Sometimes You Must Choose

Sometimes you must choose. Macaroni and Cheese or baked chicken for dinner? Cookies or Pie for dessert? Donuts or oatmeal for breakfast? Flats or heels? Jeans or Yoga pants? Sweatshirt or sweater? Jean jacket or puffer vest? ADHD or Mood Disorder?

Yes. I just threw that in there. ADHD or Mood Disorder. Because sometimes you have to choose. Choose which ‘disorder’ to treat.  And of course, this choice isn’t as easy as what you want for breakfast, dinner or dessert. I’m intentionally flippant here because I want this choice to be that easy. But it just isn’t.

My child has many diagnoses. ADHD and Mood Disorder NOS happen to be the ‘top two’, or most prevalent. Treating these two exclusively is challenging enough. But when you have both? It’s like continually trying to bake something without a major ingredient. And before anyone gets all up in arms, I’m not saying my son is missing an ingredient. What I’m saying is when you try baking something without flour, it just doesn’t turn out as well. Oh for the love. Now it sounds like I’m saying he didn’t turn out as well. That’s not the case either.

I’m struggling on finding the right analogy here. Let’s try this again.

Treating both a Mood Disorder and ADHD is like trying to bake a dessert without a recipe. You have a pantry full of ingredients but aren’t sure which to use, how much of each and in which order to use them. So you read the labels of all the things in the pantry, carefully selecting which items you think may work best, guessing on how much of each to put in the bowl and hoping you’ve mixed them in the right order. You use the knowledge you’ve acquired from many years of baking, in making these decisions, yet you know it may not turn out the way you expected. Yes. That’s it. That analogy is a little more accurate.

For the last two years, we’ve been treating the Mood Disorder first. The ADHD has been secondary…if not lower than that. Then we hit middle school. And all things changed. New school, new teachers, new case manager, new expectations, new rules, new hormones, new friends, new homework, new bus, new…new…new. The rules in middle school are much tougher, with less wiggle room. You are tardy if your rear is not in your assigned seat when the bell rings. There’s no breezing through the door at the last minute, like when I was in school. You are expected to sit still, feet forward, eyes up, hands on desk. The only reason your hands should be moving is if you’re writing. Period. There’s no gum chewing, snack eating, water drinking. There’s no getting up mid class for a kleenex or to sharpen your pencil. Stay still. Be Still. Look Still. And for the love of all pencils, do NOT even shift your eyeballs. Got it?

Okay, so this may be a slight exaggeration. Perhaps. But this is what it feels like for a kid with ADHD. And for this kid, the ‘H’ of ADHD is in caps, bold, italicized and underlined. He is in motion all the time. ALL THE DAYS, ALL THE YEARS…he is moving. Even when sleeping, he moves. So things don’t go well, when you place an extremely active kid like this, into an environment that not only expects, but punishes those not abiding by all the ‘sit still, be quiet, don’t move unless approved’ rules. In our case, his inability to be quiet and sit still led to routine visits to the detention room, which then affected his mood and self esteem. He became less confident, less able to see possibility, more prone to a ‘not good enough’ mentality.

His inability to focus and calm his physical self became such a distraction and instigator of detrimental behavior that we opted to start treating the ADHD with medication again. We knew this could come at a cost. And it has. We knew that adding a stimulant medication could make his mood disorder more volatile. We knew that adding a stimulant would disrupt sleeping patterns and appetite. But we were willing to try and see if it could improve his days at school.

It’s been four weeks now, since we added the stimulant. He’s been on them before, so we had an idea of what to expect. But the gap in two years since this previous treatment left those memories a little fuzzy. We were quickly reminded of the cost/benefit ratio. The benefits were tremendous and immediate. He reported feeling much calmer, and focused at school. He was able to stay seated much of the time during class and was getting in trouble far less than the pre-medication weeks. His thoughts were more organized and school work was easier to accomplish. His self esteem rose again as he started to feel more confidant in his abilities and capable in his education. He felt more in control of himself. This is important. Especially for a child with a mood disorder. But the cost was there too. His mood shifted more often and more quickly. The word volatile is one that best describes the impact to his emotions. When he’s happy, he’s more happy. When he’s angry, he’s more angry. And so on. In a word, he is moody. Which duh, he has a mood disorder, right? But it’s worse, and that’s my point. When his mood isn’t swinging up or down dramatically, it’s running at the lower end of the spectrum. Knowing how this story has played out before with him, this is concerning. I must watch him very closely to ensure a consistent low mood doesn’t evolve into deep depression. He’s also lost virtually all appetite and doesn’t sleep as well.

