TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: Hello. Come on back. Ruth is so happy to see you, Kevin. No? Or is she? Ruth? What are you doing, Ruth? You're supposed to move. She came rushing over. She enjoyed sitting with you so much.

FATHER: You probably didn't feed her. She wants food.

THERAPIST: She went after someone's corndog the other day.

FATHER: Well we were going to bring our food.

THERAPIST: That's never a good idea. This college girl brings in her corndog and she's sitting there and I said, "I don't know whether that's safe or not," and she goes, "Why?" [00:01:00] Ruth runs over there and starts licking at it and she'll take it right out of your mouth.

MOTHER: We actually have parent-teacher conference at 6:30 in Baldwin tonight and so we'll need to leave 5:45, which should be a problem at all.

THERAPIST: That should be no problem because we're on 4:30 to 5:30 and we're actually running, by my standards, on time. (laughs) So yeah, we should be in good shape and we just need to hit the door at about 5:30.

FATHER: 5:45.

THERAPIST: Sounds good. So, parent-teacher conference. Are you all prepared, Kevin, for that?

CLIENT: Not really.

THERAPIST: No? Do they have you write up a little summary of your schoolwork and stuff for your parents to present?

CLIENT: No. I don't go in. They just go.

THERAPIST: Really?

CLIENT: Yes. Is that right? [00:02:00]

MOTHER: Yes.

THERAPIST: In my wife's school they make the kids do a presentation to the parents.

FATHER: That's smart.

THERAPIST: She was sort of the founder of this and they had these great kudos for that because then the young person is sort of having to be responsible for his learning.

MOTHER: Right. Wow, that's interesting.

THERAPIST: So what do you expect to learn tonight? Or ask or whatever it may be.

CLIENT: 3 From the parent-teacher?

THERAPIST: Yeah.

MOTHER: I went onto Power School and printed off the grades from the last two weeks and what I've got highlighted is what ...

THERAPIST: You came very prepared to answer my question.

MOTHER: Well. (laughs) Yeah.

THERAPIST: My goodness, Kevin. Have you seen this document? What thoughts do you have? [00:03:07]

CLIENT: I feel like I'm trying really hard, but it's just not working.

THERAPIST: Because you have a D in Science and F's in Social Studies, Intro to Spanish, Pre-algebra, and Language Arts. (pause)

CLIENT: And Science must be because I forgot my one article, but everything else I had like A+'s and stuff on.

THERAPIST: Now in our last installment a couple of weeks ago, you were going to be taking charge of your self-regulation, right? That was you.

CLIENT: I don't think we really did that this — did we?

THERAPIST: We didn't quite get started yet or were we going to get to the end of the ... ? [00:04:00]

MOTHER: What he's talking about is paying you for studying and us not being on your back about Power School and stuff. So yes, we did that these last two weeks.

THERAPIST: But I'm assuming that this is probably not a reflection of how you want things to turn out. Hmm. Okay. I wish that you were going to present to your parents tonight at parent-teacher conference so you can present what your plans are to sort of get things back into shape for the second nine weeks, which I believe you started or is it not?

MOTHER: This is the beginning of that.

THERAPIST: Oh, this is the beginning. I thought this was the tail of ... Oh, the first column is ...

MOTHER: Yes. Yes. So that's what he ended on.

THERAPIST: Oh I did not ... You made such a pretty highlighting that I jumped right to it and missed the first column.

MOTHER: I don't know exactly the date that it switched over. [00:05:00]

THERAPIST: So the data here do not reflect many days of work so far, just the first [three?] (ph?)

FATHER: It reflects everything.

THERAPIST: But it's a very small sample, you know?

FATHER: Right.

MOTHER: I think the quarter started like ...

FATHER: A week ago Monday?

MOTHER: I think it's been two weeks.

THERAPIST: Oh, dear. Okay. We have two weeks' worth of data.

MOTHER: Right.

THERAPIST: Okay. So this is under your command, now. I now understand what we're looking at, so give us your thoughts on where you've gone wrong. Let's go down the list here and what your plan is: Science, that was a D last time, right? And here it is, it was a D. What is the story there? [00:06:00]

CLIENT: I forgot to turn in one science article. We pick a science article each week and that was the only thing I forgot in that class. That's pretty much the only thing I've ever forgotten to turn in in that class.

THERAPIST: That must have been a big article.

CLIENT: Yeah. It's like 50 points, or something like that, each week.

THERAPIST: And when was that due?

CLIENT: I think it was due last week, but our classes were all shortened today and it was group two's article week.

THERAPIST: So is this one you've selected already and it's under your bed or . . ?

CLIENT: No. I forgot about it.

FATHER: All he needs to do is cut it out and hand it in.

THERAPIST: Okay. So do you need like a black magic marker or something to write on your hand or what? (chuckles) What method of reminding do you want to use for yourself?

CLIENT: I usually look on Power School every single day when I'm doing my homework and I do the 80 minutes. [00:07:02]

THERAPIST: Yeah.

CLIENT: And last time I didn't take a break because I just wanted to get it over with. I didn't take the ten-minute break.

THERAPIST: Theoretically it might work, but I'm a little worried about your focus.

FATHER: The 80 minutes is taken very literally. It's to the seconds, counting down.

THERAPIST: I don't blame him. I think when that clock rings I'd probably run.

FATHER: I don't know that it's pure homework during those 80 minutes.

THERAPIST: Oh. Then it's not really being taken literally.

CLIENT: It is. You just never ...

THERAPIST: But, Kevin, if you're working that hard, which is good, we should all be happy. I mean 80 minutes is 80 minutes, but why is this a problem because you just cut the article out during the 80 minutes? I'm not just trying to harangue you, I'm really trying to get you to think about where you — this is called metacognition. It's where you think about your learning process and where it goes wrong. Because if you had 80 minutes for roughly the last ten school days probably, cutting that article out is probably what — about a two-minute process?

