The conversation your family didn’t know it needed.
By: Christina Crowe, RP
In an ideal world, if someone you love is living with a mental health condition that affects their daily life, you’d have access to your own professional.
Perhaps someone like their therapist, or someone with similar knowledge, who can help you understand what they’re going through, and how you can support them.
Because you love them, and you want to help.
But those of us who work in mental health know that making this kind of support available to families isn’t always easy to arrange in practice.
And when we are talking about attention deficit hyperactivity disorder (ADHD), it can be even harder.
What is it about ADHD that makes it harder?
An ADHD diagnosis in particular, may be harder for family members to wrap their heads around for a multitude of reasons.
A lack of understanding about some therapy-speak phrases, like ‘executive dysfunction’ (like interpreting forgetfulness or distractibility as intentional or character flaws),
Their own cognitive or emotional blind-spots. You know these are present when you hear things like “They seem fine to me“. Especially if the loved one has high aptitudes in some areas.
Old fashioned confirmation bias: noticing only behaviours that align with their existing beliefs about the person,
It’s well established that ADHD runs in families, and many parents, siblings and relatives may have undiagnosed ADHD themselves, and also are likely spotty family historians themselves,
“I turned out fine“ logic, leading to minimization or invalidation of their own mental health status,
If family members are undiagnosed, it’s easy to see how they do not recognize similar traits in themselves, which can create resistance to the idea that these symptoms are impairing in someone else.
Loads of internalized and ever-present stigma: Cultural or generational beliefs about mental health or diagnoses (“we don’t label people“), fear of judgment or blame, especially in parents who feel implicated in their child’s struggles, or concern about how others will perceive the family,
Parents often report feeling shame or fear, realizing past interactions may have been hurtful or misinformed, and a desire to protect, hoping the diagnosis isn’t “real” because it feels heavy or lifelong,
Stronger than ever post-pandemic, skepticism of the mental health system, and general distrust in providers or diagnoses. Increasing discourse in our culture believing mental health professionals “over-diagnose”, along with suspicions about medication, side effects, dependency, or personality changes.
Systemic (practical) barriers, including a lack of access to psychoeducation for families, limited involvement in the assessment/diagnostic process-leaving them feeling out of the loop or powerless, and generally feeling unclear role their role for support or treatment, especially in adult ADHD cases.
That last one is one I have personally tried to effect as much change as I can. Interestingly, there are ironic systemic parallels that begin with the gaps in our health care and education systems, and continue right down to the individuals as the actual day to day challenges of unrecognized ADHD itself become increasingly obvious the longer I practice as a psychotherapist.
Clarity begins with the right education.
As per the global guidelines for treating ADHD, early in my work as a psychotherapist, I found myself sharing a fairly consistent message with family members or partners, regardless of my client’s presentation or current symptoms (which is part of the actually amazingly wonderful part about treating ADHD, with both simplicity and complexity at the same time).
I quickly developed a waitlist for services, and I created my first course thinking that while folks were waiting, they could at least get started on all of this transformational education.
And many people did.
But a surprising number of people didn’t (and this time it wasn’t an accessibility issue). What I observed over time was that despite having access to the right information, many people still weren’t ready to consider it.
That’s when I learned about self-stigma (which is fairly self-explanatory), and stigma’s fancy cousins, ableism and internalized ableism.
Abelism is the assumption that everyone should think, move, behave, or function in the same way, and that people who don’t are somehow broken, lazy, or not trying hard enough (“I did it, they should be able to as well”).
Internalized ableism is when people hear those messages so much, they actually believe them, and turn those negative voices against themselves. They may feel shame, guilt, or believe they are “not good enough” because they don’t meet certain expectations, even though those expectations are based on a narrow view of how people “should” be.
Here’s what internalized ableism might look like in your loved ones.
It starts with a lot of with self-doubt and confusion.
They start to believe damaging labels: “lazy,” “stupid,” “too much,” or “not enough.”
They may hide their struggles out of shame, making it harder to get support or diagnosis.
They may develop perfectionism or people-pleasing habits to overcompensate.
Relationships can suffer due to misunderstanding or unspoken pain.
They may believe they’re fundamentally broken or hopeless—leading to isolation and despair.
Even when support is offered, they may resist it because they believe they “don’t deserve help” or “should be able to figure it out alone.” Increased risk of chronic burnout, workplace difficulties, or dropping out of school. They have a higher likelihood of substance use as a way to self-medicate or cope. In severe cases, ongoing internalized ableism can contribute to suicidal thoughts or feelings of worthlessness.
Educating family members about ADHD and neurodiversity helps dismantle harmful stereotypes and promotes a more inclusive environment for the person with ADHD (and we know environment is everything, when it comes to getting a handle on it).
Parents play a complex role
Parents play a complex role in both perpetuating and challenging ableism within families and society. Their actions and attitudes can significantly impact their children’s experiences and self-perception.
Internalized ableism can lead family members to prioritize “fixing” or masking neurodivergent traits rather than embracing them, which can harm self-esteem and authenticity (Lee, 2024).
Some families unintentionally collude with societal ableism by attempting to make neurodivergent members appear more “normal” to avoid stigma. This includes sculpting behaviours or discouraging traits perceived as socially unacceptable within their communities.
Non-accommodating family members may fail to provide necessary support, such as dismissing ADHD-related struggles or refusing to adapt communication styles, reinforcing feelings of exclusion and inadequacy (Neely-Barnes, 2010). Parents of children with any kind of disability face significant challenges in navigating ableist structures and attitudes. They must often balance between maintaining their positioning to pacify people in the community and trying to increase their own and their child’s social capital.
