ADHD — More Than a Diagnosis

A Psychodynamic Perspective on Working with Children and Teens

When a child cannot sit still, when homework ends in tears, or when emotions escalate quickly and seemingly out of nowhere, the word ADHD often enters the room very fast.

For parents, this moment can feel overwhelming. There are school meetings, evaluations, differing professional opinions, and often a quiet pressure to “do something quickly.” For teenagers, the experience is usually more personal. It can begin to feel as though something about them is fundamentally wrong — too distracted, too intense, too impulsive, too much.

But what if ADHD is not only a condition to be managed?
What if it is also something to be understood?

Looking Beneath the Surface

ADHD is commonly described as a neurodevelopmental condition that affects attention, impulse control, and activity level. And yes, the brain absolutely plays a role.

At the same time, children do not develop in brains alone. They grow within relationships, families, classrooms, and communities. They grow in environments that may be calm or chaotic, attuned or overstimulating, predictable or uncertain.

From a psychodynamic perspective, symptoms are never random. They emerge within a context and often carry meaning. They are expressions of an internal experience that has not yet found words.

When I meet a child or teenager with an ADHD diagnosis, I do not begin by asking, “How do we stop this behavior?” Instead, I begin by wondering, “What might this behavior be trying to communicate?”

When Feelings Move Faster Than Words

Many children and teens with ADHD struggle with regulating their emotions. Their feelings tend to rise quickly and intensely, and there is often not yet enough internal space to hold them long enough to reflect.

Frustration can feel overwhelming. Disappointment may quickly turn into shame. Overstimulation can feel almost like panic. Even closeness and expectations can become emotionally flooding.

When feelings cannot be processed internally, they are often expressed physically. Movement replaces reflection. Impulses replace language. Anger covers more vulnerable emotions such as hurt, fear, or embarrassment.

From the outside, this can look like defiance or lack of discipline. From the inside, it often feels like losing control.

In therapy, we work on gently slowing these moments down. We create enough safety and stability so that feelings can gradually become thinkable instead of explosive. Over time, the child or teenager begins to experience that emotions can be tolerated without immediately acting them out.

Restlessness Is Not Just a Modern Phenomenon

While ADHD is often discussed as a contemporary diagnosis, emotional and motor restlessness in children is not new. Historically, clinicians have observed similar patterns in times of social stress, instability, and collective uncertainty.

This does not mean ADHD is “just emotional,” nor does it dismiss biological factors. Rather, it highlights that development is always biopsychosocial. Biology, attachment experiences, stress exposure, family dynamics, and environment continuously influence one another.

Neuroscience shows us that the brain remains shaped by experience. Regulation develops in relationship. This means that while temperament may be given, the capacity to manage emotions can grow over time — especially within consistent, attuned relationships.

Why Boys Are Diagnosed More Frequently

Most ADHD diagnoses are given to boys. Boys often regulate internal tension through movement, physical engagement, and risk-taking. These qualities are not pathological in themselves; they are part of development.

Energy, competition, and even aggression are natural forces in childhood. But these forces require relational containment in order to become organized. Children need adults who can stay steady in the face of intensity — who can provide limits without humiliation and closeness without withdrawal.

When strong impulses do not find relational structure, they can become disorganized, either erupting outward in impulsivity or turning inward in frustration and shame.

In today’s digital world, many overstimulated children retreat into screens, where they experience competence, mastery, and control. While this can temporarily soothe, it does not replace the emotional regulation that develops through embodied, relational interaction.

How I Work with Children and Teens with ADHD

In my practice, I do not focus solely on eliminating ADHD symptoms—instead, my ADHD therapy work centers on understanding the child or teenager behind the diagnosis. Every child with ADHD has a unique emotional story, and psychodynamic therapy allows us to explore what is driving the restlessness, impulsivity, or attention difficulties beneath the surface.

Effective ADHD therapy for children and teens begins with safety — a consistent therapeutic frame, clear and reliable boundaries, and an emotionally steady presence. Children and teens with ADHD often test limits in therapy. They may interrupt, change topics quickly, or challenge structure. I do not interpret this as misbehavior. I see it as communication — an expression of inner restlessness or uncertainty.

Together, we work on strengthening emotional regulation and helping feelings become speakable. When emotions gain language, they become less overwhelming. Anger may reveal embarrassment. Restlessness may uncover anxiety. Defiance may hide a deep fear of failure.

Another important focus is mentalization — the ability to understand oneself and others as having thoughts, feelings, and intentions. Many teenagers with ADHD react quickly because internal and external experiences blur together. In therapy, we gently build the capacity to pause and reflect: What just happened inside me? What might the other person be feeling? What did I need in that moment?

With younger children, play becomes an essential language. In symbolic play, intense emotions can be expressed and explored safely. The therapeutic space allows aggression and competition while holding them within a secure relational frame.

Over time, children often develop a greater tolerance for frustration and a stronger sense of internal control — not because they were forced to behave differently, but because they feel more understood and more organized inside.

What About Medication?

For some children, medication can be helpful and supportive. These decisions are always individual and deserve thoughtful consideration.

At the same time, research has shown that psychodynamic and psychoanalytic therapies can be as effective as behavioral approaches for many children, with or without medication. ADHD is not one uniform story. Behind the same diagnosis, there may be very different developmental pathways and emotional constellations.

This is why I approach each child with curiosity rather than assumptions. I look closely. I listen carefully. I try to understand what this particular child needs.

For Parents

If your child has received an ADHD diagnosis, you may feel relief, confusion, worry, or even guilt. All of these reactions are understandable.

ADHD is not caused by “bad parenting.” Children develop within complex systems of temperament, attachment, stress, and environment. Your child’s behavior is not a reflection of failure. It is information about how they are managing their internal world.

With consistent relational support, emotional regulation can grow. Development is not fixed.

For Teenagers

If you have ADHD, it does not mean you are broken. It may mean your nervous system reacts quickly and intensely. It may mean your mind moves fast and your emotions feel big.

Therapy is not about changing who you are. It is about helping you understand yourself better, so you can feel more in control of your reactions and more confident in your strengths.

A Broader Understanding of ADHD

A purely biological explanation can sometimes feel relieving — “It’s just my brain.” And yes, brain processes are involved. But human development is never only one thing.

From a psychodynamic perspective, body and psyche are deeply connected. Emotional experiences shape neural pathways. Relationships shape regulation. Stress shapes attention.

Restlessness is often a signal — of overload, of unmet needs, of emotional disorganization that has not yet found language.

When we begin to understand the signal instead of fighting it, change becomes possible.

Not through shame.
Not through pressure.
But through relationship.