CLIENT: Well I've also got to find it and sometimes they're pretty hard to find. But that was the only time I've ever forgotten one.

MOTHER: Now on these other pages, the front page of what I handed you is the overall grades; but then as you go, that will be each individual class and the class is highlighted over the top. So you can see that he did get A+'s on certain things and you can see his F there where that article was worth 50 points.

THERAPIST: Yes, Kevin, there is more data here. Except for one item, which is a chapter 16 worksheet, everything you turn in is pretty good. [00:09:05] There's the article, sure enough. There are some cute, little boxes and this compound models lab isn't due yet, apparently.

MOTHER: Correct. Right.

THERAPIST: This is very good. Daily work, Facebook, 24-hour extra credit. What was that?

CLIENT: That was just extra credit that you could log on Facebook; and I don't have Facebook.

MOTHER: We don't have Facebook.

THERAPIST: Oh.

MOTHER: Which is kind of a bummer. That's one thing I'm talking to him about tonight as well.

THERAPIST: I don't know any teenager who has Facebook. I thought they were all on Twitter.

MOTHER: I think you might be right. [00:10:00]

THERAPIST: No, they don't do that anymore. What do you do on Facebook to get extra credit?

CLIENT: You just Like his page. He updates it on reminders on homework and stuff.

THERAPIST: So that helps you stay connected to him? That's his reminder page. Okay.

CLIENT: But we rarely have homework except the articles in his class.

THERAPIST: So this page tells us that when you do and turn in the homework, you do pretty well. I'm not sure what happened on the Chapter 16 worksheet; you only got half of it.

CLIENT: I'm not too sure.

THERAPIST: Okay. But that one you turned in, so that's good. Will you get downgraded if you turn in that article late?

CLIENT: I think I can turn it in next Friday and I think he'll accept it because it will be my time to turn it in. [00:11:00]

THERAPIST: So when you're sitting down with your 80-minute homework, you're saying you get on here and look at what you have to work on and you see this. This is a straight print-out from the computer, all right? Every day did you look at this and see "that's that article"? Because it has this pretty orange and yellow box next to it that says [the article is missing.] (ph?)

CLIENT: But that's my first class that I look at and then I look down at all the other seven.

FATHER: So your dad thinks you were not, necessarily — he has a theory that you were not using all the — because he's thinking, "How did he miss getting that done if he had 80 minutes every day?"

CLIENT: Well he's never home. He got home at 2:00 the other night, so he's never home to actually see what's going on.

THERAPIST: He could Skype you and stare at you while you do that. [00:12:04] You think I'm kidding; I totally have people doing that to their college kids. That seems kind of creepy, so you probably don't want him to Skype you and stalk you. Okay. So this proves that when you turn things in you do pretty well. Let's see about the next one. So we have Social Studies and then — whoops — Constitution Scavenger Hunt. What was that?

CLIENT: That was looking through the Amendments and I didn't understand it at all. I worked on it and then when I got to school I didn't have it done because I was really confused on it.

THERAPIST: Did you talk to him about it?

CLIENT: No. That's what I forgot to do.

THERAPIST: Kevin, last time I commented on what a smart guy you are. [00:13:05] I also said maybe they don't need to drive you around like a little [bus] (ph?). This was the 15^th that it was due and what is today?

FATHER: The 23^rd.

THERAPIST: Surely you're not procrastinating, are you? That was sarcasm. You didn't notice that, did you? Hmm. Do you make a list of things to do? Do you have a to-do list?

CLIENT: No. I usually just look on there and check on it every now and then.

THERAPIST: Okay, but probably not while you're at school. Do you have an iPhone or something?

CLIENT: Yes.

THERAPIST: Do you have notes on it?

CLIENT: Yes, but we're not all owed to use it in school much, though. Like when you walk into the class she'll tell you to put it away even if the bell hasn't rung yet. [00:14:03]

THERAPIST: Do you need a paper list? iPhones are nice because then you always have it on you and you can check things. You were getting ready to say something.

MOTHER: That's a good point, actually. Before we bought a planner where, ideally, he would write down what he needed to do, but there was no follow through with that. But I do think that is one of the things that it would be great if he could write those things down. I didn't think about the iPhone for that, though.

THERAPIST: Yeah, technology is your best friend and your worst enemy. I had this case one time where this girl had Facebook, a college girl, and her friend got on it, just as a joke, and changed her status to "I'm pregnant." The girl didn't realize this until her minister called up and talked to her mom and said, "Is there anything I can do since your daughter is pregnant?" (laughs) [00:15:07] And the mom, of course, didn't know this, and so the girl is telling me this story and I looked at her and I said, "Wow, that seems like a good reason to get rid of Facebook." And she said, "No, Wes, you have to understand. Facebook is a tool. It's like a hammer. You can either drive a nail with it or hit yourself in the forehead." Your phone can either be distracting to you or it can be the most unbelievably helpful tool you will ever have, particularly an iPhone because it has a to-do list on it. Some people like that because they like to check off the thing which says "talk to Mr. What's-his-face." He doesn't have his name on here.

MOTHER: For Social Studies? "... about what the deal is with this here Amendments thing." Other people like to put it in as an event, so at 3:30 every day you look at your phone. I look at this and Other people like to put it in as an event, so at 3:30 every day you look at your phone. [00:16:05] I look at this and I say, "Oh, wow. Kevin is coming in at 4:30" or whatever and I know that's what I'm supposed to do. My to-do list, basically, is Kevin during this hour. Some people like to put it in as a little appointment so you go in after school, but it is probably desperately crucial that you learn to use that that way.

FATHER: I'm not trying to be funny, I just don't think he's got the organizational skills.