The pressure to conform to societal expectations can lead to internalized ableism, but many parents also become powerful advocates for change.
Recognizing internalized ableism with our own family systems can be a turning point.
With support, self-compassion, and proper education, people can begin to rewrite these stories. They can start to understand that their brain isn’t broken—it just works differently—and that they deserve the same dignity, support, and accommodations as anyone else.
Perpetuating Ableism
(what we try to notice and move away from):
- Internalizing societal norms: Some parents absorb dominant ableist views of “normal” or “typical” development, seeing disability as a deviation that needs to be corrected or hidden.
- Normalizing behaviours: Parents may attempt to sculpt their children’s behaviour to make them appear more “normal” or acceptable to the outside world, reinforcing ableist standards.
- Seeking to “fix” or mask: Families may prioritize “fixing” or masking neurodivergent traits rather than embracing them, potentially harming the child’s self-esteem and authenticity.
- Colluding with ableist agendas: Some parents look for ways to increase their child’s social, cultural, and symbolic capital by minimizing the appearance of disability, such as encouraging the use of adaptive devices that make them appear less disabled.
Challenging Ableism
(finding opportunities to do more of this):
- Advocacy: Many parents take on the role of advocates, fighting for their children’s rights and inclusion in various settings, including education and healthcare.
- Education: Parents often educate community members, extended family, and professionals about their child’s disability and needs, helping to dispel misconceptions and stereotypes.
- Resisting dominant discourses: Some parents actively resist disabling narratives about their families, examining previously unquestioned assumptions about disability.
- Activism: The family experience of disability can lead parents to engage in broader advocacy and activism for disability rights.
- Embracing neurodiversity: Parents who challenge ableist attitudes can foster empowerment by celebrating their children’s unique traits and strengths.
A clear ‘to-do’ list for family members
Positive and pro-health strategies families can implement include the following research-based strategies and recommendations. Consider from this list what you might seek more information about, what you have tried with the aim of masking or fixing, rather than how acceptance could provide more progress than you had previously considered.
Would it have made a difference in your own childhood?
Embrace Neurodiversity
- Normalize stimming and sensory needs (ask yourself if you need to learn more about what these are?)
- Allow and encourage open stimming when needed.
- Create sensory-safe spaces or rooms for both co-regulation, and self-regulation.
- Address individual needs
- Recognize that each family member experiences the world differently.
- Avoid placing value judgments on different needs or preferences.
- Foster empathy and understanding
- Educate yourself, immediate and extended family members about ADHD and about different neurotypes.
- Encourage siblings to learn about each other’s experiences.
Adapt Communication and Routines
- Use direct and clear communication
- Be clear and specific in instructions and expectations – communicate these in advance.
- Avoid sarcasm or reliance on nonverbal cues.
- Implement predictable routines
- Create visual schedules or calendars.
- Establish consistent daily structures.
- Engage in object-based conversations
- Focus on shared interests for meaningful interactions.
- Use specific topics rather than open-ended questions.
Promote Inclusivity and Support
- Create a supportive home environment
- Celebrate neurodivergent strengths and identities.
- Support requests for accommodations at home for sensory needs.
- Encourage collaboration
- Find activities that allow ALL family members to support each other.
- Highlight how different strengths contribute to shared success.
- Offer consistent emotional support
- Be an ally and active listener.
- Ensure neurodivergent members feel understood and valued.
Expand Understanding and Advocacy
- Explore family neurodiversity
- Recognize that neurodivergence may be present in multiple family members.
- Be open to learning about your own potential neurodivergence.
- Support LGBTQIA+ identities
- Educate yourself on the intersection of neurodiversity and gender/sexual identity.
- Provide a safe and accepting environment for all aspects of identity.
- Seek professional ADHD-specialized support
- Help find neurodiversity-affirming therapists when needed.
- Participate in parent support groups or family counselling.
If you find yourself looking at these and thinking any variation of, “I can’t do those things” or “Yeah I tried that and it didn’t work“, I compassionately invite you to explore your own possible internalized ableism. If you can figure that one out, you are well on the way to being the safe harbour your loved one really needs.
By implementing these strategies, families can create a more inclusive, understanding, and supportive environment that values the unique strengths and needs of all members, fostering stronger bonds and promoting the well-being of neurodivergent individuals within the family unit.
References
Bixby L. E. (2023). Disability Is Not a Burden: The Relationship between Early Childhood Disability and Maternal Health Depends on Family Socioeconomic Status. Journal of health and social behavior, 64(3), 354–369. https://doi.org/10.1177/00221465231167560
CADDRA – Canadian ADHD Resource Alliance: Canadian ADHD Practice Guidelines, 4.1 Edition, Toronto ON; CADDRA, 2020.
Lee, C. I. (2024, October 10). Ten Signs You Have Internalized Ableism about Your ADHD. LA Concierge Psychologist. https://laconciergepsychologist.com/blog/internalized-ableism-adhd/
Medina, M. (2020, May 28). Flap like a butterfly; stim like a bee. Embrace Autism. https://embrace-autism.com/stim-like-a-bee/
Neely-Barnes, S. L., Graff, J. C., Roberts, R. J., Hall, H. R., & Hankins, J. S. (2010). “It’s our job”: qualitative study of family responses to ableism. Intellectual and developmental disabilities, 48(4), 245–258. https://doi.org/10.1352/1934-9556-48.4.245
“What is disability? It depends whose shoes you are wearing”: Parent understandings of the concept of disability| Disability Studies Quarterly. (n.d.). https://dsq-sds.org/index.php/dsq/article/view/4448/4212
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