an isolated space like in their bedroom. Access to a screen and the internet is the number one distractor that inhibits kids’ productivity, so a monitored space can help head off that distraction.
Fidgets: Some students do better with their hands in motion. If you're worried about the noise that comes from a fidget, there are plenty of silent ones available.
Sensory Supports: Some students like to run their fingers along different textures. You can find textured stickers or velcro. A lot of my students like putting them on their Chromebooks so they can feel them while working on assignments. There are also things like sensory putty/clay that some students like to manipulate while thinking.
Visual Timers: thevisualtimer.com is an easy, dead-simple site that gives students a visual for how much time they have left on a task. The remaining time is represented by color which slowly wanes. This can help students that have "time blindness." They also make physical ones as well.
Visual Tracking: A whiteboard or designated notepad can be a way of laying out different tasks. Seeing these visually can help students manage what they need to do so everything isn't swimming around in their heads all at once. Furthermore, if it's got a longer focus, it can be used to help celebrate completion over time ("look at how much you got done this week!").
Alternate Outputs: Some students hate sitting and filling out a worksheet, but if you ask them the questions on it out loud, they will answer them. Some students hate reading on their own but would read a story out loud to you if you asked. Finding ways to complete "boring" tasks in more interesting or innovative ways might spark interest for your son. Get creative!
Body Doubling: This is also called "co-working." Kids with executive dysfunction effectively have a brain that isn't regulating itself as they/we want. The mere presence of an adult can help shift that brain into a different regulatory mode. "Body doubling" is the act of simply sitting with your child while they work -- not to directly intervene or spy on them or anything -- but to be a presence that helps their brain regulate itself better. I often use this with my students by sitting down next to them and working on my own work. My mere proximity helps them better stay on track.
Incentives: My brain likes when something gets crossed off of a checklist. I get a sense of satisfaction from it. It helps me do things I don't want to do, because the act of completing something still feels good to me. Many students, particularly those with ADHD, do not feel this. Crossing items off a checklist is entirely meaningless. Creating incentives for them to work towards is a way of externally manufacturing that feeling for them.
Chunking: This is a teacher term for breaking things down into smaller tasks. If writing an entire essay is daunting to a student, we might just give them a chunk instead: "let's just write the introduction right now." It's the "How do you eat an elephant? One bite at a time" strategy of executive functioning. Many students don't have the skills to do this themselves, so assisting them in chunking things gives them access points to more challenging tasks.
Prioritizing: Students with executive dysfunction also have problems prioritizing tasks. The test that's tomorrow doesn't register as more important than the quiz a week from now (or, it does, but their anxiety inhibits this; or, it does, but they're more interested in the content on the quiz than on the test, etc.). Helping them prioritize can help clear the fog of demands and make things more accessible to them.
Time Management: Likewise, time management is a struggle. I mentioned visual timers above, but the timer itself isn't necessarily a great intervention on its own. When I use it, I have students estimate how long a task should take them, and help guide them when they're way off (either far too long or far too short). My goal is to help them learn over time how long they should be spending on given tasks, and also to overcome some of their own cognitive distortions (a hated 5 minute task might "feel" like a 50 minute task in the kid's mind).
Competition: Some students get really engaged when there's a competitive element to something. Have them race the clock. Have them race you on another task. Have them race their own best time or best performance on something. Keep a scoreboard.
Medication: Medication seems to wear one of two hats. Some people think it is the ONLY solution. Others seem to resist it entirely, thinking that if their student simply "worked harder" then they wouldn't need it. I'm of the mind that we don't tell students who can't see to simply "squint harder" -- we get them glasses. Medication can, for some students, be the "glasses" that they need to be able to function. It shouldn't be seen as the only fix (that is, in place of some of the other strategies mentioned here), but it shouldn't be avoided entirely either -- especially if the student has demonstrated long-standing issues with functioning that haven't resolved by other means.
Closing
These are not the only interventions you can try, but they're ones that I either use or see commonly in my role as a teacher.
Also, I do NOT recommend trying them all out at once. Better to piecemeal them over time so that you and your son can get a feel for whether or not a particular one is helping him.
I'll also add that most students will initially be put off by a lot of these. It can take lots of encouragement and coaxing to even get them to try it, much less stick with it for a few times.
I constantly have the conversation of "we can't know if it doesn't work until we try it out" because many of them pre-emptively and pessimistically assume that it won't help them. If something doesn't work, I don't get disappointed or mad. I simply say "well, now we know -- let's try something else!" I always try to approach my role with them as one of discovery and working towards a goal, rather than as a warden or taskmaster who's mandating that they, for example, MUST use the visual timer OR ELSE.
Also, many of them might feel embarrassed by these initially, so make sure your home is a safe and warm place when it comes to these potential interventions. Some of these are ones that I, as a teacher, recommend for home rather than at school because students don't want to single themselves out from their peers.
I wish you and your family the best of luck as you pursue solutions. This is a tough thing to tackle. Again, I'm not a parent, but it's something I deal with every single day I'm at work, so I know how challenging it can be. I want to honor your feelings and frustrations about this, because I feel those things too.
This is such an amazing response, I'm so grateful you took the time to write all this up! My wife is not a Tilderino and she was blown away somebody would give such a detailed response. There are quite a few things we have tried over the years already, but also so much that is new to me and my wife. Enough to try, and it makes me hopeful we're going to figure out some things that genuinely work for our son.
This is an excellent way to convey the issue!
My partner used the Spoon Theory For Autism and ADHD example and that helped me understand what was going on (for both of us).
That actually came from one of my students, many years ago. It has stuck with me ever since.
She phrased it as: "People keep telling me I need to do something, but if there's no gas in a car, it's not going to move no matter what. There's no gas in my tank."
Genuinely broke my heart. Depression is tough (and I say that as someone with it myself).
4/4 baby!
