I’m worried about my nephew with ADHD

Q. I hope you can help. I am writing to you out of pure desperation. I am extremely worried about my 16-year-old nephew who has reached the point where he is out of his depth and is heading for serious trouble. My sister is my nephew’s sole parent and he has attention deficit hyperactivity disorder (ADHD) and has always had behavioural problems.

Despite having a special needs assistant at school and prescribed medication, his behaviour was a constant issue with the school and for his mother. He has major problems with authority of any sort and has no respect for adults.

His mum had a good upbringing and comes from a close family unit. Despite this, she is more likely to attack then take action. Screaming and shouting is her norm as opposed to sitting down to discuss things. We’ve been jumping from one of my sister’s dramas to another for a long time now and it’s just so wearing because she isn’t willing to be proactive, although she is capable.

We do try to give her advice and support and try to point out that she needs to do things for herself but she refuses to analyse the situation and accept her role in being part of the problem as she prefers to blame the rest of the world. Despite us trying to get our sister to take action on the way our nephew has been heading from long before things became so dangerous, we now really feel that his life is in danger from being mixed up with a very bad crowd.

The family has taken our nephew aside on many occasions and tried to get through to him. He is approachable but it does no good. I just know he can be saved and would really appreciate any help or guidance you could give us.

A. When there are serious concerns about a child it can be very difficult as an extended family member whether you are a grandparent, aunt or uncle. You can be really worried about the welfare of your nephew yet you can feel confused about whether to intervene, as you are not the child’s parent.

Also, trying to help another family member is a delicate matter and hard to get right – your good intentions can just as easily be rejected as accepted. Things can be all the more difficult when the problems have been going on for a long time and involve lots of different people and agencies such as school and professional services.

Because of serious concerns and the level of your worries, it is easy to get caught up in cycles of blame and criticism – it is understandable to feel frustrated and angry and to be critical of how your sister might be reacting angrily and making the situation worse.

Your sister and nephew in turn are likely to blame each other and everyone else including the extended family about the situation. However, blame and criticism rarely help and it is important to take a pause and to try to think of a constructive way to become involved. It can be useful to try to understand where your sister is coming from.

Your feelings of worry, powerlessness and frustration are likely to mirror how she feels about her son and the situation she is in. Dealing with a child with ADHD and long-term behavioural problems when you are a single parent would be a great challenge for most people so the more you can be supportive and empathetic the better.

As well as advising your sister, the key is to try to support what she is doing right with her son. When is she effective? When does she get it right with her son? How could you build on this? If she feels supported by you then she might be in a position to listen to you about setting rules or trying to address the behavioural problems.

Good support is a mixture of emotional support such as being there, listening to your sister, etc, as well as practical help such as maybe being there at flashpoints, accompanying them to a school meeting or other professional appointments if that helped.

In addition, it is important to take a break from talking about the problems all the time, and as a family to try to have other time where you do normal enjoyable things together.

You also might want to look at how you or another family member could be a positive influence directly with your nephew. Rather than just addressing the problems when they arise, it is important to take time to connect with him and work on building a trusting relationship. Simple things like spending time with him such as being there at a weekend or taking him to a sport, etc can help.

The key is to be patient and to open the lines of communication so you can begin to talk the problems through with him and be in a position to positively influence him.

If you feel he is being mixed up with a bad crowd, maybe you can encourage other options with him, whether this is getting involved in other activities or new interests. Practically supporting him by taking him places as well as being there to listen can help too.

While there is a role for rules and consequences, at 16 years of age, any solution must involve his co-operation. If it helps you could consider as an extended family member contacting professional services and joining with your sister and son at appointments – this is something to do with your sister and, ideally, your nephew’s consent.

While of course there is only so much you can do as a concerned aunt, the important thing is not to give up on your sister or your nephew. When one crisis too many comes down the line, it is easy to feel you have had enough and to wash your hands of the situation.

While of course taking a step back at times can be helpful, staying supportively involved in the long term could make a difference. In my clinical experience in dealing with teenagers who have gone off the rails, it is often members of the extended family who can have a pivotal role and make a difference to a teenager’s life in the long term.

The challenge is to remain supportive and constructive, and to do what you can rather than getting taken over by negativity or blame.

Dr. John Sharry, Irish Times, August 2010. John writes in The Irish Times Health+ every Tuesday.