THERAPIST: I know. That's the whole issue that I'm pointing out, but he's got to find — the first thing he has to do is have a method. Now the follow-through on the method is tricky. But when you start giving them three or four different things, like a planner — I know that's the one everybody goes to — and/or a folder to carry around and a whatever, everything goes in that phone. This has been found to be so helpful that if you're on disability or voc rehab, which people with ADD can go on sometimes, they will give you a smart phone as part of your voc rehab because it is such a good tool. [00:17:15] Of course, it's useless if you don't feed it. My daughter has an iPad and part of what she is being told to do is to use the calendar to plug in events in advance so that we make sure we know what they are. You can use the calendar for that.

MOTHER: Does she take it to school?

THERAPIST: Yes, and she has it on her IEP. I think we talked about this. We talked about turning in work on e-mail. That's part of her IEP, but you don't have to have an IEP to make that happen.

FATHER: I don't think they will allow an IEP.

THERAPIST: I was reviewing IDEA today and there is something that has changed slightly in it. I did not believe they could refuse to evaluate somebody and it says on there that it's possible that you can file an appeal, but I didn't think they had the right to do that. So I've been reviewing that today. There is a book you can get on it, but even if they don't want to do an IEP with him, if you just go in and tell them you want it — they often call it a student improvement plan, and if they can find a way ... I guess somebody brought string in the other day for her and now everything she sees is string. (laughs) If you go in and tell them you just want to do a student improvement plan, they'll do that before they worry about it. The second thing is a 504, which is not legally binding, but the school will make sure he can access education. And having some form of organizer like if you provide an iPad, I bet you they would go for that; but then that's just one more device, so they really ought to just let him use his iPhone for that purpose. Now is he going to get on and surf God knows what? Kevin? [00:19:07]

FATHER: I think what's going to be helpful is the teacher conferences tonight and talking with the teachers.

THERAPIST: Yeah. Tell them we're trying to find some kind of organizational system. Our job is to figure out what system will work. Our job is including you, but none of us can follow Kevin around and say "did you put that in?" I do that a little bit with my daughter. I'm like "make sure and put that in your iPad," but we're not at school with him. Do you see the merit in this idea, that it would then tell you after school that you need to go talk to this guy; and so then you become accountable to you and your phone. And it may sound like a machine is controlling your life, but my machine tells me where to be and then that's where I go if I've fed it right. [00:20:05] I have someone to do that. Do you see the logic in that? We have to get you so that you and your iPhone calendar becomes like your second brain and you will be shocked at how well that works. But it doesn't work if you don't work it.

FATHER: Or if you abuse it.

THERAPIST: Well, right. That's the hitting yourself in the head if you're misusing your phone. You only need it out for a minute to check the calendar between classes and see "what am I supposed to do next?" That's it. He doesn't need an accommodation of it in class unless he's going to ... You can't really do homework very easily on it. I would talk to them about the e-mail theory to turn in the homework.

MOTHER: I did actually call and talked to the secretary about that and we'll ask them tonight, but she didn't think that would work. She mentioned the 504 — or you mentioned the 504. [00:21:03] We had talked about that and she thought he might qualify for that, but she didn't think ...

THERAPIST: She didn't think you qualified? I'm not teasing you, but you actually just talked to the secretary? She has no vague idea that this is a legal issue with the school and if you go in and tell them we want to get an IEP on him, they will immediately jump up and be like, "Well, let's try some other things first." And that's where you say, "Okay," and then you suggest those things. That's a principal conversation, but the place to start is the parent-teacher conferences. I guarantee you if you say anything to them really about it they can't make any policy changes, so this is more like you would talk to the school psychologist or something and tell them you want some minor accommodations. And you can even say to them that if we can just work it out informally, it's a minor situation, then they may hear what you're saying. They may understand that will be the easier way to go. I don't think he needs it out during class. [00:22:08] I don't know what he would do with it over the phone. For the e-mail, I don't know why they wouldn't accept it through e-mail. It hasn't been a problem any other time we've done it. Now I will admit your school district can be so funny about these issues. I'm really curious what they will do.

MOTHER: The phone is kind of an interesting issue because it's a source of huge contention anyway.

THERAPIST: Oh, yeah.

MOTHER: It's constant. It's like an extension; it's like another arm and he's never without it and when he needs to give it up for studying, he refuses to do that. We have to be "you don't get paid because this is part of the program that Doctor says."

THERAPIST: Why do you need it during studying, other than for the purpose I described? To hit yourself in the forehead with it?

CLIENT: Google Docs. I know I can do that on the iPad, too, but I'm a lot faster texter than I am a typer and iPad is more like a small computer. [00:23:07]

MOTHER: Kevin, be honest.

THERAPIST: This is sketchy.

MOTHER: You're constantly texting people all the time, so I can't imagine that ...

CLIENT: You asked me for my opinion so I was just giving my opinion.

THERAPIST: Do you constantly text people?

CLIENT: Not usually when I'm doing homework.

THERAPIST: Oh, Kevin. I don't like to turn your life into a technology nightmare. I'm almost hesitant to even say this, but you have to be more honest about this stuff with yourself. I can turn them onto an app that they have complete control over your phone and it's going to cost them a whole $13 a month, which is worth it. They can intercept everything you do and look at it on the computer and decide if they like it or not, like be big Nazis. That is the alternative here if you can't be radically honest about stuff. And it's easy. It won't even take a lot of their time. It will be cheap and easy to control you. Now do you really — and I'll show it to you; I'm not bluffing. It's kind of spooky and creepy, frankly. Oh, and they'll know where you are every minute. It tells them where you are on the screen.

CLIENT: Sounds like a stalker.

THERAPIST: Yeah, it is. It sure is. Why would anybody need to do that to you, sir? That's literally really a question. It wasn't rhetorical.

