Originally Posted by eco21268
With my son, the ADHD thing has never really fit because he is neither hyperactive nor daydreamy. Stimulant med has helped, but not with the big picture, only with impulsivity. And his medication makes him miserable, but what can I do?

There are many classes of meds-- if one is unpleasant, other solutions are likely available. Do you have an expert prescriber on your team who is very well versed in the details? We use a developmental pediatrician. I do not recommend letting a regular pediatrician manage this on an ongoing basis.

People do not have to be hyper OR dreamy to have ADHD, by the way. The inattentive type can be quite subtle but have profound effects on the person's EF skills.

Originally Posted by eco21268
The thing he does NOT seem able to do is self-initiate when not interested in the subject, sustain attention under same conditions, switch gears, multitask, etc. He is also pretty terrible at anything related to self care. Sounds like EF stuff to me?

People with ASD and/or ADHD often have these problems. They do improve if you work on them, but sometimes improve best with the right meds AND working on them at the same time.

Originally Posted by eco21268
He can also be a giant pain, defiant, angry, prone to withdraw, and has no real desire to be helpful or "play the game" socially in most situations. He does not have much patience or respect for anyone or anything he feels is unpredictable or illogical.

Oh, yes, this is tricky to manage, isn't it. Could very well be Asperger's (now just called "autism"-- but the Asperger label is still descriptively helpful). Or an edgy person with EF issues. Only the neuropsych will be able to tell you...