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We sit down with family physician Emma Hostetter, who shares her deeply personal journey navigating the challenges of parenting a neurodivergent child with ADHD. Emma opens up about the emotional toll, the gaps between her medical knowledge and real-life experience, and the transformative shift in her parenting approach. Through reframing ADHD and embracing empathy-based strategies, Emma found hope and connection with her child.

Emma Hostetter is a family physician.

She discusses the KevinMD article, “What medicine never taught me about parenting a child with ADHD.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Emma Hostetter. She’s a family physician. Today’s KevinMD article is “What medicine never taught me about parenting a child with ADHD.” Emma, welcome to the show.

Emma Hostetter: Thank you so much, glad to be here.

Kevin Pho: So you’re a family physician, and you really shared this poignant story on KevinMD that resonated with a lot of people. I just saw on LinkedIn, I saw that story shared and a lot of people had a powerful response to it. It’s titled “What medicine never taught me about parenting a child with ADHD.” Tell us the events that led you to write this article in the first place, and then the article itself for those who didn’t get a chance to read it.

Emma Hostetter: Sure. Yeah, I think that in my own journey there’s been a lot of learning points for me, a lot of, I think, isolation in being a parent, parenting a child with ADHD, and not really having a lot of support or understanding.

And so I really wanted to write this piece to raise awareness, and also really provide solidarity for other parents who are in a similar position, and who maybe have felt hopeless or right now feel hopeless. Let them know that there are answers, there is hope, there are solutions and ways to really thrive as a family even with ADHD in the mix. And how that can actually be, even though there are struggles with it, it can also be a beautiful thing too.

Kevin Pho: So tell us a story. We see ADHD just thrown around a lot in the mainstream media, but rarely do we see how it affects you as a mother and your family in particular. So tell us your story.

Emma Hostetter: Yeah, so I think that when I had my first child I thought I knew a lot about parenting, even though I had absolutely no skill set. You know, you think you’re going to approach things, that it’s going to come naturally.

And then I had what I thought was a strong willed child, and then I realized, hm, there are more challenges that I’m experiencing that I don’t hear other parents experiencing. Or certain behaviors that I’m like, oh my goodness, why is my child reacting to me in this way when I look around and see the majority of kids are not?

And so that kind of raised a few different red flags in a way of, why are so many behaviors so difficult, and how do I manage these, and how do I be a great mom with all of these challenges that I’m seeing in behavior? And is my kid a good kid, is my kid a bad kid, how do I frame this whole thing, am I failing my child?

And I think in the younger years it was easier. You can kind of write things off as they’re a toddler and so they’re going to have meltdowns and tantrums. But then as time passes and your kid gets older and you’re still having these meltdowns in scenarios where other kids, and most kids, would be able to handle the situation and your kid can’t, you start to feel like everyone’s looking at you or questioning your parenting. And you start to feel like, oh my goodness, I’m starting to have this disconnect with my child as well.

And so it was really this season of my life where I felt that I was not doing a good job as a parent. I was using traditional parenting methods of timeouts and consequences, and really without realizing it, more of a shame-based approach in my parenting. Trying to bring out the good in my kid, but not realizing I was really focusing more on the quote unquote bad.

And so I knew that I needed to do something different. I knew that I needed to find answers that would help my child, and part of that was medication for sure. I think that a lot of times there’s misinformation about medications for ADHD. There’s confusion about addiction, or being on a controlled substance, or all of these different things that cause a lot of alarm in parents. And even among physicians there’s a lot of misinformation.

So finding a really great medical management clinic that could kind of help piece things together for my kid was significantly important, that piece of it. Without that I think we would still be in a really challenging place right now, just with impulsivity, and with being able to self-regulate in a better way, and being able to concentrate and focus and kind of block out other noise and really being able to thrive. And medication has definitely brought that piece of things into our home, being able to thrive in school and do well academically as well, and really show everything that my child can accomplish when they have that support system.

