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.

I’m really frustrated by recent experiences interfacing with the mental health system for myself and for my teenager. For them, it’s really atrocious. There may be effective options for the upper classes, but they aren’t accessible to me.

This is inspired by @X08’s recent [post] (https://tildes.net/~health.mental/1iia/unable_to_feel_progress_lack_of_happiness_and_not_finding_motivation_to_keep_investing) . Obviously I don’t know about their particulars, but I’ve certainly had the experience of being a part of a group where it appears others are progressing while I am not. Partly this is a problem of how we perceive, measure, and judge “success.” “Don’t compare my insides to others’ outsides,” as the saying goes. But it is possible to a more faithful and reflective comparison, and it does happen that others similar to me* make progress where I don’t, and it’s really frustrating. I’m often wondering, what’s wrong with me that I can’t change and grow?

I don’t have a great answer, although my exceptionally shitty childhood certainly plays a great role.

What I really want to comment on, though, is how insensitive our current mental health system is to the impact disparate causes have on creating similar symptoms, and how that should inform treatment approaches. A gifted psychiatrist (of which there are shockingly few) once put it like this (paraphrasing): Before we look at treatment for depression, we have to make sure the patient isn’t just surrounded by assholes.

But it’s a real problem. CBT is touted by a lot of “weighty” authorities as a valid gold standard treatment for a wide range of MH symptoms, and is claimed to be effective regardless of causes. And it’s my opinion that there is a lot of reasonably scientifically rigorous research backing that claim up. But, it’s not all rainbows, and it’s not working for lots of people. For one, a lot of folks claiming to do CBT are really not. Actual CBT involves a lot of homework, and a lot of recipients don’t have home support and don’t do the homework. This is extra true for children and adolescents living in dysfunctional homes. But more than just patient effort, the research marking CBT as so favorable is mostly based on subjects who are only mild to moderately distressed.* The end result is everyone involved in the “evidence based” healthcare chain is signing sufferers up for CBT when that might not be the best approach. There are lots of other criticisms too. If a practitioner is not well-trained and dedicated, the practice can be very invalidating. It seeks to make the sufferer’s more cognitive process more ‘rational,’ but when that person’s experiences are really, objectively bad, it’s very rational to conclude the world is hostile and unsafe. The tool itself is prepared for this, but it takes a really effective therapist to pull off. Also, it’s not enough by itself, grieving and other healing is also required for success.

The same thing happens in 12 step groups. AA/NA is resoundingly helpful-for a certain set of alcoholics/addicts. Those who don’t make it are often exhorted to become more honest, more open-minded, or more willing.*** My observation, though, is that most of the ones that make it come from intact families with resources. This is not universally true, it’s important for me to point out that there are enough examples of success among folks with no such background to say that there is something valuable in that approach that transcends socio-economics. There are also plenty from well-resourced families who don’t make it, but many of those families are highly dysfunctional. Of this last group, folks from dysfunctional families, some of us find success in other groups. This is because AA/NA are designed for sociopaths, ACA**** is designed for the product of sociopathic parents (who are filled with shame).

I don’t know what the solution is. A lot of malaise, addiction, “maladaptive” behaviors are, I think, born in a dysfunctional society, and so long as that society remains dysfunctional, no individual focused therapy solution will create a permanent fix. I think right here and now, too, we are at one of humanity’s “high tides” of self-destruction, a result primarily of runaway capitalism (is there any other kind?). We also just came through a really nasty global trauma, everyone is feeling it some kinda way.

Thanks for attending my TEDz talk.

*Of course, when talking about something as complex as a human life, there may no way to determine how similar is enough to make valid comparisons

**Also, let’s not talk about the various biases and implementation problems with what those studies refer to as ‘validated’ assessments used for measuring level of distress

***I am, technically, an NA success story

****Adult Children Anonymous, aka Adult Children of Alcoholics and Dysfunctional Families, more info at adultchildren.org.