The Missing Pieces: Why Neurodivergence Treatment Needs Therapy and Parent Coaching

I see this pattern repeatedly in the ADHD Parent Support Group. A parent posts that their child's medication is working, but behaviors are still difficult. Physical aggression continues. Emotional meltdowns happen during comedown. School struggles persist despite the prescription being filled consistently. The parent is frustrated because they thought medication would fix everything, and now they're wondering if it's the wrong dose or the wrong medication entirely.

I need y'all to understand something. Medication addresses neurochemical foundations—dopamine and norepinephrine dysregulation in ADHD, or emotional regulation challenges in both ADHD and autism—but it doesn't teach skills, address comorbid conditions, or give you the tools to co-regulate with your child. 

Comprehensive treatment requires therapy for your child, evaluation for comorbid conditions, parent coaching, and your own therapy and evaluation. Without all of these working together, you're leaving your child to figure out emotional regulation, social skills, and coping mechanisms on their own while their brain chemistry is changing.

What's Missing When Medication Isn't Enough

I've written extensively about what medication does and doesn't address in Medicated and Still Struggling: What Parents Miss About ADHD. Medication improves executive function in ADHD by addressing dopamine dysregulation. For autistic children, medication might address emotional regulation, anxiety, or attention challenges. But medication doesn't teach frustration tolerance, emotional identification, organizational skills, or social communication strategies.

When behaviors feel bigger than what medication addresses—sustained physical aggression, extreme emotional dysregulation, patterns that medication isn't touching—there's usually something else happening. ADHD rarely shows up alone, and autism frequently co-occurs with ADHD, anxiety, sensory processing disorder, and other conditions. Common comorbidities include anxiety disorders, oppositional defiant disorder, learning disabilities, and trauma-related conditions. Each requires its own evaluation and treatment approach.

Understanding the difference between behavior and dysregulation is critical here. I cover this in depth in Your Child Isn't Being Disrespectful: Understanding the Difference Between Dysregulation and Behavior. When your child hits during a meltdown, that's not defiance—it's communication breakdown or overwhelm they don't have skills to manage differently. For autistic children, this might be sensory overload, communication frustration, or difficulty with transitions. For ADHD kids, it might be impulse control challenges combined with emotional dysregulation. The intervention changes completely depending on what's actually driving the behavior, which is why professional evaluation and therapy matter.

Getting Your Child the Right Therapy

Therapy isn't optional when you're dealing with concerning behaviors, and the type of therapy matters as much as having therapy at all. The therapy has to match your child's developmental stage, neurodivergent profile, and specific needs.

For kids under 10, neurodivergent-affirming play therapy and occupational therapy are your primary tools. Play therapy gives children a developmentally appropriate way to process emotions, practice social skills, and work through difficult experiences without requiring verbal articulation. For autistic children, play therapy can address communication challenges, social skill development, and processing sensory or emotional overwhelm. For ADHD kids, it builds emotional regulation skills and impulse control strategies. The therapist uses play to help children develop regulation skills, identify feelings, and build coping strategies that work with their developmental level.

Occupational therapy addresses sensory processing issues, fine and gross motor challenges, and helps kids develop body awareness and regulation skills that reduce meltdowns. For autistic children, OT is often essential for managing sensory overwhelm, developing interoception, and building daily living skills. If your child makes random noises, has repetitive movements, seeks or avoids certain sensory input, or struggles with transitions, OT teaches regulation strategies that work with their nervous system instead of suppressing natural coping mechanisms.

Parent-Child Interaction Therapy is an evidence-based approach for younger kids, especially when there's physical aggression or significant defiance. PCIT teaches parents specific skills to improve the parent-child relationship, reduce problematic behaviors, and increase positive interactions. It's structured, short-term, and highly effective for kids ages 2-7 struggling with behavioral regulation.

As kids develop more abstract thinking capabilities, usually around ages 10-12, CBT becomes appropriate. That's when you can work on identifying thought patterns, challenging negative self-talk, and developing cognitive strategies. DBT skills can help teenagers who struggle with emotional regulation, teaching concrete skills for distress tolerance, emotion regulation, interpersonal effectiveness, and mindfulness. For autistic teenagers, DBT needs modification to account for differences in emotional processing and communication styles.

