Gifted Issues Discussion homepage Forums General Discussion Meds/school/ hard choices

Is the effort of focusing at school so great that it's affecting everything else?

Obviously not academically but there'll still be a social and organisational demand. Personally I'd also consider a trial of stimulants.

Sending big hugs greenlotus, to help keep up your own stock.

A couple more random opinions to add to the above. I totally agree you don't want to force her into homeschooling, but this is also where you need to do some serious mind-reading, when you talk with her about the pros and cons. To what extent are the items in the two columns real vs. fears? If the pros are actuals and the cons are anxieties, then this may be where you as the parent own the decision. We did this with switching DS last year into a new school for grade 6, to access a gifted class. But we knew he really wanted to change into this program, he was just horrified at leaving the safety and security of the known (even if it wasn't a good known). So we told him he had to try - no choice - but whether or not he stayed would be up to him. He struggles hugely with anxiety and indecision, so having the parents take on the responsibility for the initial decision helped him get to a choice he wanted, but was to afraid to take on his own. This would clearly be the wrong way to go with many kids, but it's what this one needed.

As with medications, I'll chime in totally inexpertly with everyone above. There may be good medical reasons to focus on depression first, so dig into the psych's rationale. Depression is serious in kids this age, and should be viewed with urgency. But don't underestimate how much the ADHD may be causing your daughter to struggle, in the class and out of it. The massive rise in executive function expectations for DS in grade 6 last year were brutal. From everything I have seen in 2E kids, the anxiety hits clinical levels long before the grades start to notably slide. The fact that they *can* do it doesn't mean it's not getting harder every day. And they're watching it get easier for everyone else around them, and wondering "what the he11 is wrong with me?" So I think you got great advice above to look for primary causes. Start by changing the environment to create one that matches and is supportive of your DD, provide therapy such as CBT (which it sounds like you're already doing) - and then see how much of the anxiety and depression is already being addressed by these changes, and whether it may also need to be medicated directly. You're not ignoring the depression, but rather trying to tackle its root causes head on.

I so appreciate your comments and others"!!!!!!!

This is why we keep waffling about what to do. DD barely can decide what to eat at a restaurant!! The indecision is painful. I did do a pro and con list. From a 1-10 on fear and whether she was open to trying homeschool she was at a 5 for both. We are in a homeschool rich area so I was able to show her many many opportunities for her. I just asked her again about why she would not want to leave, and again she said she would be wasting all the hard work she did last year making friends. Which friends? I ask. She said she found some in art class. I wish that were so.


Right. I asked in a previous post how much the ADHD might be dragging her down. Just because school grades and work come so easily might she rise like a helium balloon to higher levels if she didn't have the weight of ADHD tied around her neck? The teachers think it's amusing that she doodles. She's just trying to keep herself occupied. She is VERY aware that she struggles with paying attention. She mentioned it several times in one of the psych. assessments.
Finally, I read late last night deep into the emotional assessment. DD is not happy. Not at all. Very very painful. We will honor her decision to go back to middle school, but we are setting up appointments because things need to change. Appointment call going out to a pych. tomorrow to begin a med trial.
Thank you all so much.

I also have to mention that I would be *extremely* cautious about using psychostimulants in children with depressive symptoms, as there is some data finding an increase in suicidality. The main thing, especially when trying meds, is that she needs to be monitored very, very closely by an experienced child/adolescent psychiatrist who has taken an exhaustive diagnostic history.

One of the huge challenges in children is that depressed ones often look ADHD (with either/both inattentive and hyperactive symptoms), and those with ADHD often become depressed because of the stress of managing. You really need an experienced and astute diagnostician when you have both, to tease out cause/effect/comorbidity.

It's really hard to get into a psychiatrist, which is another problem. The key is to find a really good doc rather than asking for input on an internet forum, but just finding a good doc is really hard. The psychiatrist we saw was very anti-med and took DD off abrubtly, which was pretty much a disaster. Then wouldn't listen to me when I tried to say she isn't functioning well with X, Y, or Z unmedicated. Most of them (around here at any rate) seem to have huge waiting lists or only see certain types of patients. I was told ADHD is usually handled by general practice (who, in my experience, are definitely NOT experts on these medications). I'm not clear if greenlotus is seeing a psychologist or a psychiatrist or both.

Thank you for the heads up. If you have articles concerning this, I would be interested (even if they are subscription only, I can get access).

Yes, an internet forum is not the place for a diagnosis or specific med info, but we have received conflicting advice so I wanted to hear from others who had traveled the med/ADHD/depression road before us. And, we would not use our general ped. for ADHD help! We are so lucky to have connections to and live in an area with many medical facilities so we should be able to find a good psychiatrist.

Well, this is actually a bit reassuring. I did a quick lit search, and a 2016 dissertation came up that did not find statistically-significant association between stimulant use and suicidality in ADHD:
https://dspace.library.colostate.ed...y_ucdenveramc_1639D_10298.pdf?sequence=1

On the opposing side, reviews such as this one of antidepressants and psychostimulant use in ADHD/BD children do note that some studies have found increases in either mania or suicidality in a notable minority of children with both ADHD and a mood disorder, when administered psychostimulants:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394932/

Check the bibliographies of both for additional research.

Thank you!!!!