Although in my case, the depression was more a result of the other three (alongside a broken thyroid) than anything, despite being the one therapists and psychiatrists tended to focus on. I recall one of my ADHD books pointing out that a lot of clinicians with limited experience with ADHD who encounter comorbid ADHD and depression will try to focus on the depression before the ADHD, when doing things the other way around tends to be more effective.
These are all excellent suggestions! I want to back up your point about a designated workspace and suggest getting on that ASAP. I basically managed to make my entire house the opposite of a workspace because I'd always get schoolwork done at school (including college), so I rarely had to work at home. I could focus easily enough on campus, but struggled the few times I worked at home unless it was something that interested me.
By the time I realized that, I was already near college graduation so it was a bit too deeply rooted in my head to fix it. It will be much easier to start now and build good habits while your kid is still in high school. Even if you identify and address other aspects and causes, establishing a designated workspace now will still be beneficial in the long run. The subconscious is a powerful thing, and it's hard to change a years-old, deep-set association like that.
A related word of advice: my college said that people can focus better in predominantly cool or warm colored environments, varying by individual. I don't know how much this is scientifically backed up, since a quick search just brings up regular color theory about impact on emotions, but one building had two study areas based on that. Colors do have impacts on moods and emotions, so it's worth considering!
This is excellent. I will need to come back and suggest these one by one. Thank you.
Uh, get a new psychologist would be my advice.
Hyperfocus is a known trait of both ADHD and ADD... I'd know. So would my husband.
Trust me, I can literally spend 8 hours straight playing the sims, foregoing food, water, sleep, anything. But ask me to plan out my grocery shopping and I'll avoid that task like the plague until it's almost too late and I now have to hurry to run to the shops or order food or literally go without dinner. It's happened.
If you hadn't told me you'd had an ADHD assessment already I'd advise an ADHD assessment. But since the one you had didn't say that, my advise would be: Get a second opinion.
Best of luck!
Yep. Same here. I remember playing Starcraft and Warcraft for truly unhealthy sequential hours. Same with the procrastination.
There's an old joke that the ADHD assessment should be based on how many times you miss and reschedule the ADHD assessment
Oh. Wow. I like and hate it at the same time.
I just recently (a tad under 2 weeks ago) had my first meeting with a psych provider and started arranging medication managment.
It had been on my to-do list for over 3 years. At least.
Strattera has been pretty good for me, I'm glad to stay away from the stimulants and just use caffeine to compensate
Caffeine does work for me (to a limited extent) - the days I get things done are the days I consume a higher-than-average amount of caffeine.
But then I have to balance that out by not drinking that much caffeine for a couple days so my body doesn't adapt to a 'new normal' caffeine level, meaning I can only get things done once in a while.
I'm hoping to find a med that helps after I can get the ADHD psych assessment done. Long delay there though, there's a provider shortage here and I'm stuck waiting another 3 months.
I second your thought of seeking a different psychologist. I’m not in the US, and it took me roughly 3-4 years (not exaggerating) to get a diagnosis. The first “psychologist” I spoke to didn’t even care to ask me questions while I was explaining my heart out with my symptoms and at the end of the “30 minute assessment” he concluded I didn’t have ADHD, and that it’s something else. When I asked him what it could be, he told me “it sounds like you have DID”… … … I was speechless, I had given up for roughly a year before I found a route to seek diagnosis again from a private source but funded by the government. That also took roughly a year and a bit (taken into account for the 3-4 year frame), but in the end I got diagnosed with ADHD-C.
Executive dysfunction, emotional dysregulation and inability to focus are the 3 worst symptoms I have and literally are crippling my life. So far meds haven’t been responsive.
I relate to the ability to play a game for hours but almost being unable to do other shit. Especially studying, even subjects that I adore.
My point I guess is that yes, you’re right and @caliper should seek a different psychologist.
Absolutely. ADHD doesn't mean you can't concentrate or focus on things. In fact, sometimes it is the opposite, especially when combined with other diagnoses. My SO has it and it's not like she can't focus on things. She can get hyper focused at times too. Sometimes you just can't control when it happens.
I would really, really look for a second opinion, as @Noox said.
Right. I am diagnosed, was diagnosed later in life, (well into my 20s).
My doctor noted specifically my ability to function in areas extremely well if I innately find them interesting.
But ask me to do something I don't want to do, even if I "know how" and it's like pulling teeth.
Getting my diagnosis, and receiving treatment has helped tremendously. There are also non-medication based approaches that have worked well for me.
Edit:
I would like to add, when I first went in for a diagnosis early on in college, I was rejected. I understood that the rejection sort of came with the insinuation that college-aged students are seeking for the sake of re-selling medications, which made it frustrating but understandable at the time. I sort of "knew" something was not normal with me. College was a tremendous struggle but I was able to get myself through it. When I was out of college for several years, married, and had a child. My wife had encouraged me to revisit the topic with a new doctor. They had stated essentially immediately that it was obvious I had been dealing with ADHD my entire life. The diagnosis has helped tremendously with just day to day life.
I'm stuck waiting for several months before I can get an ADHD psych eval and meds for it specifically. Are you willing to share the non-med approaches that have worked for you? I find myself interested.
One proven approach (I don't have the papers handy, it's been so long) was making oneself more aware of time.
For me, when I get lost in something time basically skips forward. By forcing myself to be more aware of time (more clocks, alarms, gentle automated lights changing), I found myself much more capable of moving on to the next task.
Removing distracting things that interest me also helps, such as keeping my phone in another room if I want to read a book. Or locking it away at night if I want to get something done that night.
Another thing that has helped, which I have not perfected yet, is mindfulness meditation. I'm talking cognitive behavioral therapy type stuff, not any sort of woo-woo stuff. I could specify some more of the specific exercises here if it would be useful.
Both my therapist, and psychiatrist, had provided some sources surrounding exercises like forcing myself to sit with my thoughts for ~15 minutes a day. I find that this allows me to prioritize well but also it allows me to sort of break from whatever I am fixating on.
It's really hard, and I don't think anyone should be avoidant of getting medicine for a legitimate need as well.
