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ADHD - focus worse during puberty?

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Just a question for all you moms who have "been there done that" - Do you notice focus becoming dramatically worse during the onset of puberty?


Focus has always been a significant challenge. But it is incredibly bad now. This son is 11, turns 12 in January, and has physical development consistent with early puberty. Could there be a correlation, or should I be looking for another cause?


Focus is poor to the point where even following a one-step instruction is difficult/impossible. For example "please go upstairs and get dressed". He'll go up full of good attitude and good intentions, but get side tracked. Until I walk upstairs with him, and stand there, it just isn't happening. 


Other things are markedly worse, too. Self esteem is suddenly way down. Defeat. "No matter how hard I try I just mess everything up." Depression. 


This kiddo is usually upbeat and extremely energetic. 


We're a family that likes to avoid meds when possible. His focus challenges have been significant enough that we've tried several meds over the last year. Ritalin, and others. He couldn't tolerate any of them. Most recently we tried a non-stimulant, Strattera. That seemed helpful at first - we saw a huge increase in ability to focus, and particularly his ability to organize himself. Then the sleepiness increased, and the focus issues increased, too, to the point where the ped. decided to pull him off and let it all clear from his system.


Not sure what to try next. I'll post separately about math issues.



ETA ...Oh, we have an appointment with the OT on Monday. Hopefully to start Interactive Metronome, but she'll run an eval. and we'll see what comes up. I still feel that this is likely missing the heart of the issue.



Edited by diaperjoys
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Yes, 9th and 10th grades were difficult. We used CBT for EF, late 10th through 11th grades, and things are much better. Not perfect, but way better. DS cannot take stimulants, and Strattera was a bust.


Eta: DS has always experienced sleep problems. Night terrors started when he was 10 months old and stopped when he was 8th grade. He started participating in football during the 11th grade so exercised 10+ hours per week. Sleep issues seem to be cleared, but football ended late October.


Strattera caused anxiety, so the experience was not good for him. Additionally, DS took a TOVA and scored worse while taking Strattera.

Edited by Heathermomster
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With Straterra, my son began having increasingly severe insomnia. He went off when we realized that was the cause, but the insomnia remained. The medication definitely kicked off severe and now chronic insomnia for him. However, I've read, many of those with ADHD develop sleep issues and insomnia particularly during puberty. We may have struggled to some extent anyway, I think. I remember asking the prescribing doctor if it might cause sleep issues prior to starting (I was told no/not true at all, as it turns out--it's a known issue), because I think I was seeing some struggle off and on already. 


So...my son's focus is truly horrible, and his other executive skill issues are worse as well. He developed anxiety too. All this drastically improves, maybe even back to where he was pre-puberty, though it's hard to say as it's been so long, when he has a patch of being rested. But those don't happen often. 

For us, then, ADHD has been far worse in puberty, but I think a lot of that is the sleep issues that are ADHD related increasing in the same time frame.


I will say I think he's over-all decreased in  hyperactivity and impulsivity compared to pre-puberty. He still has all that, but the attention deficit part of ADHD took the hit, not the hyperactivity part. 

Edited by sbgrace
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I can't speak directly to your situation but the year my one daughter did the run club was the best year of our lives. The exercise made a temendous difference. Also preteen to teen years are tough . We have a younger son who really needs every bit of energy he can muster for the school day. We keep him on a very tight routine even weekends with good protein and nutrition. We make sure he is in bed early. Guess what? It makes a difference for him but our preteendaughter benefits tenfold from this. Her coping ability and general abilities significantly improve. The challenge is getting a teen to go along with this. She is not very malleable so it's a constant deal in our house.


Diane Craft mentioned pycagonel ( not sure on spelling) and a few other dietary recomendations for ADHD. She was specifically focusing on kiddos where medication wasn't a good fit. I found her advice worthy of consideration for my son she helped me to understand ADP and come up with some good things to try for nutrition and therapy.



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For families who don't have pet allergies and parents with kiddos who need more sleep and help dealing with anxiety.


For my preteen with anxiety we have the family dog sleep with her we also have her walk and care for the dog. She had night terrors and so much anxiety she wasn't getting good sleep. The doc suggested prozac. I suggested a bigger bed and a dog. We worked with a therapist who has a therapy dog and our dog trainer. We had serious nighttime problemsbefore this my dog is just a normal dog but it's like therapy for my daughter. I got the idea from vets who have PTSD and have companion therapy dogs. It took two or three months but huge difference. Now my daughter sleeps and when she gets sleep everything else is better.


Before the dog her therapist let us try the dream pillow from integrated listening system. We loved it truly would recomend it. It's just that it hooks to an mp3 that plays night music and my daughter would probably sneak around and play something else hence the dog solution.


My son is a good sleeper but sleepwalk and wakes up. He sleeps with the cat. It's crazy he has that little cat trained to sleep on his bed. He doesn't wake up now and move around because he wants the cat to stay.


