Rethinking Children’s Diagnoses – Anxiety Disorders, ADHD, Behavioral Issues
When a child struggles with anxiety, Attention-Deficit/Hyperactivity Disorder (ADHD), or behavioral issues, the natural response is often to focus on the child—diagnosing the problem and teaching skills to manage symptoms. While these approaches can be helpful, they sometimes overlook a key factor: children do not exist in isolation. Their emotions and behaviors are deeply connected to their environment, relationships, and daily lives. Instead of seeing a child’s struggles as purely individual, it can be helpful to take a broader view, considering the role of family dynamics, school environment, and emotional atmosphere at home.
For example, a child experiencing intense anxiety may not just have an anxious temperament—they might be reacting to stress in their surroundings, family tension, or unspoken worries at home. Research indicates children are highly sensitive to parental stress, which can contribute to anxiety or behavioral problems within the child (VanderValk, et al., 2007). Similarly, a child acting out at school may not simply have behavioral difficulties but could be struggling with inconsistent routines, challenges in communication, or difficulty expressing emotions in a healthy way. Studies have found that chaotic household environments and inconsistent parenting practices can exacerbate ADHD symptoms and behavioral issues, while structured routines and a supportive environment can help mitigate them (Einziger & Berger, 2022).
Instead of asking, “How do we fix this child?” a more helpful question might be, “How can we create a supportive environment that helps this child thrive?” This shift in perspective is powerful because children are often observing and mirroring the emotional environment around them. A child’s anxiety may decrease when parental stress is reduced. Attention and focus can improve when daily routines become more structured and predictable. Rather than placing all responsibility on the child to change, we can look at how adjustments in their environment, such as at home, at school, and in relationships, can make a meaningful difference.
Some ways family therapy can help support a child’s emotional well-being include:
- Reframing Behavior: Seeing challenging behaviors as communication rather than defiance. For example, instead of punishing a child for refusing to do homework, recognizing that they may be feeling overwhelmed and helping them break the task into smaller steps can encourage cooperation.
- Parental Modeling: Learning how adult stress levels and reactions impact a child’s ability to self-regulate. A parent who practices deep breathing and models calm responses during stressful moments teaches their child effective ways to manage emotions.
- Creating Balanced Routines: Providing consistency to help children feel safe and secure. Establishing daily routines can help a child feel more at ease. However, rigid or overly strict routines can also sometimes be damaging, leading to anxiety or distress. Finding a balance between structure and adaptability ensures that routines support a child’s well-being rather than become a source of stress.
- Building Emotional Connection: Creating intentional moments of support, understanding, and reassurance. Taking five minutes each day to check in with a child about their feelings, without distractions, can strengthen trust and emotional security.
For example, imagine an eight-year-old struggling with anxiety—experiencing frequent stomachaches and difficulty sleeping. Traditional approaches might focus on helping the child manage their worries through coping skills, but a broader perspective considers the whole picture. It may turn out that the family is under stress due to financial concerns or busy schedules, leading to an emotionally tense home environment. By working to improve communication, strengthen connections, and establish comforting routines, the child’s anxiety may naturally decrease—without placing the burden on them alone to “fix” their feelings.
Similarly, consider a 10-year-old who frequently disrupts class and refuses to follow directions. A common response might be to focus on discipline strategies or social skills training. By looking at the bigger picture, we might find the child has recently experienced a major life transition—a divorce, a move, or changes in caregiving routines—which has led to feelings of instability. By creating consistency, offering reassurance, and making space for the child to express their emotions in a safe way, their behavior may naturally improve.
Rather than focusing on one individual as the “problem,” family therapy views problems as relational, helping everyone understand their role in the family system and how their behaviors impact those around them. It is a collaborative process involving multiple family members working together with a therapist to improve communication, resolve conflicts, and create a more supportive home environment. Sessions typically include open discussions about family dynamics, patterns of interaction, and challenges that may be contributing to a child’s emotional or behavioral difficulties. Parents may become more aware of how their own reactions and stress levels affect their child’s well-being, while children gain a space to express their emotions in a safe and structured environment, often receiving the validation they have been craving. The therapist helps guide these conversations in a way that allows each family member to share their experiences and perspectives in a safe, nonjudgmental space.
Children don’t exist in isolation. When we move beyond simply managing symptoms and instead focus on improving the environment around them, we set them up for long-term success. A child who feels safe, heard, and emotionally connected is far more likely to develop confidence and resilience—not because they’ve been “fixed,” but because they’ve been supported in a way that allows them to thrive.
Article by: Melissa Robinson, MFT Intern, Charlotte, NC
Melissa Robinson – Melissa Robinson (she/her) is a graduate student at Capella University working towards her Masters in Marriage and Family Therapy. She believes one of her best therapeutic tools is her own lived experiences, much of which involved sitting right where you will be sitting when you meet with her. Melissa understands the feelings of loneliness, shame, guilt, and fear- the feeling that something may be ‘wrong’ or perhaps healing isn’t possible.
Works Cited
Einziger, Tzlil, & Berger, Andrea. Individual differences in sensitivity to positive home environment among children “at risk” for attention-deficit/hyperactivity disorder: A review. Frontiers Psychiatry, 2022. Volume 13. https://doi.org/10.3389/fpsyt.2022.927411
Lees, Vera, Hay, Rosie, Bould, Helen, Kwong, Alex S. F., Major-Smith, Daniel, Kounali, Daphne, & Pearson, Rebecca M. The impact of routines on emotional and behavioral difficulties in children and on parental anxiety during COVID-19. Frontiers in Child and Adolescent Psychiatry, 2023. Volume 2. https://www.frontiersin.org/journals/child-and-adolescent-psychiatry/articles/10.3389/frcha.2023.1114850