This is all to say that nothing is ever perfect for everyone when it comes to these sorts of things. I've had some luck with those, but I do take medication which is definitely the nuclear option and works very well. I do not take medication every day as I do not need it every day.
Thank you for this - I definitely get the idea for making myself more aware of time - I do have times where I'm engaged in an interesting task and 'it's 5AM? What?!'
Not sure how well the 'force myself to sit for 15 minutes' would work for me, I'm incredibly intolerant of prolonged lack of mental stimuli.
Good suggestions. I'd add that I think analog clocks are much more helpful for keeping track of the flow of time - being able to see at a glance how far the hands have moved feels much more tangible and intuitive, and removes the need to consciously think about how long it's been since you last checked the time.
See for me I really struggle with analog clocks because I find it too easy to just ignore them as a marker of time compared to something that shows the hard numbers. But I do highly recommend visual timers, which serve a similar purpose.
I'd appreciate a link to some of the mindfulness stuff you mentioned! I've always been frustrated by the meditation/mindfulness I've tried in the past, but I suspect the stuff I was being recommended before wasn't CBT based.
Sure, there are two things my therapist suggested that really stuck with me. One of them did not work great for me as I am pretty bad at controlling "meta-thinking", the other was a little more active of an approach.
For the first exercise (which did not work great for me) it entailed sitting somewhere that was not too distracting and closing your eyes. You would then place yourself in a space to "separate" yourself from your thoughts. The ask was to essentially imagine any thought you had as floating down a river and to simply "acknowledge" the thought and move on. This was difficult to me as I often found myself trapped in "thinking about thinking" (e.g., meta- thinking). So I did not have much luck with this exercise, but I encourage people to try it as it can be relaxing. Suggestions also included adding a chime, or something, that periodically happens, to bring you back into the meditation should you stray.
The second exercise, which I am much better at, entailed selectively going through each and every muscle group. Tensing your muscles, and releasing the tension; one-by-one. This worked for me quite a lot because the emphasis was on the action and the feeling after tensing and releasing each muscle. It kept my mind from the "meta-thinking" trap, and grounded me much more. This enables me to be much more "present" with things I otherwise would not pay any attention to.
seconded..
I strongly agree with the suggestion to get a second opinion on the ADHD diagnosis. Both of my sons have ADHD, and the idea that they can't focus on any task seems very wrong to me. When he's off his medication my older son will hyperfocus on whatever video game he's playing to the exclusion of almost everything else. Off his meds my younger one would either play video games or sit and watch YouTube shorts from the second he wakes up until he passes out from exhaustion (I'd sometimes worry he'd starve to death if his mom and I didn't force him to stop and eat a couple times a day).
I felt nearly as hopeless as OP sounds, especially with my older son, until we got him diagnosed with ADHD and found medication that helps him function. Back around covid times he nearly had to be held back a year, his grades were so bad, but now he's getting straight As and qualifying for a bunch of scholarships to help with college next year. Night and day difference.
echo, second opinion.
suggestions: (1) find out how he's doing emotionally, and (2) lean into his hyperfocus
(1) is it possible that he's smart enough to have figured out this place sucks and everything is meaningless, so he's just gonna chill and "wait it out" so to speak. Like, what do you want from him and why do you want it? If it's to get through school and get a job, really, why? So he can get into mortgage debt and be bored like this, but now with debt? Sounds dumb. So what's there in the human experience that's worth his while? Have a good talk. He says he's frustrated with himself: is he having some anxiety about where his executive functioning deficits is heading, and would he benefit from speaking to an understanding professional about it? I just discovered THIS MONTH that there are occupational therapists who cover executive functioning, so maybe give that a try IF he wants help just doesn't know how to get there. Is he having trouble with making friends or confused by girls or have trouble understand intent from what others want from him or how to get people to stop having weird thoughts about him? Get thee hence to a good Speech Language Pathologist. Interview a bunch of these people before hiring them, by the way, the mileage SUPER varies. But yeah they're crazy expensive even with a good one :(
(2) Hyperfocus. This is about harnessing his superpowers. Is he into rocks? Make a budget that works for your family, and ask him to plan a rock hounding trip which includes logistics, money, accommodations, local rock clubs, field trips and local law on collecting specimens. He's smart enough to do it, and let him know you expect flaws and y'all will roll with it. Is he into defeating your cyber home defenses to get to certain sites? You guys gotta game up and ask for advice here and/or hire guns to set up ever higher and higher hurdles precisely so he can learn to leap over them, and celebrate his victories begrudgingly. Get him to volunteer at the local "seniors can't swip to answer their smartphones" help clinics maybe, and use his powers for good. Convert those volunteer hours into a resume so he can get a job doing this, and with money saved up he can plan his trip to some kind of security conference or expo or convention, or look into post secondary programs in that field. From there, maybe highschool graduation will make more sense to accomplish as a clear stepping stone to fun adult world activities.
Lastly, he's 16. He's old enough to stay home by himself and finish highschool via correspondence IF that's what he wants to do. It's not for everyone of course but he could do it.
Oh! Hi!
With the exception of smartphones not existing when I was his age, I was EXACTLY your son. Seriously, DEAD ON with your description of what works and doesn't.
I got As and Fs in school. Was the class interesting? A. Was the homework material interesting? I would have it done in class already without needing to do it at home. Was the class material not interesting to me? F - and forget about doing the homework for those classes. I had no issue at all getting things done if they were interesting to me and had an nigh-impenetrable invisible mental wall for things that didn't interest me. Homework for social studies? My parents would have time set aside for me to sit at the dining room table and work on it, and I would just.... stare at it, unable to DO. I knew I needed to. I didn't want to be a failure or disappoint my parents or flunk out. BUT. I. COULD. NOT. DO.
In fairness, mental health knowledge and definitions / coding has advanced over the years, and this was ~30 years ago for me, so keep that in mind, but I had a diagnosis of ADD (now termed ADHD). I am also high-functioning autism spectrum. Very high IQ for technical subjects / STEM stuff, laughably low EQ (emotional intelligence).
