How To Tell The Difference Between ‘Disorder’ and ‘Choice.’

As parents of children with special needs, particularly Fetal Alcohol Spectrum Disorder, we often receive the question, “How do you know if your child’s behavior is a choice, or if it’s their disorder?”

Weight Scale, Balance, Mental Illness

All I wanted to do was wrap my arms around this couple and hug them. We stood by the stage, just after I finished presenting to their foster parent group, and talked about the difficult child they were parenting. She was their first foster placement, and all signs pointed to adoption, until her bi-polar disorder forced a difficult decision. Now, she was no longer living in their home, and they were forced to visit her in a psychiatric unit. The outlook was bleak.

My heart broke for them for several reasons. Mostly over the fact that this was their very first placement as foster parents and the walls were collapsing on them. “Don’t give up on foster care,” I urged them. They both nodded and said, “We won’t.” Second, they were at a complete loss. Utterly hopeless. At one point in our conversation they asked me, “How do you know when the things your child does, or says, is a choice, or their disorder?” That caused me to step back and think.

I listened to some of their scenarios with their daughter, and answered as best I could. But later that evening, as my plane left the runway, I couldn’t escape their question.

“How do you know whether it’s a choice, or the disorder speaking?” I wondered.

The Big Difference.

I’ve spent a lot of time thinking about this over the past week. For a while I came up empty. Even though my child, who suffers from FASD, pushes me to the edge and sometimes beyond, and I should see it clearly, I found myself feeling cloudy over the major difference. But as I weighed the different interactions I’ve had with him over the past few months, the answer became clear. Here’s what I realized: A choice pushes buttons. A choice looks for a response. A choice causes unnecessary chaos, or aims to harm. A disorder rarely, if ever, does any of these things.

A disorder is a voice speaking from a place of trauma, or a place of damage that was out of the child’s control. While some side effects of a disorder, like FASD, can harm, it’s almost always the personal choices that do the most damage. For instance, my son was malnourished as an infant, before he came into our care. He was literally starving at one point. So, to this day, more than a decade later, he interacts with food as if it was scarce and he not going to get enough. We always provide balanced, healthy meals. But if he decides he doesn’t like it, or it’s not what he wants, he’ll say something like, “I hate this crap! Why can’t we have pizza or cheeseburgers? You never make me anything good!” That’s a choice. His intent is to push our buttons and subsequently, get his way.

A response from disorder would be something along the lines of, “Will there be enough food for me to eat? Or will I go hungry?” Often, these words may not even be articulated, but rather, acted out through anxiety or stress. They may not even come from a place that he or she fully comprehends.

More relatable to FASD, a choice would be to flip out, destroy belongings, verbally or physically assault family members and so on. The disorder speaking would be edginess, anxiety, frustration over sudden change, or obsessively asking the same question over and over again.

It’s a fine line, but you can differentiate.

Identifying The Characteristics.

So to reiterate…. choice is about pushing buttons, getting a reaction, or causing disruption or harm. Disorder is a voice that speaks from a place of trauma, a mental, or physical disconnect. Any time the words or actions from our children are acted out or spoken in order to get a reaction, or rise out of us, they are a choice.

The couple I talked with walked away from our conversation that afternoon with renewed hope and a sense of direction. The more I thought of the differences, the easier It became for me to relate to my children. Part of my struggle, and I’m sure yours too, is understanding and seeing the difference when the situation is tense or we’re already in a battle. The hardest thing to do in moments like these (but critically necessary) is step back and do a quick survey of the behavior you see playing out.

Then, ask yourself, “Is this a place of trauma speaking? Is this disorder? Or is this a choice?” The answer you come up with may be a game-changer in the outcome of a difficult situation.

Question: Have you struggled to determine whether your child’s behavior is a choice or the result of a disorder? Share your story with us in the comment section below. You can leave a comment by clicking here.

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    Oh I needed this today. I am really struggling with my adopted son. He has been diagnosed with ADHD, but I feel it is more. Medication has worked and he has been great until this month about taking it, he feels the benefit. He states that he stopped b/c he is not hungry at lunch. He has become angry all the time and I over react, which makes my husband mad at me.

    As I was reading this today, I realize he reacts more from a disorder then by choice. Would this be the case with RAD?

    I am so hurt and discouraged, after two years, that I have no idea how to take a step back and access the situation. Do you believe a mothers could have/develop PTSD? The Institute for attachment and child development has mentioned it, you thoughts?

    • Andrea, yes it would be the same with RAD. We’ve raised children with this disorder and, while their pursuit of other (often times toxic) relationship is a derivative of their disorder, there are still choices they make to push you away.