But then adding the piece of, how do I approach this not as a behavioral issue but really as a neurodevelopmental difference that leads to issues with executive function and leads to weaknesses in some of these areas? And how can I support my child, how can I come alongside them and parent them in a way that is not going to really diminish who they are and make them feel badly about themselves, but that’s going to allow them to just be strengthened in skills and in support and be able to thrive, and build connection with them too?

And I think that that was the biggest piece, was recognizing that I needed to throw away my old parenting skills and start fresh and lay a new foundation that was really focused on connection and attunement and really love, and getting to know my kid in a way that wasn’t shaming, that was accepting of who they were even with the struggles.

Kevin Pho: What would be some examples that you could tell us where you felt your child couldn’t handle some situations that you said other children would be able to? What would be some examples of that?

Emma Hostetter: Waiting in lines. So something as simple as going to a place where everything’s supposed to be fun, going to Disney World and seeing that there’s a line that’s maybe not even that long, maybe a 15-minute wait, that most kids who are eight or nine could handle. But that wait was literally like torture and would lead to emotional dysregulation, would lead to outbursts, that typical kids would be able to handle that disappointment.

So more of the emotional dysregulation over feeling things so strongly. So my child would have what a normal kid would see as a disappointment, but this would be more of a devastation. And so it would lead to the need for emotional regulation from someone else, so me literally sitting and helping calm my child over something that maybe would seem minor to most people looking on but was really a big deal. Which plays into rejection sensitive dysphoria, which I knew nothing about prior to having my child be diagnosed with ADHD and then really starting to dive into what that truly meant.

Kevin Pho: You talked earlier about the traditional techniques of parenting, like timeout and consequences. Tell us why that method of parenting isn’t the best for a child diagnosed with ADHD.

Emma Hostetter: And I would go even further and say it’s really not the best for any kid. I have neurotypical children as well, and I really changed my parenting approach with all of my three children.

But the main reasons, I mean, timeouts. I was actually just listening to Laura Markham, who’s great, she does Peaceful Parent, Happy Kids, and she was talking about how when we put a child in time out, what we’re doing is we’re actually separating from them. And so from a child’s perspective they see that as, I’m not good enough for your love, or I’m so bad that I don’t deserve to be in your presence right now. And from an attachment perspective that’s pretty dangerous, to think that here’s my lifeline, my parent is really my lifeline, and I’ve done something that now that lifeline is cut off.

And so kids also don’t learn skills when they’re isolated. So you put a kid in a timeout and they’re not actually learning anything, you’re not teaching them anything, they’re not developing a skill. And their prefrontal cortex is not developed enough yet for them to really know how to self-regulate. So they really need you there in those difficult moments when they’re having a hard time, to help them with that regulation piece, and to let them know that your love is unconditional no matter what they have done, that you’re never going to step away from them or leave them because they’ve done something wrong.

So I think that’s the timeout piece. And I think consequences, again it’s more of a shame base. Of course there are natural consequences in life and that’s just going to happen for behavior. But I think that when you start punishing, you always then have to look for the bigger punishment, and then it’s never big enough, once you get to a point where your kid then becomes defiant. And then it really becomes a battle of who’s going to win this argument, who’s going to fight harder and longer and stronger to win this. So it just tends to create more defiance rather than actually creating a child who wants to do the right thing and have that intrinsic motivation.

Kevin Pho: So tell us a story about how that shift in parenting, where it may not be as shame based, and then tell us how you changed in response to a perceived oppositional behavior.

Emma Hostetter: Oh my goodness. I feel like the biggest change has definitely been me working on myself, being really mindful, rather than me trying to change my child.

So I think starting with self-regulation and working on myself. So in those moments where my kid is not cooperating or is being really challenging, taking a second to be mindful and ground myself and remind myself, my kid is having a really hard time right now, they’re not trying to be bad. Their emotions are really big emotions and this is more than they can handle. And so pausing, regulating myself, so that then I can step in and help regulate my child, because they still need that. They’re still developing, their brain is not fully developed yet, they don’t have all of that growth in the prefrontal cortex, and so they need me modeling that for them.