His assessed IQ sounds right around what I remember (though human memory is fallible) - if I recall mine was tested as just a bit north of 140 and I've always been considered genius level.
For a short time I was on Ritalin, and I will say this was effective for me - but ONLY while it was at therapeutic levels in my bloodstream. Once I came down from it I had horrible emotional-crash side-effects and could not tolerate it - but I mention this because IT DID WORK. While it was in my system at effective levels I could do all the things I otherwise could not. I could pay attention to uninteresting classes and get my (boring) homework done.
Pharmacology has come a long way in 30 years and there are better options available, the most commonly known being Adderall - but there are a number of other options.
Your provider says your son cannot possibly have ADHD because he can focus on the interesting stuff? Providers are human beings and can BE WRONG. From what you have described, and my personal DAMN NEAR IDENTICAL experience in combination with being diagnosed with ADD as a kid? I call BS. Get a second opinion from a different provider or practice. Seriously.
Fwiw, Adderall is not necessarily more effective than Ritalin. From what I've read, different people with ADHD respond better to one or the other (and it's split about evenly), but they're equally effective. There are now additional options for both that stay in your system longer, and those are the game changers imo. Vyvanse is GOAT, and I've heard people on Concerta are similarly pleased with it.
FWIW Vyvanse, Concerta, Adderall, Ritalin did not work for me: not knocking them and I'm so happy they exist for others, but just for folks who tried and don't work, don't panic, it's not just you and it's okay to keep trying new ones until you find something.
Yeah, while stimulants for ADHD treatment do have some of the best results statistically of any psychiatric treatment, nothing works for everyone, and it's a good reminder that there are still other options if you do end up not responding well to them for one reason or another.
I've also heard of Vyvanse, though this is the first time I've heard of Concerta. I mentioned Adderall and Vyvanse to my psych provider as I knew of those (finally went through with scheduling and saw one just under 2 weeks ago) - they put me on Bupropion as something they could issue right then and have arranged for ADHD testing in order to prescribe something like Adderall or Vyvanse - (which I have to wait several months for unfortunately).
Don't let them give you generics, by the way. A lot of these meds, eg concerta, gave a unique slow delivery mechanism which make them last most of the day, vs generics which are chemically equivalent but not the same. It's like saying buying a pile of wood pulp is the same as buying a house.
Well... darn (money).
I get it though. Specialized pill layering / time-release mechanisms. Stomach acid eats through one pill layer and releases drug layer A, under which there is layer B and C or some functional equivalent for the concept.
Still, I appreciate being told. Thank you.
I do take generic Adderall and it works fine. The newer drugs may have more complex mechanisms of delivery but that doesn't inherently mean they don't work for some folks. It's just worth knowing
Thanks DNAF!
...may I call you DNAF?
𖡼𖤣𖥧𖡼𓋼𖤣𖥧𓋼𓍊
Works for me
Concerta is also extended-release, but it contains methylphenidate (the same active ingredient as Ritalin) rather than amphetamine. I'm definitely happy with my Vyvanse, but some people with ADHD do better on methylphenidate-based meds than amphetamine-based ones and vice-versa.
I had a psychiatrist who tried putting me on Bupropion instead of pursuing an ADHD diagnosis and then tried diagnosing me with Bipolar 2 instead when I had a bad reaction to it, so that particular one left a bad taste in my mouth. That said, bupropion is commonly used off-label for ADHD, even sometimes in combination with stimulants, so it's probably not a bad idea to see how it works while you work to jump through the hoops of getting formally diagnosed.
And strangely, I didn't do to well on Ritalin(it was really not fun to say the least) but well on Medikinet(which I think is essentially the same as Concerta, or at least similar judging by your description). Not sure whether I just react better to starting with it in the morning, or if it's due to my brain seemingly being sensitive to change of medication. But yeah, people can react differently in strange ways.
...yikes. I'm glad that they aren't your psychiatrist before and have medication that works for you now. :\
Medikinet was the first thing they put me on! It seems to be the "starter stimulant" for adult patients here in Germany. I don't know much about what specifically makes it different from Concerta, but it is doing something very similar by being an extended release methylphenidate-based treatment. I think especially for adults, extended release stimulants really are so helpful and important.
And yeah that psychiatrist sucked. She was a free one at the university when I was an undergrad, and I doubt any amount of ADHD symptoms would've gotten me stimulants out of paranoia over study drugs. Not even to mention how many hoops I had to jump through to see her in the first place...
Medikinet XL is what they started me on, the first week there wasn’t really any difference but the second week when I upped the dosage it drove my emotional dysregulation wild, I was so angry I could’ve probably gone to jail lmao. They told me to stop it and now I’m on Elvanse with no difference. :/
What’s it like for you on Vyvanse? As in, before and after you take it for the day?
I’m currently on 50mg Elvanse (Vyvanse) and honestly I am not seeing any difference other than heart palpitations.
I still procrastinate and can barely focus, I still get crazily overstimulated, and it’s honestly like I am not even taking it. :/ This is the second medication I’m trying. Maybe it’ll kick in better at 70mg…
I'm on the lowest dose they prescribe to adults here afaik (30 mg) and I don't really feel a different right when I take it. In fact, on several occasions I've taken it and then immediately gone back to sleep. But then I've never had insomnia problems with my stimulants, so I'm just really good at sleeping ig.
What I do notice is a more general effect on my mood throughout the day. When I've taken my Vyvanse I'm much more likely to feel a desire to work on some sort of project and have the impetus to actually start that work. Certain types of little projects definitely appeal to my brain more when I'm medicated -- coding scratches the right itch, as do city-builders -- but it generally helps decrease the amount of energy I need to get started on almost anything.
