For most of us, parenting is about choices. Some choices are easy. Which diapers to use? Which toothpaste to buy? Which cereal to feed our children? Of course, there are always more difficult choices and decisions to make. For those of us raising children with ASD, the choices are often related to therapies, schools, level of childcare and long-term planning related to lifetime care. But aren't these the difficult decisions that every parent has to confront?

In this episode of Parenthood, the decision Adam and Kristina need to make (about whether Haddie can go to Cornell) is framed by whether Max would be able to continue with his many needed services. I know from experience that the services a child with ASD needs are expensive.

Then again, everything about raising children seems to be expensive.

Several years ago, a young friend of ours discovered that he and his wife were expecting twins - their first children. He is a tax attorney and very proactive when it comes to finances. He asked us, "Exactly how much money should I start putting away for the children?" We laughed and told him, "Every penny you make now and for the rest of your life."

Adam himself outlines all of the other financial issues the family has faced over the past year, including his decision to start a business. These have nothing to do with Max and his services, which is just one more set of expenses that has always been there. The others are newer burdens. These are the ups and downs of every couple struggling with the financial pressure of raising a family.

Framing for themselves and Haddie that there aren't funds to go to Cornell because of Max and his diagnosis actually displaces the decision's emotional burden. This isn't fair to Max or to Haddie. It's potentially damaging to their long-term relationship and engenders unnecessary resentment.

It's an easy out on the part of Adam and Kristina to lay the blame for the decision at the feet of ASD; the emotional burden is thus shifted to Max and his diagnosis. In reality, however, many children don't get to go to the colleges they want to attend because of finances, and it has nothing to do with ASD. Most of the time it doesn't even have to do with the parents making decisions that led to those options being out of reach. The options were out of reach from the start.

The difficulty in this situation is that Cornell was a possibility at one point, ASD or not. Now it is a less certain possibility at best. That's a tough place to be. It's heartening that Adam and Kristina, in the end, make the decision to try. They also begin to have a more emotionally honest discussion about the efforts it will take to send Haddie to Cornell and about finances in general. I also believe that it would be important to include Max in the discussion.

Over the past several years, we have included both of our children in discussions related to finances. They have a growing sense of what is and isn't possible, including Frankie. He will even ask, "How can we afford that?" when there's a discussion about what he perceives to be a big expense. He understands there are choices to make when it comes to money, and these choices affect him and the services he receives.

Clearly sending Haddie to Cornell will mean sacrifices for everyone, Max included. And isn't that how it should be with choices made in any family?

Written by Roy Q. Sanders, M.D.