And so, I mean, it’s a thousand times a day, right, with kids. I have three kids, and so the interactions that come with sibling rivalry, the interactions that come with homework overwhelm. So I could use a thousand examples even from this week alone of times where a child was just really having a really hard time, maybe with being upset over an interaction with a sibling.

And then instead of me jumping in to judge, it was taking a moment, pausing, regulating myself, and then acknowledging their feelings and saying, I get it, sometimes it’s really hard to have a little brother or a little sister because they can be so annoying and they can get on your nerves, and I totally understand where you’re coming from. So affirming those feelings, and then saying, let’s take a minute to just calm down, let’s just take a minute to just be, to settle, to take deep breaths. And really help give those regulation skills, hand those down to my child, and modeling those for my kiddo has been really helpful.

I think when our kids feel that connection and they feel seen and understood, then those bad feelings tend to kind of dissipate, and then they’re able to move on and move through those feelings. It’s not that we say you can’t feel angry, we don’t tell them they can’t feel upset. It’s really accepting all of those feelings and letting them air those feelings, even when they feel really hard for us as parents to listen to.

Because just that feeling of acceptance that they get from us, that their feelings are welcome and acknowledged and understood, then they’re able to move through those feelings and come to the other side of it and know, I can survive these bad feelings and I’ll still be OK, and my mom still loves me even when I have these bad feelings, and she’s not going to walk away from me, she’s here with me in those hard moments.

Kevin Pho: How difficult was it for you to sometimes take that pause and self-regulate in response to a difficult situation? Because I’m a parent myself, I have two daughters. Sometimes if they’re being difficult you have that impulsion to just react and say something, and it’s not easy sometimes in the moment to take that pause and self-regulate. Tell us, was that a big transition for you? How difficult was it for you to do that?

Emma Hostetter: I mean, it’s still difficult. I don’t know that it ever stops being difficult to some extent, because our kids trigger us, right? We don’t even know sometimes that we’re triggered by things that are from maybe the way that we were raised or different life experiences that we’ve had.

But I think that building in a mindfulness practice has been really helpful for me, where outside of triggered moments or outside of difficult moments, I take the time to breathe, to ground myself, to say mantras to myself. I do Pilates like three times a week just to have that calm and quiet and that sense of control and breathing and all of that. So I think building in practices for self-care, that has been really helpful for helping me to pattern this.

And then continually listening to educational resources so that it’s always on the front of my mind. Sticky notes with mantras are helpful too. But I think that as humans we need constant reminders, because this doesn’t necessarily come naturally for most of us. I think it’s more of a practice that gets easier with time, but it definitely takes intention and it takes effort.

And I don’t always get it right. So there are moments where I do not stay regulated, and I think as parents that’s something we have to acknowledge, that we sometimes are going to lose it a little. And we have to be willing to say, hey, I got it wrong, I raised my voice, I got really frustrated and that came out at you, and I should never have raised my voice at you, I should have taken a minute, and I’m really sorry.

So I think taking the time to show our kids that we do mess up, we don’t always get it right, but that we can always work on repairing that with them, and then kind of do a do-over and say let’s start fresh now. Mommy’s not perfect either. It also lets our kids realize, like, it’s OK to not be perfect, we’re human. So I think that there’s just a realness to that.

Kevin Pho: I’m going to safely assume that this parenting aspect when it comes to ADHD isn’t really taught in residency or medical school, and not everyone of course has lived through that. So how have your experiences parenting your child, how’s that informed you when you talk to parents of children with ADHD in the exam room?

Emma Hostetter: So I think that when I was training I got a very brief education on ADHD, and my understanding of it, and I allude to this in the article, but my understanding of it was very limited. I thought it was pretty cut and dry. I’m going through my board review questions and I always got the right answer, which was behavioral therapy and add in a stimulant medication.