The effects on my ability to focus are definitely still relatively mild, and I'm very much still able to get distracted, especially right as it wears off. If anything, it makes it harder to pull myself out of focusing on the wrong thing, so I have to practice some personal discipline when it comes to directing my period of better brain towards stuff that actually needs to get done. It doesn't do that part for me.
Honestly though the biggest positive effect that I would miss if I stopped taking it is on my mood, rather than my ability to focus. I had a depression diagnosis and Vyvanse has done a better job stabilizing my mood day-to-day than the SSRIs I was on before, and with decidedly fewer side effects. This is usually how I notice I've forgotten to take it -- my mood will be noticeably lower when I haven't taken it. And note that I use "lower" intentionally, as it's depression symptoms rather than irritability or what people usually mean when they say "bad mood".
Different people are different though, so work with your psychiatrist on it. If it's not helping you, maybe you do need a higher dose or maybe you need to switch to a different type of medication. Wishing you the best of luck there.
I see, thank you for the detailed write up.
Yeah I’m definitely working on it with my prescriber (as it’s not the psychologist directly that handles my meds) and we’ll see how it goes. I just worry that if none of the stimulant based meds work that nothing else might.
We’ll see. Thanks again.
I totally understand your worries there. I think @chocobean mentioned having had issues with the major stimulant based options and still finding something that worked if you want that perspective
I’m in the same boat, I had some pretty negative reactions to Vyvanse (emotional numbness, decrease in endorphins from exercise, heart palpitations) with seemingly no benefits. It kind of scared me off medication for a while, but apparently that’s pretty normal.
I’m going to start tying strattera, a non-stimulant based medication, and am hoping I have different results. I think the nice part about trying the medication is that I don’t lose anything other than when im on the meds if they don’t work, and if I do eventually find an effective one then I’ve gained something. It’s taken a while to get to that mindset.
Also, in case I have a kid with similar traits it’s nice to know what the process is like and how a mismatch feels so that guiding them through the process will likely be easier.
Thank you for taking the time to share your own experience, that really is reassuring to read. The unable to DO sounds a lot like I've seen him, but also how I can feel myself. I've always felt a lot of guilt about being unable to do some things, feeling ashamed not being able to perform some tasks. I always chalked it up to being lazy, being too stubborn to do some things. It is kind of crazy to realize I may not have been capable to change it all that much. It also makes me realize I have been hard on him when he's blocked, getting frustrated with his inability to just get it done. Argh, parenting is so fucking hard.
No one is born knowing and a solution to a problem will always have a stage of 'I have never solved this before and it is daunting'.
You're current self has more experience than your past self. Your future self will have more experience and know how to solve / deal with more things than your current self.
If you find you are mentally / emotionally beating yourself up over a failure (real or perceived), please remember you are not all-knowing and never have been, and if any self-recrimination has a root of 'if only I had magically always known this thing I had to experience and seek out information / help with and learn about' - just remind yourself you're a human being and shouldn't be expected to be magically all-knowing. And that's normal and OK. And it's normal to screw up with stuff you don't yet know or didn't-then know how to deal with. It's also normal to find better, more elegant ways of dealing as time goes by and you deal with a given thing more.
It is not your fault for not magically knowing the answer to every problem.
You had an unknown-unknown. You didn't know that there was a thing there that you didn't know about. That happens, and it is also normal.
Last thing. This kind of thing can be frustrating and depressing. "I've been doing it so wrong all along!?!?" You can help yourself with how you mentally frame this. You weren't 'doing it wrong all along' - you just learned something that may well improve your life and the life of your son. It wasn't a bad thing in the past (there was always going to be a period of time where you didn't have an answer, or didn't have 'as good' a solution), it's a good improvement to your lives right now.
Absolutely not true.
I have a diagnosis for ADHD-pi (primarily inattentive). The hallmark of inattentive ADHD is the "ability" to hyperfocus, which is sometimes an asset but more often than not it's a handicap. It's what makes me prone to addiction-like behaviours even now that my mental health has been very good for years. When I was young and depressed, it was even worse but even now I have to sometimes set online blockers for myself and use other methods such as only accessing certain forums on desktop/browser, never on my phone.
(I can be quite certain I wasn't misdiagnosed as well because I went through my country's public healthcare system which is extremely stingy about diagnosing people. The process took about a year and involved ruling out all sorts of mental health conditions and personality disorders that may sometimes manifest in similar behaviours.)
I wasn't diagnosed until I was in my 40's, due to ubiquitous misinformation regarding ADHD and because I did well in school despite not doing any homework (nobody even realised I wasn't doing it), and because I wasn't hyperactive. I would give anything to have been diagnosed sooner. Like others said as well, definitely get a second opinion.
Gonna add to the chorus here, but definitely get a second opinion. This truly does scream ADHD to me as someone who had an early life diagnosis. Him being able to focus on things he likes should not disqualify him from having the condition because as another commenter said, I can focus on things im interested for hours straight without breaks. I have played games I like for 12 hours straight before, only taking a few bathroom breaks here and there. Hyperfocusing is a real part of the disability, especially when its to the point of affecting other aspects of your life. Was your psychologist older or been in the field for a long time? ADHD is still often ignored/dimissed by older providers, so maybe try looking for someone a little more recently accredited or something? Either way, best of luck getting this figured out. I feel for you both having lived a similar experience.
Can second this, have done exactly the same.
Just to add to what people already have been saying. Hyperfocus, is a very specific ADHD trait, the fact that your psychologist doesn't recognize that is a red flag to me.
As others also already said. If something grabs my attention, I can easily focus on it for ours. Often at the detriment of things I actually need to do and in the past my mental health.
How to handle this really differs per person. ADHD much like autism exists on a spectrum (in recent years I have heard say that they might even be overlapping spectra). This means that some things are more pronounced for some people than others. This also influences what sort of approach is effective and helps.
Having a good mental professional (or even an organization) to help in that area can help a ton.
Taking a quick break from my honeymoon Tildes hiatus for this one because it’s so important!!!