CLIENT: I really don't know.

THERAPIST: Because you would not giving them what you need to be doing and refusing to give up your phone at a time when you don't need it. And then they just push a button and it shuts itself off. If they get really mad at you they hit the "Like" (ph?) button and it just wipes out everything on your phone. [00:25:05] They have to get my written authorization to do that, so they don't go crazy. (laughs) You kind of get into a mood about these things and you think that you have a lot of power and you don't — just be doing your 80 minutes and then text your friends. I showed lots of faith in you last time that I do think you can do this and it may take a little more getting used to; and I think we owe you that. But I'm just telling you what the alternative is. They don't need to even take your phone. They can blow your phone to pieces with the push of a button if they want to. Does that sound like fun? This is getting worse; they can turn your phone into a bug and listen to what you're doing. You don't even like this. (chuckles)

MOTHER: No, I don't.

THERAPIST: It sounds horrible.

MOTHER: The control of it, that part of it, turning it off when I want it off doesn't sound bad; but yeah, I don't really want to know everything. [00:26:06]

THERAPIST: Well you can use whatever features you want, but once you have that power, if I were Kevin I wouldn't feel like I liked that very much. So the question is: I believe you can be more accountable, but when you say "I won't give you the phone," what's going through your head?

CLIENT: Yesterday I said "no" and then I ended up giving it to her. The other day — I haven't used my phone during the 80 minutes at all.

THERAPIST: Oh?

CLIENT: Have I? (pause) The phone is always downstairs right next to you.

MOTHER: I think we've only done that about three times, because the other times you had things to do.

THERAPIST: Which things, like taken it or . . ?

MOTHER: Studying. There has been refusal to actually study for 80 minutes and then there's also refusal to give the phone up, so I think it's only worked three times where he has studied and given his phone up. [00:27:00]

THERAPIST: Ohh.

MOTHER: And so the other times he'll lock himself in his room.

THERAPIST: Well this isn't going as well as I thought, Kevin. And when your dad pointed this out you said he wasn't there, but he was actually right, wasn't he?

CLIENT: That's not entirely right.

THERAPIST: What happened? Tell us about that.

CLIENT: I usually do give up my phone. There has been two times where I've locked myself in the room because I either took my patch off early because it fell off in gym and then I was angry. She's saying that there's only been about three times that I've studied; it's been more like four or five. I haven't gotten overly angry since the last one. What were you going to say?

FATHER: Overly angry — no. Defiant — yes. You may not be outwardly yelling, but you're still defiant. [00:28:09]

CLIENT: I haven't seen you in like three weeks.

FATHER: I was there with you Saturday when I asked you to do homework and you refused. You had locked yourself in the room the night before. When I asked you to open it up and you refused, I told you that you had to pick up all the walnuts because of that.

CLIENT: That's what I'm doing when we get home.

FATHER: And you still haven't done that and you refused to do that on Saturday. You said, "No, I'm not doing that."

THERAPIST: So you guys do understand why the specter of the phone-destroying machine pops into my head because that would be nightmarish for you and you're having a hard time complying with some small things. [00:28:59] What we're trying to give you a little more freedom to self-regulate and you're regulating yourself into a walnut festival. Why were you locking yourself in the room? This happened how many times, John?

FATHER: I know of three that he has ... The door is not supposed to be locked and I'll come up to talk to him and the door will be locked. I will ask him to open it and he refuses. It's been three or four.

MOTHER: In the last couple of weeks. It's been an ongoing thing. We've taken the door off the hinges before.

THERAPIST: Do you guys have a bathroom lock on it so you can pop it easily?

MOTHER: Yeah.

THERAPIST: That's a good way to do it. I think kids should have locks on doors. That's nice, but it has to be locks that are more about sort of symbolism than you literally cannot get in, so that's a good ...

CLIENT: And the reason I was locking my door because I was sleeping and my sister runs in and she opens up my door. Who knows? I could have been changing and she's done this three times, actually, she just runs right in without even knocking. [00:30:08]

THERAPIST: I don't think anybody that lets you have a lock on the door is saying you shouldn't use the lock, it's that you're refusing when you know it's them to open the door. That's sort of going beyond what the purpose of the lock is. That's the problem with that. Whenever we have locks on doors there is that sort of understanding that it's to keep little sisters and people out and it's to give parents some — to let the kid have some privacy. But if you're doing that to hide out from their authority, that's completely different.

CLIENT: I only locked the door when I was mad, haven't I? I've never been happy and gone up there and locked my door, have I?

MOTHER: Oh, yeah. It's locked a lot.

CLIENT: I usually open it to you because I usually forget that I locked it because it's just a habit.

MOTHER: That's true. When you're not angry you to unlock it. [00:31:00]

THERAPIST: And you were mad because you were — what? Coming off Daytrana or what?

CLIENT: No. It' s usually when I get mad at my mom sometimes and then she starts fueling it and then I go upstairs and I lock it until my dad gets home. He'll come up and he'll try to open it and I'm just so mad that I don't want to talk.

THERAPIST: Okay. Maybe you had better walk me through one of these incidents.

CLIENT: I really honestly don't remember any of them.

MOTHER: They typically start with homework. At 4:30 it's time to do homework, so going up and study and then hand your phone over. A typical situation is, "Nope. I'm not giving you the phone. You need to give me the phone." "No." And then ... (pause)

CLIENT: I've started to not do that anymore.

FATHER: Well, you did that Saturday.

