Why does my 24-year-old son with ADHD miss deadlines?

Question

Hello doctor,

I am the mother of a 24-year-old son who was diagnosed with ADHD two years ago, and despite being on Methylphenidate 36 mg extended release, he is still constantly missing deadlines at his new job, and we are really worried he might lose it.

Why does someone at 24 with ADHD keep missing deadlines despite trying hard? He uses reminders, a planner, and even alarms, but something always falls through.

His psychiatrist recently added Atomoxetine, but it has only been three weeks. His sleep is very irregular, sometimes four hours, sometimes 10, and I wonder if that is making the ADHD worse.

He feels so guilty and ashamed after every missed deadline, even though he genuinely tries. Is this a medication dosing issue, or could there be a co-existing condition like anxiety or autism spectrum that is not tested for yet?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for your query. I understand your concern.

Atomoxetine is a stimulating (activating) medication, and in some individuals, it can interfere with the sleep cycle. It would help to know the current dose and the time of day he is taking it, as both can influence sleep.

Anxiety is also commonly seen as part of adult ADHD (attention-deficit/hyperactivity disorder, a common neurodevelopmental disorder marked by persistent inattention, hyperactivity, and impulsivity that disrupts daily functioning, often emerging in childhood), so it can be difficult to determine whether the anxiety is a core feature of ADHD or a separate condition. Based on the information provided, there is not enough detail to suggest a diagnosis of autism spectrum disorder at this stage.

Since Atomoxetine can also help with anxiety symptoms, a gradual increase in dose (if not already optimized) may be considered under medical supervision.

For sleep disturbance, short-term use of medications like Clonazepam or Lorazepam may be helpful. These can also reduce anxiety, but they are typically used cautiously and for a limited duration.

Another option is Clonidine at night, which can support sleep and may also help with some ADHD-related symptoms, if it has not already been tried.

Overall, the next step would be to review his current medication schedule and symptoms in detail with his doctor, so that treatment can be adjusted in a balanced and safe way.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.