Like most other folks here, I see a ton of your son in myself. I’m a combo dyslexic (diagnosed around age 9) and ADHD (diagnosed at age 36). Like you, my mom looked for so much additional support (tutors, programs, engaging material) and very little of it panned out. I do have a few thoughts on what I’d do differently, and what I’m planning to do if our current bun in the oven turns out to have a spicy brain like me!
Unlike others in the thread, I was pretty much a B student. I could bullshit well enough on the tests, and rarely did homework so I’d come in with average grades. I think homework often felt like busy work and arbitrary, something that to this day I struggle to do. The few classes that engaged me more with material, like US History AP, I did well in. Like your son, it needed to be engaging! And unfortunately we don’t incentivize or reward teachers for teaching that way. If you can add material, like going to a location they are learning about of figuring out what is cool for your son about a lesson and reframe it through that lens it might help. But it also might not. I hated reading but found out I just hated the books we were assigned, George Orwell really opened my world here. I really found a love for reading when I started communting by train and got to pick my own reading.
Secondly, fuck RFK jr, and sometime a broken watch is right twice a day. Exercise has been an incredible help for me managing my ability to focus and general mood. Sometimes I literally feel like a drug addict, coming home from a bike, swim, or run with an incredible mood and focused energy. It can literally be night and day before and after. I played groups sports throughout school (practice 1-2 times a week) and played at recess, but I think more active time really would have helped. I got really into scuba diving in college (see hyper focus) and started run/swimming to improve my lung capacity for free diving. I stopped looking for external stimulants - alcohol/drugs, because I was more interested in diving. That’s when things started turning around for me grades wise, probably a combo of the two things. Now I get an hour in the morning (swimming), an hour at lunch (biking/gym), and and 1-2 hours after work (swim, biking, volleyball). For a long time it was rock climbing (if you have an indoor gym near you I suggest you check it out) as that’s a great combo of exercise and problem solving - perfect for the ADHD brain!
One thing I’d really lean into, and I may differ from other folks in this regard, but entering the working was an absolute transformation for me. Hands on tasks with less arbitrary deadlines made me thrive!
All in all, school can be a tough go if you aren’t cut from the cookie cutter cloth but it gets so much better! I hand tons of thoughts on this and would be happy to chat if you’re interested. I’ll be traveling for another week but am free starting the week of the 20th if you want to find time to connect. In any case, good luck!!! It’s a tough challenge!
Thankfully, this is pretty standard advice for mental health, and not sage wisdom from worm-brain. An additional one my doctor clued me into:
Once a week, pamper yourself. Get cleaned up and dressed like you're going to a seven-figure job interview, then go out of the house and have dinner or something. Go sit at a bar; booze, sushi, coffee, whatever.
This has become especially important for those of us who work remotely, who can now spend entire years never leaving our front stoops.
So glad to get your opinion, sorry to break your Tildes hiatus!
This is somewhat painful to read, but maybe I'm projecting fears I've had over the years. I've always wondered if all the things we've tried, had any negative impact on his self esteem. It feels like we're always trying to fix something.
When you say you'd want to do things differently, what are you thinking of?
No worries! I can imagine how difficult it is navigating the traditional system with a non-traditional kid!
I wouldn’t let my results drive your fears. This was 30 years ago, we know much more about ADHD and the like now, and my mom had no place or group to commune about it with. Also, she had seen how many kids who were medicated kind of “went inward” so she was apprehensive about it with me. So while many teachers suggested she gave me tested for ADHD, she would always respond that I was “just a busy kid”. Who knows what meds would have done, but since experimenting with them in the last year I’m kind of ok with the path she picked. Not to say that people cant be medicated extremely successfully, but again it was a different time with a much narrower set of options. All to say, I really appreciate how much she did try.
As to what I would try, I’m planning to focus more on learning and less on grades. Think Montessori type lessons. Like your son, I’m very motivated to learn about a subject if I’m interested in it or if there is a component I’m keen to understand. So reframing boring topics, supplementing with interesting materials, hands on or location based learning, and putting an emphasis on curiosity.
What about Cannery Row engages them the most? We live nearby, maybe we can see where some of the locations were set! Where should we go? Or maybe we can host our own party like Doc Ricketts! What would we need, who should we invite, what should they act like? Both of those create an external reason for reading the book and engaging with it more deeply. Same with Animal Farm. I’ve heard the characters are based on real Communist leaders, so you think we can figure out who is supposed to be who? I think doing it together, if your my kid was interested in that, would be great. Excitement can be contagious and you can hold back and let them lead.
Second is to encourage a sense of play around topics. So often we have a rigid set of rules and standardized methods of assessment. I believe failure is an absolute necessity to being a content adult. And getting comfortable accepting failure as an estar (I am currently) vs ser (I am permanently) is really important. So letting them try things out and having a real go at things, while removing the punishment for failure or the coercion to continue. This doesn’t work for everything, everyone has to math, but being more open and flexible than would traditionally be expected.
Also, we’re entering a weird world. The school > university > career pipeline doesn’t seem to be functioning the same way these days. So to me, the ability to learn and a keen sense of curiosity are the best way to prepare for an uncertain future. In my opinion, Spending time figuring out what an interesting, fulfilling path is better use of time than chasing the “successful” one. State schools are still fantastic. The trades are a totally viable career. And if you or my kid finds an academic avenue they really love, it won’t matter if they are at San Diego State or Princeton for undergrad. (Well, Princeton might help, but there are plenty of folks who started at a junior college and ended up in a PhD at Stanford).
Lastly, encouraging play in the most literal sense. Figuring out what activities they enjoy and leaning into them. Is it swimming? Let’s see if we can get a group from school to go before first period! What about soccer? Could they start an after school pickup game that starts afterschool everyday? Rock climbing? What programs does the local gym offer? Could you get some of the parents together to climb while the kids do? It boils down to how much time can I get them outside, engaging with others away from a screen, focused on something positive, and personally get to participate a bit while still giving them autonomy. I think if there are fun alternatives to screen time it might be less appealing, or at least delayed until we get home. I often fall into the camp of watching a YouTube video on Cycling rather than actually cycling, but if I have someone keeping me accountable (like a friend I’ve pre-arranged to ride with), I’m so much more likely to go. Tomorrow I’ve agreed with someone from a local swim group to meet up for a mile swim, if I hadn’t done that I’d definitely be sleeping in. So adding extra accountability is key for me.
