Q: I’ve been working with the family of a teenager with behavioral issues and suspect the dad may have untreated adult ADHD. What should I do?
A: ADHD in the family correlates strongly with children’s behavioral issues, so assessing for undiagnosed ADHD in these parents is a solid starting point. As an ADHD specialist, when I’m doing this sort of exploring, I like to trot out an adage of my own making: that impulsive apples with attention problems don’t fall far from impulsive trees with attention problems. Research backs me up. Some studies show as much as a 75 to 91 percent chance that a parent with ADHD will pass it on to children. Thankfully, downstream effects for the entire family are often very positive when an ADHD parent gets treated.
After all, parenting with untreated adult ADHD poses inherent difficulties, including the parent’s impulsivity, emotional dysregulation, and rejection sensitivity. Adults with these difficulties often experience higher rates of alcoholism, marital conflict, depression, and anxiety, and they face a heightened risk of having trouble maintaining a job. When kids come along and add more stress to the family system, these families are often primed for conflict.
Brian and Stacey came to me for help with parenting their 15-year-old daughter, Claudine. Fiercely defiant, Claudine tended to do what she wanted when she wanted. She’d recently begun taking ADHD medication to help her improve in school, but her behavior at home remained challenging, and she’d get into screaming matches with her parents whenever they tried to hold a boundary with her. Brian did his best to parent her calmly, but his own struggles with consistency meant he tended to get really angry really fast.
In essence, Brian’s difficulty with remembering tasks and appointments were having a negative effect on all areas of his life, including his parenting. He continually missed Claudine’s soccer games, had shown up late for her last birthday party, and almost never remembered to say “good night” and “I love you.” Despite his remorse, because Claudine had learned her dad often failed to deliver when he was supposed to, her respect for him had cratered. Also, he couldn’t manage to follow through on his attempts to discipline her, which shored up her negative and uncontrollable behaviors.
Still, I saw in session that Brian meant well and was trying his best to find ways to build a positive relationship with Claudine. But when he felt attacked, threatened, and undermined as a parent, he’d get enraged, in effect modeling the behaviors that were shaping Claudine’s development.
For example, after months of nagging, Claudine had finally convinced her parents to get her a new iPhone. Wisely, they conditioned the purchase on Claudine’s agreeing to charge the phone outside her room no later than 10:00 p.m. But the very first night, Brian noticed it wasn’t in the hall at this time, and when he asked her to hand it over, Claudine refused. “Sorry Dad. I need it for my alarm clock,” she explained.
Wishing he was doing anything but heading down this all-too-familiar road with her, he responded shakily, “Honey, we made a deal.”
“Don’t be crazy!” she whined. “Do you want me to miss my bus? What kind of awful parent are you?”
Brian folded like a cheap suit. “Well, I guess it’s okay if it’s your alarm clock only.”
Overhearing their conversation from the bottom of the stairs, Stacey called up, “Wait, no, Claudine. A deal is a deal. Hand over the phone, now!”
“Dad said it’s fine. He gets it. Don’t be such a jerk!” Claudine yelled.
Brian, knowing he’d messed up with both his wife and his daughter, lost his cool. “Don’t you start calling your mother names!” he hollered. With his face beet red, and neck veins bulging, he got in Claudine’s face. “Give me the phone now or you’re losing it for a week!”
Claudine shot back, “Shut up! I don’t need to listen to you when you’re acting crazy. You are the worst parents! You can’t even get on the same page about what the rules are.” As she stormed into her room and locked the door, Brian and Stacey were once again left to argue over who was to blame for another night in their house ending in misery.
Treating The ADHD Parent
This story could happen to any family with teens, but in this case, Brian’s inability to implement a consistent behavior plan set the stage for Claudine’s unwillingness to follow the rules. And whenever this happened, his difficulty with emotional regulation got the better of him.
While a neurotypical dad might have an easier time staying calm and firm while thinking his way through the problem, Brian and others like him end up broiling inside until they lose it and blow up. Scenes like this are common in intergenerational ADHD houses and can make life hard for everyone.
When I shared my thoughts about a possible ADHD diagnosis for Brian and described the disorder’s common impact on parenting, including difficulty with follow-through, consistency, and staying calm enough to deescalate conflict in the moment, both Brian and his wife Stacey nodded knowingly. “I’ve thought for a long time that maybe I’m not naturally warm enough, or too lazy as a parent, and that’s what made me so awful at it,” Brian said, taking a slow breath. “The idea that there might be a biological explanation for my shortcomings is wild.”
