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Dr. Olsen
Dr. Olsen, Psychologist
Category: Mental Health
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Experience:  PsyD Psychologist
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My grandson, aged 14, has ADD and impulse control problems.

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My grandson, aged 14, has ADD and impulse control problems. He has been kicked out of school for fighting, has been punished, grounded and been going to counseling for 8 years (since his mom died); he's been sent home from school today for fighting (2nd time in two weeks). We don't know what to do anymore. Any suggestions?
Submitted: 6 years ago.
Category: Mental Health
Expert:  Dr. Olsen replied 6 years ago.
Hello Thank you for bringing your question on JustAnswer. I am sorry to hear your grandson's situation and what he went through for the last 8 years because of the loss of his mother.


He is seeing a counselor on a regular basis and taking medication as prescribed. So he is

on the right track in these terms. Your grandson's ADD has to do with his mother's death. I hope his therapist is helping him to work on this loss through GRIEF COUNSELING for child. This is a PRIORITY and ongoing treatment for your grandson.




Other things for his school performance issues are working with your son’s teacher based on his IEP (I assume he has IEP). Your son needs Behavioral and Cognitive-Behavioral interventions by classroom teacher, AND Positive reinforcement by teacher and parent. Parent also need to attend
Parent Training (Behavioral parent management) where they are educated about ADHD, develop a list of specific target behavior, develop a reward system, and implement the reward system, establish teacher-parent communication routines, and generalize the procedures to out-of-home situations for your grandson.


You also may teach him how to control his impulse for instant gratification in middle of his routine. One of strategies is telling him "STOP, LOOK, LISTEN, AND THINK" to delay his instant desire.
Also, PRAISE whenever he sticks to routines and completes whatever he has to do at the moment. PRAISE (positive reinforcement) is as important as correcting her behavior. Importantly, he has to feel positive about self and his achievement...

For your information, you may also check resources at
National Resource Center on AD/HD.
(Website address:
http://www.help4adhd.org/ )
You may call 1-800-233-4050 in the National Resource Center on AD/HD for any question on AD/HD.

Finally, let me touch on your grandson's conduct issues. If he gets into fights with other kids often, he is developing conduct issues.

In general, treatment for children of conduct problems consists of 1. PARENT MANAGEMENT TRAINING, 2. FUNCTIONAL FAMILY THERAPY, 3. MULTISYSTEMIC THERAPY. Medication is not recommended unless your son has ADHD or major depression. 1.2.3 are conducted with outside help from psychotherapist/counselor who teaches effective parenting and disciplining skills, a psychotherapist who work with the entire family (if necessary), Classroom teacher, and/or afterschool program teacher, and a psychotherapist for the person with Conduct problems. The rational for these interventions are, Individual therapy may help the person with conduct problems to develop social and academic skills. Family interventions may improve family communication between the parents and teachers and arrange appropriate educational placement for the person.
Importantly, your grandson has to develop internal controls and a sense of personal responsibility. If he is dealing with emotional issues like anger and sadness, his psychotherapy has to include anger management and coping for LOSS/GREIF.
Please ask me if you have more questions.

Edited by Dr. Olsen on 9/1/2010 at 5:56 PM EST
Customer: replied 6 years ago.
He has an IEP but is in high school now so interaction with teacher(s) is more difficult because there are many. He has not been able to develop coping skills, so far, and is totally unreasonable at the time of his meltdowns. Sometimes it takes 24 hours before he can be talked to. He has no sense of personal responsibility and his therapist has been working on those things with him for a long time. He does receive praise and positive reinforcement but has very low self esteem and usually believes that people are just saying stuff and don't mean it. He was adopted by his maternal aunt and uncle and there are 4 other kids in the home. He dislikes all of them, including his blood sister and thinks that no one loves him and it seems he is out to prove that he is bad and everyone will eventually "leave" him.
Expert:  Dr. Olsen replied 6 years ago.
It sounds like your grandson is suffering from depression and low self-esteem that is tied to the loss of his mother. His primary diagnosis may be Depression or Dysthymic disorder, not ADD. Symptoms of ADD/ADHD are similar to anxiety, depression and PTSD in children as well as adults. Your grandson may need a psychotherapy (CBT or Interpersonal or Psychodynamic) focuses depression, grief, and enhancement of his self-esteem. He also may benefit from attending a support group for teens who lost parent or a family in his area. Please let me know if you have more questions.
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