CLIENT: I said "started," so ... [00:31:57]

THERAPIST: I think between now and our next session you had better ... I haven't told you this yet, but there are two words I really want you to ban from your vocabulary forever; and that's "try" and "want." Yoda says in Star Wars, "Do or Do Not. There is no try." And so you need to just decide this is what I intend to do. The phone thing, I think you had better surrender on that or prepare to be boarded. I really ... You hear how hesitant I am because I think that is such an invasion of your privacy, but you are kind of begging for it; and so my recommendation is that they give you two more weeks and you're supposed to be self-regulating. I don't think they ought to start up any arguments with you about study time. That's what they should not do. If you don't do it, you don't do it; and then we reconvene here and if you're not able to manage your own study time, then we're going to put the nuclear trigger on that phone. [00:33:06] I deeply encourage you not to take it to that point. And by this I don't mean okay, if you can pull it together for two weeks, then that's completely off the table. I'm saying if you can't ... This whole thing is based on you being able to make better choices, whether they're going to talk to this guy or putting stuff in your phone. That phone can be shut down and the calendar still works just fine. You don't need to upload the calendar to Google, it will work without that. Signaling, turn off, put it in airplane mode, lock it down. I think you should surrender on that. (pause) [00:33:59]

MOTHER: I do think he has a very good point about the medicine.

THERAPIST: The patch falling off problem?

CLIENT: That was because I wasn't using the tape.

MOTHER: He is in total control of when that patch comes off. He's supposed to wait for me but he doesn't. I don't think the patch works for him because he has the ability to do that — and this is kind of in your favor. These grades and what's happening at home, I feel, have a lot to do with him not being medicated like he's supposed to be, so I think maybe he's not a candidate for the patch.

THERAPIST: There is an early removal problem.

MOTHER: Right. And if it's itchy for him, then maybe he has an allergic issue or whatever.

THERAPIST: Well, (laughs) the biggest problem — and I'm working on this for my book and I'm sort of getting consumer product information — there are about three reasons to hate the patch and about 20 to like it; and one of the three reasons is because people with ADD can feel things that other people don't (laughs) and that patch is one of them. [00:35:06] They feel it. Girls don't like the Nuvaring for birth control because they're sure they can feel it.

MOTHER: Really?

THERAPIST: Yeah. And nobody else feels it. So that is the weird problem with it, that sensory thing.

FATHER: Have we tried different areas?

THERAPIST: Yeah, there's a good question.

CLIENT: And I use that KT tape and it hasn't been itching for a little while. Sometimes it will itch right when I put it on, but then ...

MOTHER: But not once have you come to us with it. The deal was I was to be in the know when the patch came off.

CLIENT: I did that today in the car.

THERAPIST: Okay, but Kevin, buddy, your answer for everything is "I did it once" out of 364 times. That isn't going to do it and I think — you're kind of inching personally. Do you not trust anybody but you to decide things?

CLIENT: No, I do but ...

THERAPIST: Really? (pause) Go ahead. I didn't mean to cut you off. Do you really? It just seems like you don't trust anybody but you. [00:36:13] (pause) If that's true, please do say it. Do you guys feel very trusted by Kevin to make any decisions?

MOTHER: I don't know if I ever look at it in that term.

FATHER: I have. I think he trusts me when he's in a good mood or when he is Kevin.

THERAPIST: Thinking; when he's in a thinking mood.

FATHER: Correct. And I've made the comment before, "Do you not trust me? Do you not think that I'm trying to do the best for you?"

THERAPIST: That is really the question. [00:37:04]

CLIENT: I trust my dad more than I do my mom because sometimes ... It hasn't happened in a little while because I just haven't been trusting her as much, but I trust my dad more because he's more like me and he trusts me more than my mom does. Like he'll trust me with driving the car out, like when we're coming back from hunting. He trusts me with driving the car and he trusts me with guns all the time. He'll let me go out hunting by myself when we're out, when it's just me and him; but my mom doesn't trust me as much as my dad does and I think that's one of the problems. I've noticed when I was doing my homework when my dad was helping me with it, I was feeling a lot more secure about it and with my mom, I was just mad all the time. Yeah. [00:38:11]

THERAPIST: And the purpose of our last session was to try to get her a little bit out of the nagging role. That just causes stress between the two of you and doesn't make too much product. That's all based on you nagging yourself. Do you know what I'm saying? I am banking on you being mature enough to do that at this point. I really am. I'm banking everything on that and everything is you being able to pass through junior high and into college. That's what we're banking here. That probably makes your mom a little uneasy, but it's you that has to make these decisions. So I'm actually putting a lot of faith in your judgment and we shall see if it is misplaced. [00:39:02] But so far, you're not off to a super great start. Would you like to argue that point? I'm really inviting you to. Okay. You don't trust her to decide when to take the patch off?

CLIENT: No. I was just saying that I trust my dad a little bit more than my mom because my mom doesn't trust me as much as my dad does.

THERAPIST: I hear you. Trust is a one-way street with parents and teenagers. And it sounds bad, but it isn't. Your parents have to act like mature adults. That is their job and you get the luxury of being a teenager and that makes you inherently not trustworthy. It isn't really a question of being trustworthy. Now your dad, with the gun example, what he's really saying is that he has faith in your judgment with guns; but in terms of trusting you to follow through on commitments and things, I think we're all a little worried about that. Do you understand the difference? [00:40:02]

He knows you can handle a firearm safely and will shoot only what you're supposed to shoot. Am I right? Is that about right? Okay. But all of us worry that you are not going to follow through on other commitments, so that's the difference. You have to be able to trust him. I understand it's hard for you. I totally respect that, okay? You get to trust them and they show that they're trustworthy. That's what's lucky about being a teenager. You just get to be a teenager. So I need to know why your mom isn't trustworthy enough to decide when to take the patch off because that seems to be ... You're going to blow this particular medicine-delivery system because you're taking it off too early.

FATHER: I don't know if it's the right dose as well.

THERAPIST: And that's the other thing.

CLIENT: I think it is. [00:41:06]

THERAPIST: The problem is we can (chuckles) [be pretty sure he's not following the protocol] (ph?) so it's hard to figure that out. You're on what — how much?

