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My 19-year-old son has been diagnosed with ADHD, depression, and Oppositional Defiant Disorder. He refuses to do anything –- go to school, get a job. He just hangs around and plays video games. He has prescriptions but refuses to take them. Frankly, he contributes nothing to the household but stress and is a bad role model for his younger siblings. How can I make him take his meds and shape up? I’ve already taken all his privileges away.
Reply from Steve McCrea, M.S.
The teenage years are very complicated in our very complex society. One of the most important jobs adolescents have is to figure out who they are, how they fit into the world, and what they want to do with their lives. I think this is the real issue presented by the situation you are living with. The details may be unique, but there are some general principles you can apply that will help you figure out what’s going on with your son and how you can help.
Stop Struggling, Start Probing
The first thing I’d do is to stop getting into power struggles with him. This includes any tussles about “taking his meds” or “accepting his diagnosis.” If that were the answer, you wouldn’t be in the position of having to write this letter. He is the one who has to decide for himself what is happening and what he needs to get his life moving forward. Someone else defining for him what he needs to do and think will result only in continued resistance, albeit by passively refusing to cooperate rather than actively rebelling.
The next order of business would be to have a serious discussion with him about what he wants his life to look like a couple of years down the road. It may be that you can do this yourself, or perhaps another person needs to be engaged. This individual should be someone he respects but who ideally has no formal authority over him (someone who isn’t in a position to “boss him around,” as he may view it). He may have absolutely no idea what he wants, or he may believe that his goal is hopeless to accomplish. He may also have what you consider to be unrealistic dreams, like becoming a rap star or making millions creating and selling video games. Don’t worry about that. Your goal is to get him to identify what he wants/needs for himself in his life.
Nurture Insight and Action
Once he’s done this, the next stage is to get him to identify what it is that he would need to do to accomplish these things. A great resource on this approach is the work of William Glasser, the author of Reality Therapy, among other things. Refocusing on the conflict between what a young adult says he wants vs. what he is doing is a central theme of Glasser’s works and should be highly applicable to your situation.
What you want to accomplish is to help bring your son to the realization, without any judgment whatsoever, that what he’s currently doing is not going to lead to accomplishing his goals. And that in order to get anything done, he will have to decide to change how he is living. Having him predict the likely outcome of continuing to behave the same way versus making some changes can really help him get perspective on what his options are, and the real work involved in making good things happen in life.
Eliminate the Freebies
The other principle of Reality Therapy is that the only person whose behavior a person controls is his own. This rule applies to you, the parent, as well. You can’t make your son do things, but you can refuse to participate in making it easy for him to continue in his current behavior pattern. You say you’ve taken away all his privileges. Why not also consider the “services” you are providing for free – food, transportation, electricity, water, shelter, companionship, etc. Think about which of these he is particularly motivated to take advantage of and then choose to stop giving them away. Then consider what kind of conditions or requirements you’d like to set before you agree to provide the services he so wishes to have available.
A simple one is internet service. You don’t have to provide free Wi-Fi, and I can guarantee that he wants or needs it to continue his internet use. But in the real world, if you weren’t there, he’d have to pay for it himself, wouldn’t he? So you can start by letting him know that you’re going to alter the password and from now on he’ll have to pay you $X a month in order to find out what it is. This means he’ll have to figure out a way to get some money together, which means working, etc. Of course, he’ll probably get upset about this, and rail about how unfair you’re being. But anger is a much better state than apathy.
Reinforce a Positive Identity
That last example provides just one of many possible scenarios, and it may or may not be a good idea depending on the dynamics of your relationship. The idea to convey is that he’s part of a community and that in any community, people need to contribute in order to enjoy its benefits. So he needs to do his part if he wants to be a part of your community (his family). That’s how the world really works.
In terms of his psychiatric “diagnoses,” the biggest issue I have with the DSM labels is that they allow a child (or adult) to avoid taking responsibility for the results of his actions. “What do you expect? I’m disabled!” becomes a handy excuse for avoiding any positive steps. I hope my answer provides some ideas on how to start chipping away at that idea.
It is very late in his young life for him to learn some of these lessons, and it may be very painful for you both. But it’s not too late, and the sooner you get started, the sooner he’ll start figuring out a way to live a better life.
Steve McCrea, M.S., is a mental health professional, advocate, and author who has worked for over 30 years in social services, including over 10 years as a mental health professional. He recently retired from his work as an advocate for children in foster care. Steve is a member of Portland Rethinking Psychiatry, an educational and advocacy group inspired by the works of Robert Whitaker.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.