Find a therapist with specific training in working with neurodivergent kids. Standard therapeutic approaches often need significant modification to work effectively with executive function challenges, attention differences, sensory processing differences, and communication styles common in ADHD and autism. Ask potential therapists directly about their experience with neurodivergent children and comorbid conditions, and make sure they use evidence-based, neurodivergent-affirming approaches appropriate for your child's age and profile.

Why You Need Parent Coaching

Your child's therapist works with your child for one hour per week. You're with your child the rest of the time. Parent coaching gives you the knowledge and tools to support your child's neurodivergence effectively—understanding how ADHD, autism, and comorbid conditions affect your child, learning co-regulation techniques, recognizing patterns before situations escalate, and creating home systems that reduce executive function demands.

The most important shift I’ve seen in my parent coaching programs is that it provides is changing the framework you use to understand your child's behavior. When you see hitting as disrespect, your response will be punitive.

When you understand hitting as communication breakdown or overwhelm that your child doesn't have skills to manage differently, your response becomes focused on teaching and supporting. Parent coaching also helps you implement what your child learns in therapy at home, because if the home environment doesn't support using those skills, they won't generalize.

Set up a Free Discovery Call and we can talk through how I can help you understand what your child is going through and how you can help them.

Getting Your Own Support

You need your own therapy and evaluation, not just parent coaching. If you're constantly dysregulated, struggling with your own executive function challenges, or finding it impossible to stay calm when your child is melting down, there's a reason. Neurodivergence runs in families. If your child has ADHD, there's a 70-80% chance you have it too. If your child is autistic, the genetic component is even stronger.

You can't co-regulate a dysregulated child if you're dysregulated yourself. You can't implement strategies consistently if you're running on empty without support for your own neurodivergence. Getting evaluated isn't just about you—it's about your ability to show up for your child. It's also about modeling that neurodivergence is manageable, that asking for help is strength, and that building systems and getting support is how you thrive.

Your own therapy addresses what parenting a neurodivergent child brings up—frustration, grief, guilt about past mistakes before you understood what was happening. It helps you process your own childhood if you grew up undiagnosed and struggling. It gives you strategies for managing your own nervous system so you can be the regulated presence your child needs. If you have ADHD, autism, or both, your therapist can help you develop the skills and systems you need to function effectively while parenting a child with significant support needs.

Getting your own evaluation and treatment isn't selfish or optional. It's essential. You cannot pour from an empty cup, and you cannot teach your child regulation skills you don't have yourself. If parenting feels overwhelming in ways that go beyond typical stress, if the challenges your child has feel uncomfortably familiar, if you're struggling to implement strategies because your own executive function is a mess, get evaluated. Get into therapy. Get the support you need.

Taking Action

If your child is on medication but still struggling with concerning behaviors, contact your child's doctor with documentation of what you're seeing: when behaviors happen, what leads up to them, how long they last, and what helps your child calm down. That information helps professionals identify patterns and determine if comorbid conditions need evaluation or if medication needs adjustment.

Get your child into appropriate therapy. For kids under 10, that means neurodivergent-affirming play therapy and potentially occupational therapy. For older kids and teenagers, CBT or DBT with a therapist experienced in ADHD and autism. Don't wait to see if behaviors improve on their own—therapy teaches the skills medication can't provide, and the earlier you start, the better.

Get yourself into parent coaching and your own therapy. Parent coaching gives you the framework to support your child effectively. Your own therapy gives you the support you need to stay regulated and functional. If you haven't been evaluated for ADHD or autism yourself, do it. The support you need matters as much as the support your child needs.

Comprehensive neurodivergent treatment means multiple pieces working in coordination. Medication creates the foundation, therapy builds the skills, parent coaching ensures the home environment supports everything that's happening, and your own support makes it possible for you to show up consistently. Your child needs the full support system, and so do you.

If you're feeling overwhelmed trying to figure out where to start or what your child actually needs, I can help. I work with parents to understand their specific situation, identify what's missing from their current approach, and create a plan that actually addresses what's happening in their family. Set up a Free Discovery Call and we can talk through what you're dealing with, what comprehensive treatment looks like for your child, and how parent coaching can give you the tools to support them effectively. You don't have to figure this out alone.