FATHER: The lowest, 20.

THERAPIST: So this is just your doctor's entry dose for you, but what's the problem with leaving it on until the agreed-upon time?

CLIENT: I have been leaving it on since I've gotten the tape and one day I completely forgot that I had it on.

THERAPIST: That will happen.

CLIENT: That happened today until I was in the car and it has pretty much happened every single time since I've started using tape.

THERAPIST: And the tape helps in keeping it smoother so it doesn't fall on your shirt or something?

CLIENT: Yeah.

THERAPIST: Okay.

FATHER: Do you notice a difference when you're wearing it?

CLIENT: Yeah. [00:41:59] Like the other day I forgot to put it on. I was tired and I wasn't aware at all. I didn't want to do anything.

THERAPIST: I think your dad is probably correct and it's something you're going to want to talk to your doctor about. This was the entry-level dose to basically be sure it doesn't make you zany and it hasn't if you feel like you're doing well on it. The wash-out is when they get irritable and I would normally stick up for you on going to your room at a certain time of the day because that's when the wash-out period happens and you need to kind of have quiet time, but I just feel like you're using that to your advantage. Lesson nine in ADD planned with Wes is practice radical honesty. You have to. I know it is harder, but you have to live an honest life with people or then they do this thing that you feel frustrated about, and that is not trust you and think your judgment is poor, whatever it may be. [00:43:03] So we've got to come to an agreement when the patch is supposed to come off. I don't think we ever talked about this and I don't want to forget.

MOTHER: I think you said at the start of homework, make it through and then ...

THERAPIST: Sam, he's got two hours to drift on it afterwards. Yeah.

CLIENT: So what's wrong with that idea?

FATHER: Do homework and then take it off?

MOTHER: No.

THERAPIST: What's wrong with that idea?

CLIENT: With taking it off during homework?

THERAPIST: Well, yeah. Or right after or whatever. Any of those.

CLIENT: I don't really think I have a problem with it.

THERAPIST: Can you commit to it? Can you do it?

CLIENT: Yes. I have every single time, but my mom, again, hasn't trusted me.

THERAPIST: [Taking off] (ph?) in front of her. Kevin, this is an argument I've never, ever had with my son. We are a team and we discuss medicine on a daily basis and I remind him if he needs to take it off or he asks me "should I take this thing off now?" We look at the rest of the day and we think, "Yeah, you've got some more work to do tonight. Why don't you leave it on a little longer?" [00:44:04] And he doesn't say anything like, "Well I don't want to do that." It's not because he's so perfectly obedient, but because he is on a team — and he just turned ten, so I know you can do this. Can you be on the team? It's your team, man. Nobody else's. It's not here for your dad or mom — well not directly here (laughs) for your dad and mom; but you're the man. So you have this grim look on your face. Are you really agreeing with me or are you just shutting us off?

CLIENT: No, I do understand. Yeah.

THERAPIST: Because we want you to have the right brain to do the work; and so you're going to surrender the phone, take off the patch, do 80 minutes, and then if he wants to lock himself in his room at that point, is there a problem with that?

MOTHER: As long as ... No.

CLIENT: Whenever we're at home ...

MOTHER: We don't like his door locked because we don't know what's going on, but it's typically because you haven't done those other things, so we do typically ask him not to lock the door. [00:45:10] But if that's what you're saying ...

THERAPIST: Well if he's in there smoking a bunch of weed, no, I don't think he should have his door locked. (laughs) What are you worried he's doing?

MOTHER: Honestly, we've had some issues. He opened a Facebook page against our wishes when he was told not to do it and he did it anyway. That all happened behind locked doors and then we kept getting phone calls from people about how inappropriate some of that stuff was.

THERAPIST: So you didn't just open a Facebook page, you put up inappropriate things on it?

MOTHER: Right. Bad language and that kind of stuff. Arguments with friends and that got ugly, so we always found out about this stuff because — we didn't even know he had a Facebook page. A lot of stuff has happened like that behind closed doors. I hardly ever go up and check on him, but when I do go up there ... It's hardly ever. He has so much freedom, which is ridiculous, but I don't check on him all the time and I don't check on his phone all the time. [00:46:16]

THERAPIST: If you want a Facebook page, why don't you just have them be friends on it?

CLIENT: Because they don't want to have a Facebook.

THERAPIST: Well you do that secretly.

MOTHER: Both of our kids are adopted and our daughter came from a bad situation.

FATHER: We didn't trust the father and we thought there would be some retaliation.

MOTHER: And so we want to stay under the radar. We don't know his birth father and they have shown some interest pursuant from that angle; and we just want to stay under the radar because we don't know about these elements. I don't know that a whole lot of good comes out of kids with Facebook pages anyway. You hear a lot of it; so we just said no Facebook. [00:47:01]

THERAPIST: Well that girl was sure right about the Facebook example I gave. It really is either a tool or a way to hit yourself in the face and because Facebook is a public document, it's like having your own super printing press. I absolutely think minors' parents should be friends with theirs on Facebook, and questionably so. I use this example on the radio (chuckles) because half of my radio shows, my mom is with me in the green room because we're going to an eye appointment. I schedule those on the same day, and so I have commented a time or two that I know my mom is listening to the show, right now. (laughs) And being cognizant of that is helpful for me in thinking about the little old ladies listening to me or whatever. We do some pretty heavy-duty content so some days that's a little bit uncomfortable. I was really glad she wasn't there — oh, wait, she was there for the show about pornography. [00:48:04] I can't tell you how happy I was that it was also going to be the [pledge class to help when they were pledging, so they turned down the speaker.] (ph?) Oh, God. I felt happy about that. You don't really want to put anything up on Facebook you don't want your granny to read. And that's not just because you're respecting adults, it's because anything your granny can't read probably shouldn't be published in your online newspaper. Same as with Twitter, although I follow a lot of teenagers around the world and I finally quit my subscription feed to people I follow that you could get on there because it had gotten so raucous. Those kids will say some amazingly great things and the next thing they'll say is some weird reference to cocaine that even I don't understand and you're just thinking "oh, God, no." [00:49:02]

FATHER: And I know of people that have tried getting jobs and bosses will go and look at Facebook pages.