    • L Owen

      I am so sorry you are feeling hurt and discouraged. Make sure you are doing some self care as we as foster/adoptive parents can get compassion fatigue. I would also highly suggest doing a bit of research of the effects of trauma on the brain. I have several children with PTSD, RAD, and complex trauma. I have learned a lot over the past several years on how trauma (even in utereo) can effect brain development. Yes, I believe our children do make choices but when their brain has been wired in a different way because of trauma they may not even understand why they behave the way they do. Check out any you tube or books by Dr. Seiberg or anything by Bessel van der Kolk. This article sounds very black and white and what science is telling us is that is really isn’t. I hope this helps.

    • Pam

      If your child has rad, you have ptsd

      • Michelle Sackett McKinney

        Good point.

  • Jessica McNally McCoy

    Thank you for this article! We have struggled with for the last 5 years. Our 3 children are adopted siblings. My middle son, has FASD, Severe ADHD, PTSD, and a couple of other disorders. He was born tongue-tied (the little piece of skin under his tongue was attached all the way to the tip of his tongue) causing him to not be able to communicate. He would go in to rages and the birth parents would lock him in a room so they didn’t have to deal with him. He finally got it clipped and began speech therapy while in foster care. Everyday is a new battle. But we have come sooooooo….. far in the last 5 years. We now homeschool because I spent more time in the office at his school than I did at work. Homeschooling has been a game changer for us. Now I can observe and differentiate his behaviors, but wow, We still have those days when he wakes up and just decides that he’s ticked off and everyone is going to pay for it! Our baby girl also has FASD. I do a lot of praying. Thank you for your articles. It really helps to know we’re not alone in all of this.

    • Jessica you are so welcome. You are definitely not alone on this journey. 😉

  • Jeanette Bousman

    This is a question we ask ourselves constantly in dealing with our 15-yo FAS son. It isn’t always easy to tell whether it is his impulsiveness that has gotten him into trouble or whether it is a choice that he had control of. We have come a long way in the 4 years he has been with us — from almost daily meltdowns to mostly non-existent meltdowns. But, his poor social skills (especially with his peers), his impulsiveness and his lying so easily and convincingly it would cause the Pope to ponder are all parts of his disability … AND sometimes his choice. Sometimes, we just sit back and scratch our heads thinking WHAT was THAT! It is very difficult in the midst of a crisis situation to discern what has just happened. So frustrating !!!! Just want to flip a switch in his brain.

    • This is definitely a tricky balance. We deal with this too with our children.

  • Cindy McQuay

    We also have struggled with this and I believe he has been misdiagnosed with just ADHD, and depression. I have taken him to countless Drs and appts, finally out of persistence we have a possible.FASD diagnosis. But he seems so smart soemtimes, yet his behavior is so antisocial at times. He is now in his 2nd legal battle for breaking the law, and since he is 18 it will be harder..Pray for us all!

  • Allisonm

    I find this a more complex question than could be covered in a short post. My son 13-year-old son has PTSD, RAD, fetal alcohol and drug effects, mixed developmental disorder, a mood disorder, and ADHD. I am my son’s eleventh mother. Choice exists where my son has viable alternatives from which to choose. For our first several years together, those were very limited because he was in such extreme distress that he couldn’t cope well enough to be taught healthy coping skills. He was either raging or completely shut down. He appeared very manipulative because he was cornered-animal-level desperate to control his environment to help himself feel safe. He punished himself for every loss of control by doing the most extreme thing he could think of to make things worse for himself. He demonstrated an extreme determination to survive, which I now view as a great strength–though I feared it would be the death of me at the time. Professionals recommended institionalization because his behaviors were extreme. I just couldn’t. I had to keep asking myself what need he was trying to communicate by each behavior and how could I meet it. As I learned to understand the behavioral language of trauma and focused on meeting his real and perceived needs, he began to develop some trust in me (read: strangling terror that I would die). By meeting his needs first, we established enough safety that he could VERY slowly calm down enough to get out of fight-or-flight enough to begin learning and remembering some new skills. Then he began being able to use those skills more of the time. By age eleven, he was even able to start telling us some of what was going on and his blow ups decreased to fewer per day. Now, he can tell me how he feels about half the time and he rarely has a serious meltdown. He has skills he can use and we hold hm accountable for using them. The funny thing is that his typical kid misbehavior is a lot less frequent than in many other kids. He so wants to keep his self control. So I find in our situation that this is a very complex question that I evaluate many times daily and try to respond to in the way that will best help my son move forward toward a healthy and productive adulthood. His entire team thinks he’s going to become a successful adult, despite the difficulty of the road to get there.

  • Kate Sommerfeld

    HUGE question as we seek to parent our kiddo with ARND. Especially since depending on which one you are currently dealing with, the situation needs to be handle with drastic difference. Thank you so much for trying to tackle a bit of it and to share this with us. I would love to see a book written for this specific topic.