Is this all worth it? For more focus in school and less time in the detention room? This is what I am constantly asking myself. Am I making the right choice giving him this medication? Am I being diligent enough in researching all the treatment options? Am I listening to my gut? I have one shot at this parenting thing. And making the wrong choice could be dangerous for him. This is the reality. Is it that dire that a choice I make could cause immediate harm? No, probably not immediate harm. But keeping him on a medication that can cause more mood volatility, which can lead to deep depression or mania, which can lead to impulsive and dangerous actions , which can lead to harm…well, that is possible. And on the flip side, if I don’t give him this medication, how does it play out? What I can tell you from the first few weeks of school, when he wasn’t on this medication for ADHD, is it was also a dire situation. Every. Single. Day. was a struggle. He was so down on himself, feeling constantly singled out for being different. Always in trouble for talking, singing, standing, moving. His self worth took a direct and hard hit. He didn’t feel valued. And this is also a difficult and dangerous place to be when you have a mood disorder. This too could cause harm in the long run.

So which choice does a mother make? Because sometimes you must choose which disorder to treat first. Knowing it will impact the others. You research and ask questions and choose. And then you second guess. All the days, most the moments, you second guess. You have a ‘good week’ on the meds (less mood volatility, more happiness, seeming to feel more like himself) and you think you made the right choice. Then the next week, not so much. He struggles, sits in the basement for hours on end, seems depressed, doesn’t smile much, isn’t social, doesn’t want to go outside. And then you think, dammit, you’ve made the wrong choice and he should come off the meds.

And then you remember he is a pre-teen. And moodiness and changing hormones are the norm. You watch the trees raining golden leaves and you’re reminded how Fall and Winter impact his moods EVERY year. Regardless of treatment.

And you know that sometimes, you must choose. You have to choose which disorder to treat. Because it is incredibly difficult to successfully treat both. And it sucks. And you just want your kid to be a kid, without the worries of tracking moods, being watched, and measured on how many times he’s gotten out of his chair. Because really? You call me from school to inform me that my son got out of his seat nine times during his one hour class and that is unacceptable?

You guys. I get it. Managing a class of 30-35 seventh graders is NOT easy. You NEED decorum and order. My son getting up from his seat nine times disrupts said decorum and order. But really? He’s in trouble for this? When there are far worse things (like bullying, harassing, abusing) that have happened to him at the hands of others kids throughout his years of school?

Again, I get it. Teaching is hard. Teaching middle schoolers is even harder. This is NOT LOST ON ME. I know, there must be rules and they need to be followed. But as the mother of a child who struggles with many disorders, this ‘violation’ is hard for me to swallow. Really, understand this. I’m just bitching here, because it makes me angry. Every single day I am making choices that could impact his every emotion, action and abilities…and you want to talk about the number of times he was out of his seat?

So then, you know what I do? I choose. I choose to treat the ADHD, because then he won’t have seven teachers in the course of the day chiding him for humming while he is working (he doesn’t even realize he is doing this most of the time), then he won’t get sent to detention as many times for being disruptive. Because then, he will be able to focus on his work and turn it in on time. Because then, he stays seated. Because then, he talks more quietly. Because then, he’s more liked by others, and in turn, treated better.

There’s not a nicely wrapped end to this story. Not yet anyway. And I’m not sure of it’s purpose, other than to expel my frustration and angst that comes with choosing. It hurts. I’m tired of it hurting. I’m tired of second guessing and not knowing if I’m getting it right. I’m tired of being angry at teachers, because I know they’re doing their best and it’s not their fault. I’m tired of tracking and watching and evaluating. I am tired of specialists meeting with Noah and later telling me how complicated he is.

I. am. tired.

So if I’m tired, can you imagine how tired Noah must be? To face this every single day, with courage and heart. With fear and frustration. He is the real hero in all this. Knowing he’s different and often misunderstood. Knowing he’s trying but it’s not recognized. Knowing all he’s feeling and all he’s keeping inside. He too makes choices every day. But often they’re made for him. And he’s forced to live with them.

Sometimes, you must choose. And it just hurts.