So I didn’t realize all of the emotional pieces, all of the challenges of even just getting out the door in the morning, that were so much more challenging for families with kids who had executive function delays. And having to remind your child over and over and over again, or actually having to be a body double for your child to get tasks accomplished. And so I think that all of these pieces of it were left out.

And I think since the time that I trained, a lot has come to light. I’m hoping that there’s more education and more is included in training, but there’s a lot to fit in in a family medicine residency, and so you only have three years to learn all of this, you’re learning so much. So I think that back in residency and during my training I just didn’t have a good grasp on what ADHD was. I didn’t understand the scope of it, or how it could impact the family unit, how it could really impact not just home life but school life and peer relationships and really every aspect of life.

And I don’t see ADHD as a bad thing. I think that neurodivergence has beauty to it as well. We have a mix of neurodivergence in my home. I have a highly sensitive child as well, I have a neurotypical kiddo, I have one with ADHD. So we have kind of a mixture in our home of different temperaments and different strengths and different weaknesses, and that’s really how we approach it.

I think that I try to approach things with more of a balanced approach with my kids, to say that we all have areas that we struggle in. And so I think with patients and with clients now, bringing that balanced approach, because you see a lot of stuff out there, you see some people who really focus on ADHD being a superpower and ignoring the fact that there are all of these challenges that go along with it. And I don’t feel that that is fair to the child or to the family, because parents who seek me out are looking for help. So if everything’s magnificent and everything’s a superpower, you’re probably not going to be looking for help, because you feel desperate.

But at the same time, only focusing on the negative can be very harmful for a child’s sense of self, because when you’re focusing on behavior, and that’s really what you’re seeing on the outside is behavior, your kid starts to feel like they’re a bad kid because you’re focusing on all these behaviors that are challenging that they have.

So I really try to focus on it from a balanced approach, saying, hey, there are certain areas that are going to be way more difficult, but your kid’s also going to have certain strengths, and brings excitement and life and creativity and all of these other wonderful things to the table that maybe they wouldn’t if they weren’t neurodivergent.

So I think that’s a good starting place as families are walking into this journey of understanding what life is going to be like with ADHD. I try to be really honest about medication, saying that they’re a piece of the puzzle, they’re not going to solve everything, but they definitely can help. Especially if you have a child who has a really hard time with impulsivity, because I think that that is one of the scariest parts of ADHD that can be the most challenging, is if you have a child who doesn’t have that self-regulation piece and maybe is making choices that are really dangerous for them or for those around them. And so medications can definitely help with that.

And then reframing to say, OK, my kid isn’t willfully doing bad things, my kid isn’t willfully trying to make these bad choices, or can’t sit still in their seat, and that’s because they just can’t. They’re not trying to be defiant or trying to manipulate a situation. But reframing and helping parents understand that it’s really about reframing this, that your kid isn’t able to right now. And so if they’re not able to and they don’t have that ability, that means they need more support. And that support comes with accommodations, it comes with medication, it comes with skill building, it comes with scaffolding, and all of these areas to help your child succeed.

But you really have to frame it from that perspective of, my kid needs support, they’re not trying to make life more difficult for me or for themselves or for those around them. So I think that that reframing is helpful for parents, and definitely something I spend a lot more time touching on, and really asking how the whole family unit is doing I think is really important, because it’s really about the parents too and how they’re responding, because that makes a huge difference in how the child is going to thrive or not thrive.

Kevin Pho: We’re talking to Emma Hostetter. She’s a family physician. Today’s KevinMD article is “What medicine never taught me about parenting a child with ADHD.” Emma, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Emma Hostetter: Yeah, so I think that for me, recognizing that there’s no shame in acknowledging that you don’t know what you don’t know, and being willing to be teachable. Even as physicians we’re always doing continuing medical education, right? So sometimes we get things wrong, and when we do get things wrong, being willing to pivot. And when that is something as personal as parenting, that can feel bad. But I think being willing to pivot and to learn and to grow is really important.

Kevin Pho: Emma, thank you so much for sharing your story, perspective, and insight, and thanks for coming on the show.

Emma Hostetter: Thanks so much for having me.