Q: My highly intelligent 16-year-old daughter was diagnosed this year with attention-deficit/hyperactivity disorder. We are seeing a therapist who has suggested ways that we and the school can support her, but she is rejecting all of them. She acts very agreeably in the therapist’s office but then refuses to cooperate with any of the suggested coping strategies. No matter how gently we try to persuade her, she turns sarcastic and even hostile. I’m not sure where we should go from here. If she is not motivated to work on things, should we just back off? I’d hate to see her waste her potential because she refuses to avail herself of help.

A: Oh, man, you have all my compassion on this one. It’s tough. It is obvious that you care deeply, because all of your family is going to therapy. Good for you. Let’s take a look at what could be going on and how to help your daughter.

To begin, you mention that your daughter is “highly intelligent,” so my first question: Is she gifted?

Although most parents will boast about their gifted children on the playground, the fact is that being gifted is a special need. There are significant challenges in parenting and educating many gifted children. These children tend to mature more slowly, be more sensitive and often have symptoms that mimic ADHD. Or they truly have ADHD or other executive-functioning issues. What our culture often forgets (or doesn’t know) is that a high IQ does not necessarily correlate with emotional maturity or intelligence. Children with powerful brains are often burdened with weak emotional regulation. So it can be stressful to live this way.

We also know that children who have endured years of ADHD without proper treatment are far more susceptible to depression, anxiety and poor self-esteem, and those issues can lead to substance abuse, cutting and other self-harming behaviors. It is so isolating to be bright and yet not have your brain work the way you want it to. It is likely that your daughter has been watching her peers seemingly sail along while she may have been struggling with basic tasks and basic organization. Although one part of her brain understands deeper and more complex ideas, the other part of her brain cannot keep everything on track. The frustration that comes from this disconnect is overwhelming, and if this frustration goes on for years, the heart hardens.

Imagine her heart, strong and healthy. And then imagine that life keeps hurting and wounding her (emotionally speaking). Her brain slowly and purposely begins to build a wall around her heart to protect her from feeling pain and failure and loss. She will smile and go along to get along, but inside this wall is strong and thick.

The saddest part about the wall? It keeps out the bad and the good.

So here you are, finally arriving at a potentially lifesaving diagnosis for her. Awesome. But how can your daughter receive this help? How can your almost-grown daughter render herself vulnerable enough to see these fixes and techniques as good for her? Her brain is saying: “Nope. I do not trust this. This is not safe, and we are not trying it.” The brain will powerfully hold on to what it knows, even if it is hurting us. This is not a dysfunction, per se. Her brain is doing exactly what it should be doing when faced with chronic suffering and frustration and alarm.

So first: She is not wasting her potential. If anything, she has survived her brain, and nothing has been wasted. She can feel you pushing her to get with the program, and she is going to push back. Hard. After all, she has spent her entire life like this, and now she needs to change? Why? She doesn’t trust you or this therapist, so back off.

What do you do instead? Your connection with her needs to be rebuilt.

I would focus solely on being in each other’s orbit with talk of school and learning strategies. Because she is so resistant, I would plan mini-getaways with her (it doesn’t have to be expensive or extravagant) where you have — are you ready for this? — fun. Lots of laughter, silliness, sleeping, eating delicious food and relaxing. Be creative and make this whatever will bring joy. Swimming, hiking, seeing a beach or lake or mountains, horses, dance, music, art, shopping — anything.

Why am I telling you to have fun in the midst of a crisis? Because that wall around her heart is not coming down with a wrecking ball; it will need to be chipped away with a tiny hammer. Laughter and ease provide the brain with relaxation, and when the brain is relaxed, it can begin to feel safe. And when the brain feels safe, the heart can feel vulnerable. This is not an overnight process, and, yes, she still has to go to school and try. But in the moments you are together, let it be easy.

You also should get a therapist just for her. I don’t know whether she has depression or anxiety (which can show up as hostility), but she needs a safe place to sort through her big feelings. And it should not be the therapist you are all seeing, by the way. She should have one all to herself so she can build trust with someone new.

I know my advice will feel counterintuitive in our push-push-push culture, but trust in your daughter a little. The more you push, the more she is refusing your help. So ease up, knowing that your connection with her is ultimately more important than her potential.

Good luck.

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