One of my co-workers gave me some safe words about ADHD: either you can conform yourself to the expectations of this world, or you can conform the expectations to you. As a kid I was 100% the former, because our systems are rigid. And for you son and my future child I hope they can find a hybrid path, one that gives them flexibility within those more rigid expectations. And as an adult I’ve been lucky enough to make a life where I can control much of the way I’m expected to navigate the world. That additional flexibility has granted me a real sense of self and purpose.
I realize that’s quite the ramble. I hope some of it is helpful and if you have questions or want to pushback on anything please feel free. I’m still speculating and a soon to be dad, so I haven’t actually “field tested” any of this.
PS: all of Kfwyre’s strategies resonated with me: I’ll put instrumental music, like Ratatat, on when I work -sometimes just repeating one song for hours. I like having a rubber band or screw or something with me to fidget with. Co-working is huge for me too. And having support talking through prioritization.
PPS: I really dislike having a new thing thrust upon me, but I like choosing them. I heard about the concept of “the big sit” for ADHD and was really excited when I started implementing it with great success. My partner saw this and started giving me new things to try, which I hated. Potentially showing your son the presented options and letting them pick what to try might help things go smoother. I think it’s about having agency and support rather than mandates and expectations.
Lol I am the only neuro-typical person in my board game group, the rest of my group has ADHD with varying innattentive and hyper-focus variants, so it's just a bit funny to me that board games were the pyschologist's specific example.
When my wife was seeking diagnosis for her ADHD the first psychologist brushed her off saying "everyone these days thinks they have ADHD."
She sought a second opinion and it changed her life. My wife is brilliant, but before starting treatment she almost had to drop out of her grad school program. She's been taking medication for the last 2 years, and it's been the best time of her life.
I hope your son finds similar success one way or another!
Their rationale is that people with ADHD cannot focus on any task, even if they like them.
This is unusually incorrect, whoever told you that is incompetent to the highest regard. I mean, honestly, I saw this 30 second video over a decade ago and that makes me more qualified to diagnose your son than whoever that was
https://youtu.be/167se17RNHw
Preamble & non-unique thoughts, kind'a
You've got a lot of thoughts/advice around ADHD and possible diagnosis. I'd follow that.kfwyres wrote an excellent comment chock full of actionable advice and strategies to try. I'd read that too.
I would like to say a couple of things...
First off: thank you for fighting this hard for your son. It is important. I sense that you feel like you are failing him and/or going insane while trying. That's OK, and even if you are not able to help him just having you in his corner makes a huge difference. You are a good parent <3 remember to take care of yourself too! And co-parent(s).
Secondly: my suggestion for something to try is to: ask him. Like create a calm and safe space and ask him:
Hey you, you know how we fight a lot over your screen time and nag you about your homework and shores. Do you understand why we do that? How do you see this situation? How do you describe the problems? What are things you see as solutions?
Or something like that, I hope you understand what I'm aiming at.
I'm just thinking he is 16 with an IQ of 145, he knows things and understands a fuck ton about screens, addiction, avoidance, society, family life, school, etc, etc. Ask him!
In 2 years he becomes a legal adult£ I'm sure he can contribute meaningfully to decisions about himself already!
£: since you didn't mention where you live I assume it's the USA and iirc 18 is adulting age there.
I'm sorry for responding this late. My social anxiety really kicked in when replies started coming in. This is my attempt to show I read all the comments and want to thank everybody so much for the thoughtful replies.
It is very helpful for me and my wife to read your insights, and above all, it is good for us to know we aren't crazy thinking the psychologist is talking out of their ass. Among all the great tips and personal stories, getting a second opinion is definitely the number one suggestion. I'm going to discuss this with my son to make sure he is on board with seeing another person. We'll make extra sure this time we end up with somebody that is familiar with ADHD. In addition, there's a ton of things we can work on/try at home. Hopefully we'll find something that works for my son.
Where are you located in the world? My understanding is that there has been a lot of resistance to uptake ADHD diagnoses from a cultural perspective in other countries (in the US as well, but especially in other countries).
This sounds like textbook ADHD to me.
I've got inattentive-type ADHD and I've got to agree with all the other commenters that whoever is providing the diagnosis has no clue what ADHD is.
Hyperfocus is a significant part of ADHD so their rational for dismissing it is garbage. That does not mean it is ADHD, it means your son certainly appears to have multiple traits of ADHD and should talk to somebody who understands it.
I addition to finding somebody else to talk to your son I'd read up on how to work with, instead of against, ADHD. E.g. rather than trying to force concentration on one thing try to find ways to allow him to "nibble" at multiple tasks, so he can keep bouncing between multiple things as he gets bored/stuck/blocked. Making "some progress" on 3-5 things (e.g. multiple chores, homework subjects, books, etc) rather than trying to force completion on 1 is an adaption that works for many. And if he finds himself in hyperfocus on something useful try to avoid interruptions!
I'd also have a look at the @HealthyGamerGG youtube channel, they have some good content on ADHD.
Hey, I have had my son seen by a number of psychologists and psychiatrists.
They all say different things. Some are sure it is ADHD. Some are sure it is not. Most hedge their bets are recommend further testing.
I try to avoid labels and focus on outcomes. You want to find someone focused on helping you and your son find good outcomes.
Are psychologists even able to prescribe medication in your area? You might want to consider seeing a psychiatrist and a different psychologist.
In terms of the phone, it sounds like your son is aware of the problem but is having difficulty managing the problem. Would he agree to hard limits enforced via Apple's screentime or whatever the equivalent is for the Android? There are ways to technically enforce limits, but I think your son might be too old for that.