THERAPIST: We talked about it this summer on the show. I had a couple of kids from [Lawrence] (ph?) that were actually a couple, a girl and boyfriend. It just happened that they were a couple. They both came in talking about technology and the boy is, apparently, going into computer science. He had quite a bit to say about that very issue and he said, "I don't recommend anybody post anything they don't want an employer to see." He said they're selling that information as part of the data vetting process, too. He had a lot more knowledge about this than I do. It's all public information. Facebook owns all that. They can keep it and there are laws they're trying to write in California that adults can expunge all of their crapola they put up as minors. And they are running into just tremendous problems implementing this law. [00:49:59] It's called the scrub the web law. They're trying to even respond to this because kids have such a tendency to do themselves in. I don't care if you all do a Facebook, that's an interesting concern you have, but if you do a Facebook you need to come to some peace about it together and agree on what the rules are going to be. When one girl was on there, she's moved all the way to college, she said that as soon as she's an adult, she's going to defriend her family. (chuckles) But she says, "I understand to this point why they felt they needed to be on there." I disagreed with her about that. I thought when you're in college if you don't want your parent to see something you ought not to probably be doing it and not posting it, but I understand. I respect the adult in her to differentiate. I don't know what she decided to do on that, but you have a lot of media issues, man. I'm going to tell you that in the next two weeks you get in charge of your media issues or I'll love you enough to crush you to death. [00:51:02] How's that? Fair enough? I'm pretty tech [oriented] (ph?) How's that? Do you want to know what teenagers think about? You just get on Twitter. You just get on Twitter and you will know what teenagers think about because they don't spend on second between here and Tweeting. It comes right out. It is the most powerful ethnography of adolescence in America today. I have learned so much and it gives me material to sort of talk with kids about things I'm not thinking is on their minds, and it absolutely is. It's really interesting. We have no idea what that whole system is doing. So you know your plan for the next two weeks. What is it? [00:51:57]

CLIENT: To turn in the phone, try to get everything turned in, do my homework.

THERAPIST: Get your list of things you need to do, to talk to the teacher and whatever it takes. And then take it off in front of her. Then she knows.

CLIENT: The patch?

THERAPIST: Yeah, the patch. (laughter) I'm sorry. I jumped over words that were important. Yeah, take off the patch in front of your mom so she knows the story; then there's no argument. Because I'm telling her not to nag you a bunch and I'm telling you to show her your good faith in taking the patch off before homework starts. Your mood will be better longer, too, the longer you can put off the wash-out period without harming sleep. In a perfect world, you would take the patch off at exactly the right minute that when it washed out of your system, you would hit the pillow. That's just the perfect scenario. [00:53:03]

FATHER: How long does it take to wash out?

THERAPIST: From the time you take it off or its total life span?

FATHER: From the time you take it off.

THERAPIST: About two hours. The problem is you may get a little longer drift on things like not sleeping or something, so you want to watch it. How is your sleep on this?

CLIENT: Pretty good.

THERAPIST: Okay. So so far, so good on that. For some people it makes them sleep better. Are you putting it on him in the morning before he gets up? We had that conversation.

MOTHER: Not before he gets up. A lot of times it's like right around breakfast time or whatever.

THERAPIST: There are two ways you can go at it. You can do it at breakfast. It was sort of back-and-forth with my son because I found he ate a little better if I let him wait on the patch, but I liked his functioning better if I put it on him before he got up while we were traveling this week. So those are your two possibilities; because if you put it on while they're still in bed they tend to operate better in the morning, but you may clobber his appetite. How has your appetite been? [00:54:12]

CLIENT: Good. Really good.

THERAPIST: You might get away with that then.

MOTHER: We've already touched on this, but I am curious about what time you do take it off. I know one day — it was probably unusual — he took it off at lunch. But I am curious at what time of day. Do you wait until you get home to take it off?

CLIENT: No. Since I've gotten the tape I've taken it off at home every single day.

THERAPIST: You just do it right when you're done studying? That can be your "I'm done" time. And then you get just enough medicine the rest of the evening that you can focus immensely on just the right text to the most beautiful girl in the school or whatever it is. Believe me, people on medicine text a lot smarter stuff. I know because I receive those texts. (laughter) [00:55:02] Seriously, there are some kids I know that are texting stuff and I text back, "Are you on medicine?" and they're like "no" because you're just like what are you talking about? So people will be like "wow, your texts are so meaningful." Yeah. And you don't have to tell them the secret. Go tell them it's like auto-correct or something. It's like existential auto-correct. It changes the depth of meaning in your texts. I might have to invent that. That seems like a really good idea.

MOTHER: It does.

THERAPIST: And don't be whiny about any of this this week. They're trying to give you freedoms here. You see them as taking them away. I see them as trying to sort of meet in the middle. The other thing about the door, the door locking isn't going to fix Facebook. I see where your theory is on that (chuckle) because he's doing it with the computer. Hmm. [00:56:03] Why don't you just have it so you lock the door but if they want to come in they knock and you unlock the door? That's normally how we do it. That gives you a sense of privacy.

CLIENT: I usually do that, but I usually don't when I'm mad.

MOTHER: We haven't talked a whole lot, but he seems to get angry and I think it's gotten bigger as he's gotten older, but angry quicker and more frequently; so things escalate very, very quickly.