My other kiddos don't care and sleep fine but the best part is more sleep helps with anxiety and stress. Also when they sleep so do I which is the best part.






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I have a kiddo with ASD, Tourettes, anxiety disorder, and adhd, and I've found that everything is worse during puberty. Puberty has such an effect on executive function skills as it is, so when a kiddo is weak in that area already it can be an extremely tough time. Sorry I have no real encouragement to offer, as we struggle daily dealing with how much worse everything is right now during his puberty, and some days it's hard to think things can ever go back to being how they were when it wasn't this bad. Good luck.

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Yes puberty definitely increased focus issues but also anxiety and depression in my son.  But I myself have trouble staying on task and I am definitely NOT a pubescent teen, LOL.  Hugs.  I know how frustrating this can be, for all parties.  I applaud you for caring and wanting to help instead of just writing him off as lazy or uncaring.  Unfortunately, many people do not understand how hard simple tasks can be when dealing with ADHD.


I did want to mention that you may not realize how challenging a simple task really is.  FWIW, "Please go upstairs and get dressed." is actually a multi-step process, not a single step process.  Your son has to stay focused through a multi-step process and frankly that can be exceeding challenging.  Lets break this down a bit.  "Please go upstairs and get dressed" translates into at least the following...

1.  Walk up the stairs.

2.  Go to your room.

3.  Think through what clothes would be appropriate to wear for the day.

4.  Find all the various articles of clothing that are needed.

5.  Put each item on in the order that is most appropriate.


While this may seem simple, your one step instruction actually requires multiple steps to complete. With every single one of these steps it is quite easy for the 1000 other thoughts demanding attention to distract him.  All of those 1000 thoughts are equally demanding his attention.  All of them.  Unlike in an NT brain that can push aside all those other thoughts while it stays on task to complete a task, an ADHD brain has tons of thoughts that ALL demand attention ALL AT THE SAME TIME.  Trying to keep one rather boring thought at the forefront, and then remembering the next step in that process, and then the next and then the next, until the overall task in completed can be very challenging.  Very.  Add in puberty hormones and it becomes much much more challenging.


Let me share an example from my own life.  When I have to take on daily boring tasks I HAVE to break those tasks down onto a very detailed list that I work hard to keep coming back to so I can complete the tasks I need to finish.  What may seem simple and a one step process for someone else is simply not for me, or for my son.  Not at all.


Let's take the statement "do the laundry", which actually came up on another thread a while back.  I need to do the laundry.  But I don't just write "do the laundry" on my list because that doesn't even remotely reflect what goes into that task.  Instead it is the following:

1.  Bring all the dirty clothes downstairs to the laundry room.

2.  Pull out the blue towel for washing.

3.  Put the blue towels in the washer and start the wash.

4.  Move the blue towels from the washer to the dryer.

5.  Put the black t-shirts in the washer and start the wash.

6.  Fold the blue towels.

7.  Move the black t-shirts to the dryer.

8.  Put away the blue towels.

9.  Fold the black t-shirts.

10.  Put away the black t-shirts.


At every point there are multiple things that need doing so this could be broken down even further (put detergent in/dryer sheet/etc) but for me I don't need it broken down to quite that extent but I DO function better when I break it down like above.  This way also if I get interrupted I can remind myself where I left off and can start up again where I left off.  I can also feel like I actually accomplished something because I can check each step off instead of looking at my list at the end of the day and once again feel like a failure because maybe I ran out of time to put away the clean clothes so I can't check off "do the laundry" from my list.


Basically, what might help both of you is if you recognize that a single sentence task that SEEMS simple may actually have many steps involved.  There is a very good chance that with each tiny step there is a chance for distraction and difficulty completing everything needed to reach the overall goal.  Perhaps written instructions that include each step would help?  You would need to train him to check that list frequently, check off things as they are accomplished, etc.  It may take quite a bit of time to develop that skill and right now may be a hard time to start, but it MIGHT help.


And again, hugs.

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Thank you all for the great input. So many valuable things here! Extremely helpful!


We had a breakthrough this week. The OT eval showed that his vestibular system is off. We're in the insurance approval process which may take a couple weeks. So, rather than wait it out, I decided to step up his sensory diet at home. I added in some spinning, and lots, and lots of deep pressure. I'm kicking myself for not thinking to check this before - I kind of thought that he was self regulating his sensory needs, since he has the freedom to move around here at home. 


Anyway, huge, massive difference. He loves, loves, loves the deep pressure, and says he feels calm and refreshed afterward. We're not where we need to be yet - however, his focus is much better, his depression is much improved, anxiety is down, he can follow instructions better, the tears are gone. I'm estimating a 50% to 75% improvement. Now, of course, I've only done this with him two days, and I expect we'll have our ups and downs. But...sheesh! those of you who have these kiddos will understand how massive and life changing a shift like this is. Once we get the OT working with him, she may be able to help me fine tune his needs more than I can on my own. 

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