The more we worked together, the clearer it became that it wasn’t that Brian didn’t care to show up as a consistent dad, or husband, or worker: it was simply that he didn’t have all those adult appointments logged in his brain as most people would. The executive function and working memory deficits that came along with Brian’s ADHD had been making consistency extremely difficult.
“In my core,” he told me, “I’ve always felt that I must be an awful person. Who else misses all these appointments or loses their temper like this?”
It took a formal evaluation, some trial and error with medication, and the assistance of a great therapist who specializes in adult ADHD, but he and his family found new hope for improving their family dynamic.
A Road Map to Restoring Harmony
If you’re seeing a struggling family and you believe that a parent or parents may have untreated ADHD, exploring this possibility further can lead to significantly improved outcomes for treatment. I’ll often bring up the possibility with parents in a nonthreatening manner by asking, “So which one of you jokes about being ADHD?” Ninety percent of the time, one parent will exaggeratedly point their finger at the other, who will smile sheepishly. Sometimes both parents point at each other and burst out laughing.
Once the ice is broken, you can offer psychoeducation on the impact of ADHD on parenting and marital harmony. Helping them understand why they act the way they do and providing options for treatment is a great first step toward getting the family back on track.
As with any case of diagnosable ADHD, medication is a first-line intervention. Stimulants have been shown to reduce symptoms of ADHD by up to 50 percent. Adults who first try stimulants in their 30s or 40s are often blown away by the difference they make in their lives.
Working with a competent psychiatrist or psychiatric nurse practitioner experienced in treating ADHD is a vital first step, but not everyone has a positive response to meds right away, and it may take some trial and error to get to the right medication and dosage. When clients know success isn’t immediate or guaranteed, it keeps them in the game.
It’s good to remember that by the time untreated ADHD families make it to your office, things are generally quite awful at home. The endless hamster wheel of negativity will have taken its toll, and parents will often have learned to avoid conflict by steering clear of their teen altogether, which means nearly all remaining interactions are negative.
Helping ADHD parents see their own brain-based, biological challenges is crucial to helping them move away from thinking of their kids as manipulative, angry, and out of control. When an ADHD parent is treated, a door will often open to spending more positive time with their teen and rebuilding their relationship.
Brian, for his part, began taking a stimulant and working with an ADHD coach who specializes in improving executive function. He made slow and steady progress on becoming more consistent and less forgetful. He began working on emotional regulation to help him stay calm when things got tense. And he downloaded an app the ADHD coach had recommended, which pinged him several times on Claudine’s game days, ensuring he showed up on time. Whether Claudine’s team won or lost, they’d drive home together, and he’d mention positive things he’d seen about her contributions on the field.
In fact, we worked on getting Brian to praise Claudine regularly. For example, when she showed him her doodles in a notebook that he was concerned she wasn’t filling with the right amount of schoolwork, he grinned, told her how amazing they looked, and asked how she’d done them. This deceptively simple interaction turned into an avenue of connection. From then on, he’d ask to see new doodles from time to time, and she’d glow when showing them off.
In our family sessions, we talked about the importance of complimenting children with ADHD when they do things right. So when Claudine would bring her laundry down to the hamper instead of leaving it on the floor, Stacey would say, “You brought down the laundry, good stuff!” Praise goes a long way in an ADHD household, even if it seems silly. At first, Brian felt he was talking to Claudine as if she were a five-year-old, but in addition to creating more positivity and goodwill, he was helping her feel valued and appreciated.
As we therapists know, the success of any parenting model depends on consistent implementation. For families with ADHD, this can be especially difficult. Inconsistently parented teens will take a bit more time to come around as they begin to realize that things are changing, so it’s important that the ADHD parent be prepared for hiccups along the way, but the teens will be happier, calmer, and less explosive as their parents settle into a consistent model of parenting.
My experience is that patience is everything here. Some clinicians find they need to spend more time seeing the ADHD parents separately to make sure they’re staying on track and help them focus on their own executive functioning, emotional regulation, and rejection sensitivity. Ultimately, change can, and in most cases, will happen—and the impact on the whole family system will make working with these families a satisfying and rewarding experience.
Dovid Becker, LCSW, ADHD-CCSP, adjunct professor and program director at the Wurzweiler School of Social Work, is a New Jersey–based clinician in private practice, who’s passionate about helping teens and families with ADHD.