Once again, I found myself curled up on the kitchen floor, head between my knees, sobbing. My shoulders shook and my chest heaved as I gasped for air, but air alone wasn’t enough. What I really craved was hope, but I didn’t have it during this relentlessly difficult period of my “neurodivergent” parenting career.
I don’t know what made that moment any different from the countless wild nights that preceded it. Perhaps the words of self-loathing and hatred from my young, intelligent, and energetic child filled me with simultaneous feelings of hopelessness and determination. That determination can only begin to be felt by parents who feel like they have lost their child. I was determined to find answers that would help children understand their own greatness and that would help re-establish this belief in them despite their difficult behaviors. did.
As a board-certified family physician with an MPH, I “knew” about Attention Deficit Hyperactivity Disorder (ADHD). I was qualified to treat this neurodiverse subset, but I was completely unprepared for it at home. Medical school and residency taught me that ADHD is a behavioral disorder characterized by difficulty concentrating and an inability to sit still. The perfect answer to my treatment was stimulants as a student with behavioral therapy. But as I sat writhing on my kitchen floor with the trauma of emotional and physical dysregulation that befell my child, I was struck by the complexity of ADHD’s nervous system. My medical training tragically oversimplified the neurology, medications, parenting strategies, and educational interventions necessary to develop creative, energetic children. My child was full of beautiful personality traits, but they were overshadowed by impulsive and explosive behavior that he couldn’t really control. School stimulants and sticker charts are never the perfect solution.
My child will be the first to admit that he did not feel seen and understood by me during this difficult period of his life. I’ll be the first to admit, I was failing my kids, but I didn’t know how and why. My education did not paint a complete picture of the emotional dysregulation, severe impulsivity, and parent-child frustration that accompany executive function delays in ADHD. Drug rebound, rejection dysphoria, oppositional defiance, sensory processing hypersensitivity, time blindness, frustration intolerance, inner restlessness, and sleep disorders were not in my textbook. They failed to equip me with the effective parenting skills I so desperately needed to meet my child’s unique needs, without mentioning the chaotic stress that ADHD can add to a family unit. I couldn’t.
By accepting and accepting that “I didn’t know what I didn’t know,” I slowly began to see the hope that I had been desperately struggling for. I read medical journals, new research, best-selling books, personal experiences, and signed up for newsletters and workshops from reputable ADHD educators. I was greedy. With cautious optimism, I joined a social media support group for physician mothers of children with ADHD, where I found a sense of solidarity with fellow female physicians. I cut 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 for ADHD revealed that my child’s medication was not being optimized and medication rebound was causing problems in the afternoons and evenings. Finding an ADHD medical management clinic that accepts new patients was a challenge, but it was reassuring to have a provider who listened and validated my child’s daily struggles. The drug trial was difficult, but by finding the right class and combination, the child gained more control over his behavior. Instead of impulsively climbing up the ledge of a 6-foot-tall front door window, damaging the wall in a moment of severe frustration, or resorting to violence, my child more often Now I can stop and think. We knew that optimizing dosing was only one part of the puzzle. Effective parenting skills were needed.
Not only were traditional parenting strategies ineffective, but they also led to poor relationships with children, opposition, rebellion, and low self-esteem. My breakthrough moment came when I stumbled across the books “How to Speak as Children Listen” and “How to Listen as Children Speak” by Mazlish and Faber. . Despite being published in the 1970s, this book marked a turning point in my parenting journey and launched me into other invaluable resources that would forever change my perspective on parenting. It was me who had to change. I wasn’t a bad mother. I loved my kids so much and was doing the best I could with the skills I had. I now realize that I need to reframe how I view ADHD, my child’s challenging behaviors, and my own parenting approach.
Reframing ADHD
ADHD is a neurodevelopmental difference (not a deliberate behavior) that can be more clearly understood through the lens of delays in executive function skills, particularly self-regulation. My child wasn’t being rebellious or trying to do something “difficult” when focusing on boring or mundane tasks. They simply couldn’t “will” to concentrate, organize, or sit still. They frequently became bored due to lack of stimulation and then dysregulated due to overstimulation. My child had an interest-based nervous system that craved dopamine. This diverse nervous system gave them many advantages, including seeing things in unique ways, being able to establish flow states without hyperfocus, and being passionate about injustice. Their poor working memory and easy distractions made it difficult for them to get to school on time, but their impulsiveness led to adventure, excitement, and discovery. Big emotions still caused difficult moments, but I learned there were better ways to support my child through all the emotions that came up.
raise children
My traditional parenting approach (unbeknownst to me) was rooted in behaviorism. Consequences (positive and negative), time-outs, and unintentional shame-based approaches failed because they made my child doubt his own worth while simultaneously threatening his safe and secure attachment with me. Compliance was achieved at the expense of connection, ultimately leading to opposition, defiance, and emotional overwhelm. The parenting strategies I was implementing (many of which were promoted in best-selling books specifically for ADHD) were hindering conformity. These methods, which ignored the human part of parenting and focused solely on changing behavior, made me feel sick and inadequate.
The new parenting strategies I was rapidly implementing incorporated polyvagal theory, conformity, and attachment. They parsed out the nuances of behavior and dismissed oversimplified views of behavior as simply “good” or “bad.” We’ve learned that all behavior is communication, and “bad” behavior often stems from unmet needs or lack of skills. When my kids were acting out, it was because they were having difficulty, not because they were trying to be difficult. In these difficult moments, my child’s prefrontal cortex, which controls self-regulation, was still developing (and his ADHD meant he was at least behind neurotypical children), so his nervous system It needed my calm, sturdy presence to help regulate the system. 3 years). Accepting children’s neurodevelopmental differences has helped me adjust my expectations and approach frustrating situations from a position of empathy rather than judgment.
In addition to gaining a deeper understanding of behavior, I learned the importance of acknowledging and validating my child’s feelings, and providing a safe space for them to vent, even if I disagreed with them. Although I couldn’t tolerate every action, I learned to tolerate every emotion and my emotional intelligence increased. I was able to help my children improve their skills by building models and collaboratively problem solving during non-enthusiastic hours. Instead of isolating my child, I was able to help them work through big emotions. By giving my child more positive feedback and limiting negative feedback, I was able to restore healthy self-esteem to my child while reinforcing the behaviors I wanted.
By adjusting my parenting style, reframing my perspective on ADHD, and finding a combination of medications that worked for my child, my children’s behavior began to change as well. Opposition and defiance melted away, the children began to like themselves, and I had no doubts about how much I liked them too. Not every day is going to be great, and our home will never be “typical.” We will always continue to take on further challenges with deep emotions and strong emotions. But now, when a child is having a hard time, they ignore bystanders who misunderstand the moment. I go into that moment confident that I have the skills to help my child regulate. And even if I can’t help regulate them in the moment, my steady loving presence as we weather the storm together provides connection, attunement, and positivity for them. Enough to build a sense of self. My child has more than a momentary challenging behavior. Their brains are wired differently, but their neuroplasticity continually creates new pathways with new skills.
While medical science is still figuring out the answers to the nuances of the brain in ADHD, many medical and educational institutions are working to reimagine, rethink parenting, and promote new best practices for children and patients with ADHD. I haven’t caught up yet. We can and should do better for these children and their families. Because, as I have discovered, there is hope in nights filled with cuddling, laughter, shared tears, connection, rupture and repair. There is hope that a perfectly imperfect family can thrive despite all its differences.
Emma Hostetter is a family physician.