THERAPIST: What was he on before the patch?

FATHER: He's not going back to that.

THERAPIST: No, that's fine. I'm not saying that.

MOTHER: It was the methyl-whatever. Sorry.

THERAPIST: That ended, yeah. That was [actually more than you realized.] (ph?) That's why they don't use that. They were going to call the Daytrana patch the Methyl patch, and I think they realized how bad that sounded. [00:57:08] What was it? It was the extended-release?

MOTHER: That was the generic methyl-whatever and before that. He's had the best luck with the Ritalin group. Before that he's done Concerta, which we loved, and then Focalin was before this methyl-whatever; but he was only on that a little bit when we found out about the patch and tried it. He didn't even use a whole month's supply of that end one.

THERAPIST: There was something I was going to ask you about that. (pause)

FATHER: Talking about anger?

THERAPIST: Yeah, that's it. Do you find when you're on medicine that you feel any different in your ability to manage your temper? Is it better or worse?

CLIENT: (chuckles) Not around my sister at all.

THERAPIST: Neither way is good?

CLIENT: No. If I have it on it's not good; if I have it off it's not good. [00:58:05]

THERAPIST: And what's wrong with her? I'm probably starting up a whole thing when we meet ...

CLIENT: She tries to annoy me.

THERAPIST: How old is she?

MOTHER: Eight.

THERAPIST: That is the best reason to have a lock, isn't it?

MOTHER: She's a great kid, but she will push buttons on purpose. (pause)

THERAPIST: Is that why you were mad the other night, because of her or you and your mom?

CLIENT: No. It's just me and my mom.

THERAPIST: Okay. And what's the worst that gets of late?

MOTHER: Well, like the other night we were driving home from and she wanted the radio on so I turned it on; and he turned it off, so I immediately turned it back on. It's just little things like that. It escalated from that and, as I'm driving down Highway 10, he's grabbing my arm and fighting me like that. [00:59:10] That was a bad one.

CLIENT: No. That was because you — I can't remember what you were doing because I was so mad — you — what were you doing?

MOTHER: I think I confronted you about when he's backed in a corner, he comes out fighting. I had called him on something, I can't remember what it was, but maybe it had to do with homework because I haven't been doing the homework thing, so that wasn't it. I apologize. I can't remember what that situation was. [00:59:59]

THERAPIST: So we have to send a recorder home with you guys so you can just record it. (chuckles)

MOTHER: I thought about that before. It might have been that he refused to pick up the walnuts. Maple Leaf weekend was last weekend and my father let him drive his Land Rover in the parade, he and her. And then we go back home and his friends showed up and I said, "You know you can't ride the Land Rover anywhere." I made him give the keys over. I turned around and I hung them where we hang the keys. I go to Maple Leaf and I come back and he's driving the thing, coming around the corner with a friend in it and so he had been driving it. It might have been that that came up in the conversation. I don't know. Somehow that all related and I think maybe it escalated in the car.

THERAPIST: The Land Rover isn't one of those things that's made in England, is it?

FATHER: No. This is a four-wheeler. He was carrying wood in the Maple Leaf.

THERAPIST: I just assumed that was the case. So here's what we're going to find out and this will be a good place to wind up. Get him up to the right dose of medicine and these things go away, then what we will have learned is that they are a product of indeliberative thinking; he isn't thinking things through before he does them. And so then he thinks them through and he thinks, "Oh, man. I want to drive the Rover really bad, but I probably shouldn't. I'm going to get in trouble." That's going to be one scenario. (chuckles) The other scenario would be he gets worse and then we're going to have to start looking at some different issues. If he doesn't get any better and he doesn't get any better with the anger thing, then we're going to puzzle over that a little bit more because it may just be oppositional defiance. [01:02:10] I tend to go to that last because it's sort of unproductive behavior for a teenager so it's usually driven by something else. But if that's it, then we're just going to have to go into lots of consequences. The worst part of the consequences for the oppositional people is you always look for the ones that are the most annoying. That doesn't sound very fun, does it? So you're going to do a couple of weeks. And the other thing I'm trying to figure out, Kevin, how often are you having your break time where you cool yourself off. I think that's a nice thing, but that should be about a tenor a 15-minute process; and if it's two and three hours, that seems like you're sketchy to me. [01:03:07] That's just the thought. I want to hear what it is you're angry about, what's triggering you and how you're handling it.

MOTHER: At some point, do we continue to come or do you see us individually?

THERAPIST: I love seeing all of you. We haven't gotten quite to it yet. There may be an occasion where I want to talk to Kevin for a while on his own, but that tends not to be as helpful with the oppositional people as it is with the just regular ADD people and they have their own private frustrations about how they get along in the world. Right now his main frustration is with you guys and your main frustration is with him, so I'm happy to see you all. Do we have an appointment set? [01:04:06]

MOTHER: We do. We went ahead and set four more up, I think.

THERAPIST: Well that's a happy day. So you know what your job is? Oh, is this your copy?

MOTHER: No. That is yours.

THERAPIST: Okay. Do you have the power to e-mail it to me?

MOTHER: I do.

THERAPIST: Because that will get it digitized so I can put it right in your file.

MOTHER: Okay. I can definitely do that.

[ ] (crosstalk at 01:04:24)

THERAPIST: Oh, my gosh. We need a nice Macintosh.

FATHER: Unfortunately, my business Pro Man doesn't work with a Mac.

THERAPIST: That is the one downside. Things like QuickBooks, they have one for Mac; but it's not very good. We have an emulation program that we run and it runs on the Mac; but it takes extra software.

FATHER: I've done that before.

THERAPIST: All right, guys. See you later.

MOTHER: Thank you.

THERAPIST: Take care. That's my daughter at the monument.

FATHER: Take care.

END TRANSCRIPT