ASK THE EXPERT:David Coleman answers your questions
Q I HAVE A 14-year-old nephew with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD).
Until two years ago he was the best lad around, but recently, it has all gone horribly wrong. As I’m write this, my heart is breaking for him, his parents and his grandparents.
He is causing so much hardship for us all and we don’t know where to turn. My sister and her husband are in contact with the local HSE services and are trying to do everything that they are told to improve things.
However, things are going very rapidly downhill. He is now in trouble with the guards, and every day is just a nightmare – we are so worried what is going to happen next, both to him and his parents.
Is there anything that you could suggest to help my sister and her family before it falls apart?
AEven though you don't describe the kinds of difficult behaviour that your nephew is exhibiting, it does sound like stress levels are very high in your extended family.
I am glad to hear that your nephew and his family are linked in to the HSE services.
When problems are long-term and chronic, the best support can be offered by a team approach within the HSE. Hopefully the services there are able to offer an individual service to your nephew, perhaps focused on helping him with social skills, communication, decision-making and managing his anger.
Alongside that I would imagine that his parents are being offered various advice and strategies to manage some of his difficult behaviour.
Youngsters with ADHD and ODD combined will often show a lot of angry, destructive and challenging behaviour. They will pick fights and rows; they will stubbornly refuse to do what is asked of them; they will appear bad-tempered, dismissive and rejecting.
In the midst of a lot of rows and negativity at home (as I imagine there is) your sister and her husband may be tempted to give up. Sustaining the stress of living with a teenager who is constantly disrespectful, challenging, dismissive and possibly even threatening can often feel like too much to bear.
It can be really helpful, therefore, for them to look for as much social support from the extended family as is possible. As well as the professional support from the HSE they might want to link up with parent support groups for ADHD and ODD.
These groups can be great for directing parents to additional services and reminding parents that they are not alone with the level of difficulty they are experiencing with their child or teenager.
Also, do remember that somewhere under the skin of your nephew’s current defiant attitude is the heart that was there all along. If he was good-hearted two years ago, then he has the potential to be good-hearted again. This means that your sister and her husband need to not give up hope.
Although the consensus among the professionals is that his current behaviour is associated with ADHD and ODD, could there be other causes or associated factors? What about drugs?
I always think it is worth considering the possibility of drug use when teenagers seem to go far off the rails. Regular use of any drug, as well as the social pressure of being part of a drug culture, always leads to major confrontation and conflict between parents and their son or daughter.
Youngsters who get caught up in drug use are likely to be suspicious and antagonistic to most adults. The general consensus among such peers will be to be negative about, and disrespectful towards, the Garda and parents alike.
Gangs of youngsters who are involved in buying and selling drugs are going to be delinquent in other areas of their lives too.
You don’t mention if he has maintained any interest or engagement in sports or other pastimes. If he has, then these could be another positive source of influence on him.
It may be worth trying to identify someone in your extended family, or even, ideally, outside your family, who could take him under his wing as a mentor. I say “his wing” because I think the most helpful role model and guide will be another man – particularly one who seems to have lived life and has wisdom and some street smarts with it.
If you feel that part of his trouble is the group of friends he is mixing with, then perhaps think radically about giving him a chance to move away for a period of time.
Do you know of anyone who could take him for a couple of months, maybe on a farm or someone attached to an industry where he can be put to work?
There are just some youngsters who experience adolescence as a challenge and go on to spread the challenge around. That does make it difficult for the adults involved to cope.
I know it can be exhausting for family members but keep sticking with him. Despite the hassle he is causing I am sure he is worth it.
- David Coleman is a clinical psychologist and broadcaster with RTÉ television
- Readers' queries are welcome and will be answered through the column, but David regrets he cannot enter into individual correspondence. Questions should be e-mailed to healthsupplement@ irishtimes.com