Do you say "yes" to everything non-device? It's never easy nor convenient, but I will say yes to anything non device related. Want to make butter chicken tonight? Yes! I am on the hook to double check we have all the ingredients and to do all the boring cleanup and to assist during cooking. Want to go to a competition in this obscure sport on the weekend? Yes! I am on the hook to book it and manage all the other details.
The only reason we went to this psychologist was to get the okay to try medication, which our family doctor requires.
We had Apple screentime. We had app limits. We had passwords. But in the end, he found out you can change the date or timezone to get around it. It came to light when SSL certificates were considered expired by Safari, and the browser wouldn't load anything. It cracked me up, but at the same time we were screwed at that point. He's found other ways to get around rules, so in the end we've decided that having those limits was impossible to enforce. It made family life miserable, especially for his younger brother.
This is an eyeopener. I really need to do this more. He loves board games. I hate board games because I'm too competitive and can't enjoy a game unless I'm winning. But he would love it if I would play more often. So I should suck it up more often and just do this for him.
You can install hard limits on a phone with Apple Configurator, and I believe one of those is disabling the ability to change the date and time. You can also make it so that the configuration profile can't be removed, except by the macbook that placed the configuration profile. It is enterprise grade, a little technical, but bullet proof. Again, only worth doing with his agreement. We got agreement to certain restrictions by positioning the device as a time suck that sucks time away from non device interests (non device interest that I promote and support very heavily.)
There are some great co-operative board games like Slay the Spire, Forbidden Desert, Far Away or even Gloomhaven if you like something more complex. It still feels bad to lose but losing to a set of rules and dice rolls instead of another player means it won't ruin your day.
I want to say that this is a very valid way to experience this and would most likely have the same feelings if I were in your position.
It's one thing to have a disagreement over perspectives but it's not a good sign that they're essentially telling you what should work as opposed to exploring what may work. Every human is different and even if it is truly not ADHD(which I personally doubt for the reasons other have already outlined here) that doesn't mean that their strategy would automatically work, as you've experienced firsthand due to already having tried it.
I have to work around many issues myself and it's been a struggle to learn how to manage it, and would like to echo the suggestion of finding a different mental health professional better suiting the needs of your family.
Others have also made suggestions about exploring the emotions, feelings, and your child's idea for the future with them. Personally, I'd say that's just as important as managing executive dysfunction. The two of them might be linked and I wouldn't rule out them not knowing how to express something that might be the key here. It was like that for me for a long time. I only got diagnosed with ADHD as an adult as a result.
Your son reminds me a lot of me when I was that age -- I didn't have the same technology as early on, but otherwise it's all so familiar. I didn't even pursue an ADHD diagnosis as an option until adulthood, and I too had a therapist who was poorly informed about ADHD insist I couldn't have it because I could focus sometimes -- in my case, it was that I could focus when writing an essay or something for school, despite the fact that I brought that example up because I was only able to write essays in one sitting, rather than in a more measured way with planning. Ultimately I'm going to echo the sentiments others have expressed here: find another psychiatrist. Even if your son doesn't have ADHD and it is something else, their reasoning is unscientific bullshit, and I would lose all trust in any other opinions or findings from a child psychiatrist who is so misinformed about ADHD in 2025.
If you're interested in bridging the gap when it comes to your own knowledge about ADHD, here are some books by experts in ADHD that I was recommended when I got diagnosed. Hopefully they might give you some insight on how to cope with your son's ADHD outside of medication:
My last bit of advice is for the future, but: even if you get him put on ADHD medication and it does help him, it's not going to be a miracle cure for every issue. That doesn't mean it's not working. I still struggle with completing tasks around the house regularly even when on my ADHD medication, and I'm almost 30. Some things are still a struggle even with medication. It's just that much harder when a lack of the right medication is kneecapping you. I wish your family the best of luck here.
Caveat: I am not an expert nor in any way trained in clinical psychology. However, some of the symptoms sound quite similar to what a teenage relative has been experiencing over the last few years, particularly as an intelligent kid with a seeming inability to do simple tasks, for example in his case, cleaning up his room and other household chores. His symptoms / behaviour got quite severe such that his parents were at their absolute wits' end and eventually brought him to a psychologist. ADHD was the immediate suspect but in the end he was actually diagnosed with OCD, meaning, as I understand it, a good deal of his behaviour was out of his own control. Initial psychological treatments, such as CBT, weren't very successful but in recent months he started receiving transcranial magnetic stimulation (TMS) and that has resulted in a big improvement in his case.
Again, I'm not trained in this area, but it may be another avenue for you to explore. As others have suggested, look into getting a second opinion if you're dissatisfied with your previous psychologist. Wish you the very best going ahead.
The phones are a problem for everyone at that age. It's okay to keep trying, and to expect some improvement. Find a spot where he can actually put the phone away until chores or homework are done. Explain that this is an essential life skill, and part of becoming an adult now. If he's fighting you on it, then yeah it's going to be impossible, but I think it's a fight worth having.
Hopefully at that age he can understand you are actually worried about him. Maybe talk to him about what he thinks adulthood will look like in a couple years. Is he looking forward to it? Has he thought about it at all? Maybe he feels like he's on track and doing fine, but maybe not.
I think the fact that he is able to focus on things he enjoys is a really good sign in that he's fully capable of getting through this. Maybe working together on some chores at the same time for awhile could help him view them as important social time instead of only something tedious that gets pushed out of mind.
I did not see it mentioned, but ADHD tends to be hereditary. If one parent has it, there is a strong likelihood that a child will get it.
With your comment quoted above, it might be worth doing some self reflection. You have not shared enough where I can comment about you, but as others have mentioned it does seem like your son may ADHD.
One of the things that I have found has helped me a lot with the hyperactivity of my ADHD is commuting by bike rather than car. Starting the day off with exercise helps regulate me a lot.