Behavioral strategies did very little for me but re enforce ] my sense of inferiority. When  it didn't work, I got blamed for the process failing. The process was doomed to fail. I  am a 68 year old educator who devoted her life to providing methods , and inventions that broadened  the knowledge of the  many different ways of learning . I  promoted success, and built self esteem. AADHD is not a curse, but society, and our schools treat it like it is. Adderal, and an anti depressant made it possible to control these conditions. in me. It's horrible to go through life as if someone has the remote control to your brain, and has a thumb stuck on fast fcrward button constantly. But, it wasn't until 7 years ago when I began adderall, that I was able to reach , by the time I reached my present age of  68 , that I finally liked myself.  Your son has learned to cope with the humiliation he has had to face for the past 19 years in the only way he can. I did it through my ability to be funny as a commediane. But, behind that laughter is a person in pain. Skip tough love and chooe  the best professional, almost aways , a  psychiatrist, who specializes in the treatment of these disorders, especially  AADHD , and  respects the needs of children and adults who have suffered for years being told that  they could, if they just wanted to. It's like saying,"we could see, if we wear glasses, if  we wanted to.   In the severest cases , and not so severe, medicine such as adderal, is the beginning of a better life. This is a brain disorder, and not something he caused. I wish I was his teacher because I would have seen the beauty in him that one teacher finally saw in me, and changed my life forever. A boy of 19 years , has far too many other issues along with this to complicate his life, and add to his confusion. Find that specialist. He's worth it. God Bless You.