Once again, I found myself balled up on the kitchen floor, head between my knees, sobbing. My shoulders shook, and my chest heaved as I gasped for air, but air wouldn’t be enough. What I was truly gasping for was hope, something that had eluded me during this perpetually challenging season of my “neurodivergent” parenting career.
I’m not sure what made that moment any different from the countless dysregulated nights that preceded it. Most likely, my young, bright, neurodivergent child’s words of self-loathing and hatred had filled me with a simultaneous sense of despair and resolve—a resolve that only a parent who feels like they are losing their child can begin to grasp. I was determined to find answers that would allow my child to see how wonderful they were, and that would help me reestablish this belief in them despite their challenging behaviors.
As a board-certified family physician with an MPH, I “knew” about attention deficit hyperactivity disorder (ADHD). I was licensed to treat this subset of neurodiversity, yet I was sorely unprepared for it in my own home. Medical school and residency had taught me that ADHD was a behavioral disorder marked by poor focus and an inability to sit still. My perfect answer for treatment was school-day stimulants with behavioral therapy. But, as I sat struggling on my kitchen floor, traumatized by the emotional and physical dysregulation that had engulfed my child, I was struck by the complexity of the ADHD nervous system. My medical training had tragically oversimplified the neurology, medications, parenting strategies, and educational interventions needed for my creative, exuberant child to thrive. My child was full of beautiful character traits that were being overshadowed by impulsive and explosive behaviors truly beyond their control. School-day stimulants and sticker charts alone would never be the perfect answer.
My child will be the first to admit that they didn’t feel seen or understood by me during this challenging season of our lives. I will be the first to admit that I was failing my child, but I wasn’t sure how or why. My education had never painted a full picture of the emotional dysregulation, severe impulsivity, and parent-child frustration that could accompany the executive function delays of ADHD. Medication rebound, rejection sensitivity dysphoria, oppositional defiance, sensory processing sensitivities, time blindness, frustration intolerance, internal restlessness, and sleep disturbances weren’t in the fine print of my textbooks. They had failed to equip me with the effective parenting skills I desperately needed to meet my child’s unique needs while failing to mention the tumultuous stress ADHD could add to a family unit.
Accepting and embracing that “I didn’t know what I didn’t know,” little by little led me to the hope for which I had been so desperately gasping. I consumed medical journals, new research, best-selling books, personal testimonials, and signed up for newsletters and workshops from reputable ADHD educators. I was voracious. With cautious optimism, I joined a social media support group for physician moms of children with ADHD, where I found solidarity with fellow female physicians. I waded through conflicting theories and opinions, gross misinformation, and “evidence-based” approaches rooted in behaviorism to find better answers rich in empathy, neuroscience, and practical application.
My self-assigned CME on ADHD made it clear that my child’s medications weren’t optimized, and medication rebound had been sabotaging our afternoons and evenings. While finding a medical management clinic for ADHD accepting new patients was a feat, I was relieved to secure a provider who listened and validated my child’s daily struggles. Although medication trials were taxing, finding the right class and combination empowered my child to feel more in control of their behavior. Instead of impulsively climbing on window ledges over our 20-foot-tall foyer, damaging walls in moments of severe frustration, and lashing out physically, my child was able to pause and think more often before acting. I knew medication optimization was only part of the puzzle; I needed effective parenting skills.
Traditional parenting strategies had not only been ineffective but had worsened my relationship with my child, resulting in opposition, defiance, and poor self-esteem. My breakthrough moment finally occurred when I stumbled across the book How to Talk so Kids Will Listen and Listen so Kids Will Talk by Mazlish and Faber. Despite being published in the 1970s, this book was the turning point in my parenting, pushing me toward other priceless resources that would forever change my perspective on parenting. I was the one who needed to change. I wasn’t a bad mom. I loved my children immensely and was doing the best that I could with the skills that I had. I now recognized that I needed to reframe how I viewed ADHD, my child’s challenging behaviors, and my parenting approach.
ADHD reframe
ADHD is a neurodevelopmental difference (not willful behaviors) that can be more clearly understood through the lens of a delay in executive function skills, specifically self-regulation. My child wasn’t trying to be defiant or “difficult” when focusing on boring or mundane tasks. They couldn’t just “will” themself to focus, get organized, or sit still. They were frequently bored due to understimulation and then dysregulated due to overstimulation. My child had an interest-based nervous system that craved dopamine. This neurodiverse nervous system gave them many advantages, such as seeing things in a unique way, being able to hyperfocus and establish a flow state, and being passionate about injustice. While leaving for school on time was a challenge due to poor working memory and distractibility, their impulsivity led to adventure, excitement, and discovery. While big emotions were still sparking challenging moments, I learned there was a better way to support my child with all feelings as they arose.
Reparenting
My traditional parenting approach (unbeknownst to me) had been rooted in behaviorism. Consequences (positive and negative), time-outs, and unintentional shame-based approaches had failed because they made my child doubt their own value while simultaneously threatening their safe and secure attachment with me. Compliance had come at the cost of connection, eventually leading to opposition, defiance, and emotional overwhelm. The parenting strategies I had been implementing (many of which were promoted in best-selling books dedicated to ADHD) prevented attunement. By disregarding the human part of parenting and focusing solely on behavior change, these methods felt bad and fell short.
The new parenting strategies I was rapidly implementing incorporated polyvagal theory, attunement, and attachment. They parsed out the nuances of behavior, dismissing the oversimplified view of behavior as simply “good” or “bad.” It made sense that all behavior is communication, and “bad” behaviors often stem from unmet needs or lacking skills. When my child was acting out, it was because they were having a hard time, not because they were trying to be difficult. In those challenging moments, my child needed my calm, sturdy presence to help them regulate their nervous system, as their prefrontal cortex responsible for self-regulation was still developing (and due to ADHD, was lagging behind that of most neurotypical children by at least three years). Accepting my child’s neurodevelopmental differences allowed me to adjust my expectations, approaching frustrating situations from a place of empathy rather than criticism.
In addition to deepening my understanding of behaviors, I learned the importance of acknowledging my child’s feelings, validating them, and providing a safe space for them to be aired, even if I didn’t agree with them. While I could not allow all behaviors, I could allow for all feelings, thus fostering emotional intelligence. Through modeling and joint problem-solving outside of heated moments, I could help my child develop skills. Instead of isolating my child, I could help them work through their big feelings. By giving my child more positive feedback and limiting the negative, I could help reestablish their healthy sense of self-worth while reinforcing the behaviors I wanted to see.
By adjusting my parenting style, reframing my view of ADHD, and finding an effective medication combination for my child, their behavior began to change as well. The opposition and defiance melted away, leaving a child who liked themself and had no doubt about how much I liked them too. I don’t get it right every day, and our home will never be “typical.” We will always have more challenges with deep feelings and strong emotions. But when my child is having a hard time, I now ignore the onlookers who misunderstand the moment. I step into the moment knowing that I have the skills to help my child regulate. And, even if I fail to help them regulate in that moment, my steady loving presence as we weather the storm together is enough to build connection, attunement, and their positive sense of self. My child is more than their momentary challenging behaviors. Although their brain is wired differently, its neuroplasticity allows new pathways with new skills to be continually created.
Medicine is still uncovering answers to the nuanced differences of the ADHD brain, but many health and educational organizations have yet to catch up with reframing, reparenting, and pushing for new best practices for our children and patients with ADHD. We can do better for these children and their families, and we should. Because, as I discovered, there is hope for nights filled with snuggles and laughter, shared tears and connection, rupture and repair. There is hope for perfectly imperfect families to thrive with all their differences.
Emma Hostetter is a family physician.
