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

A 2 part question:
So, I have posted that we were leaning towards homeschooling for younger DD11 (grade accel. one year). Middle school was not the best last year. She has admitted that the only good classes at school were her electives. She is stretched in math (running about 3 years ahead). The rest of the year in basic 6th grade classes. She said she doodles most of the time (on paper, her legs, her arms....)

Ok, so now it's becoming clear how miserable she is. Her assessments are indicating depression and anxiety on top of the ADHD (inattentive) we already know about. She's miserable and oh so irritable.

We are receiving different advice from two different psychs (one who did testing/one currently used for therapy) concerning taking DD out of school. One (who did the testing) says she doesn't usually recommend homeschooling, but in our case she thought it was a good idea. The other is not anti-home schooling but thought DD needed to be on board with it, and asked if I could let DD dip her foot into the homeschool waters by joining a co-op class to check it out. DD was kind of open to the change but ultimately said no because she would have wasted all that time last year trying to make new friends. Let's be clear - she didn't have one playdate with those kids last year, maybe a few texts, and we didn't see any playdates this summer although she kept texting and emailing these girls. DD finally admitted yesterday she would love to find kids "who think like her". So, I wonder, do we really let her make the decision or should we make it for her? DH is hesitant about change. He is leaning towards letting her try public school again for a few months. I'm feeling pressure to decide because school starts very soon.

Next - meds. DD has not been medicated for ADHD. She did well in school last year (straight A's). She's a mess at home. It's almost impossible to keep a conversation going with her as she is apt to go back to reading or watching her Ted Talks. Never mind the disaster bedroom/forgetting what we say 2 minutes after we ask her to do something. But now - wondering about the depression and anxiety. What to attack first? ADHD? Emotional side? Psych. feels we should address the depression first.

I'm paralyzed with indecision. When I kiss her good night, I just want to hug her forever so she doesn't have to feel so sad.

Last year I was slow to recognize my son's depression. It was the end of the school year and we all toughed it out. Summer came and he decompressed, took several camping trips, online class, band camp and did a bunch of reading. This year looks better....we asked for and got three subject accelerations, but the rest with his grade level. Hoping this helps, even if the pace remains excruciatingly slow. If not, I have no idea what to do. I wouldn't hesitate to consider homeschooling. But I will recognize the first signs of depression and I am hoping he can communicate that with me better.

If she is hesitant about homeschooling, I would lean towards sending her to school and then pulling out if it's not going well.

i think the only way I'd force a kid into homeschooling (personally) is if I thought the school environment was actually harming them psychologically, as in causing the anxiety, depression, etc and I couldn't figure out how to make it better.

See how things go w/ different teachers, classes, etc. and then maybe there will be clarity as to the best choice.

In terms of the meds, it's not hard to do a trial of stimulants and if you don't notice an improvement, stop them and address the other issues. Some kids (like my DD) feel really bad about themselves when they cannot focus, get things done, etc. so the meds help in that way. A lot of people w/ ADHD also have anxiety and depression. I'm not a doctor so if she/he has a valid reason for not wanting to medicate the ADHD at this point, then go w/ whatever he/she says.

Just had a good discussion about all this with DH. We both agreed (as does the psych) that if DD just had one good friend she would be so happy. If she could find someone who was crazy about art, loved to talk about politics and weird mushrooms and the history of the American magic school connected to Hogwarts.....
We both agreed that middle school hasn't supplied anyone like that. Anyone she labels "nice" is in art class, but we haven't seen any true connections occur. She keeps trying though!! I have seen her ask for so many girls' phone numbers this summer so she can text them. They don't respond. She did click with a home school girl recently. They have been swimming together (I am so thrilled).
Kids at school have called her "weird", or told her there was something wrong with her and made fun of the books she was reading. Ugh. Oh, she really got excited about the thought of a writing club to meet other writers.

Psych. stated DD is doing well in school so ADHD meds were not going to bring a higher reward there. She thought addressing the depression would be more fruitful.

I think that is the central question - is the school environment so toxic it is harming her? Last year I was very hands off as the school really pushed away the parents. If we stick with brick and mortar, we will absolutely be more involved.

greenlotus, you might have discussed this before but how was your DD doing socially during the elementary school years?

What if the ADHD is contributing to the depression. My experience is depression is hard to treat. Maybe the ADHD would respond to relatively minor doses of meds and will ease the depression. Maybe not too.

Yes, that's what I was trying to say. ADHD affects functioning in life besides school. I would be more worried about anti-depressants than meds for ADHD, in terms of safety concerns and how fast you would see a difference (with stimulants you can tell right away, assuming the dose isn't too small), but that's just me.

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!!!!