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When Traits Run in Families: Family Therapy for Neurodiverse Families

  • 5 days ago
  • 5 min read

By Harry Motro Clinical Director, Neurodiverse Couples Counseling Centerc


Mosaic shows people connected by colorful lines to a tree-like figure, with text: Weaving Connections: A mosaic of neurodiverse minds.

It often starts with a child. 

A school raises concerns. 

A clinician names what’s been going on. 

And suddenly the family has a word for something they’ve been wrestling with for years: autism, ADHD, or both.


Then something else happens—quietly, but powerfully.


A parent starts recognizing themselves in the description. 

Not in a dramatic way. 

In a “this explains my whole life” way.


And then the family zooms out.


A sibling who has always been intense and rigid about routines. 

A grandparent who melts down when plans change, but calls it “just being practical.” 

An uncle who disappears for months, then reappears like nothing happened. 

A family culture that labels differences as laziness, selfishness, attitude, disrespect, or “you’re too sensitive.”


This is one reason neurodiverse families feel so exhausted. 

They’re not only managing nervous systems. 

They’re managing interpretations. 

And those interpretations become the story everyone lives inside.


If you want the science behind why this pattern shows up across generations—heritability, sibling recurrence, AuDHD overlap—read our deeper dive: The Genetic Ripple Effect ([Genetic Ripple Effect blog link]).


The blunt truth

Sometimes individual therapy helps a person feel steadier, but the home stays chaotic. 

Sometimes, couples therapy helps two people communicate better, but the family system keeps re-triggering the same fights.


That’s not failure. 

That’s a mismatch in what’s being treated.


If the pain lives in the family system, you have to work with the family.


The science behind “it’s all over the family”

Here’s what many families don’t hear clearly enough: neurodiversity often clusters in families.


In a large prospective, international “younger sibling” research network, about 1 in 5 younger siblings of an autistic child developed autism as well. (PMC) And when there’s more than one older autistic sibling, the recurrence rate is higher—around 37% in those multiplex families. (PMC) Population-based research also shows autism risk is substantially higher in siblings, and still elevated in cousins, reflecting real genetic and family-system clustering. (PMC)


ADHD shows a similar “runs in the family” pattern. 


Twin research consistently estimates ADHD is highly heritable (often around the mid-70% range). (Nature) And large registry studies show strong familial aggregation in siblings. (PubMed)


So when families say, “Once we saw it in our kid, we started seeing it everywhere,” they’re not being dramatic. 

They’re noticing something real.


(If you want a clearer explanation of what those numbers actually mean—and what they do not mean—read The Genetic Ripple Effect here: [Genetic Ripple Effect blog link].)



Why this matters clinically

If neurodiversity is woven through the family tree, then the family’s habits, roles, and “default interpretations” get shaped around it.


Here’s what that looks like in real life:

One person functions by deep focus and routine, and gets labeled controlling. Another person functions by urgency and stimulation, and gets labeled irresponsible. A child melts down from sensory overload, and gets punished for “attitude.” A parent is chronically maxed out, and everyone assumes they’re angry or cold. Grandparents mean well, but invalidate neurodiversity and unintentionally intensify shame.


The family isn’t lacking love. 

They’re lacking a shared map.


Our model at Neurodiverse Couples Counseling Center

We use what we call an orchestrated family approach.


Not “everyone in therapy forever.” 

Not “let’s drag the whole family into a room and hope for insight.” 

And definitely not “let’s blame the identified patient.”


Instead, we work like this:

Step 1: Start with the couple (the anchor)

We typically begin with the couple because the couple is the hub. If the hub is dysregulated, everything spins off.


In this phase we:

Build a shared language for what’s happening in the home. Identify the repeating loops (the fight beneath the fight). Clarify differences in nervous system needs, pacing, and communication. Create a realistic home plan for transitions, conflict, and repair.


This is where many families finally stop asking, “Who’s the problem?” And start asking, “What’s the pattern?”


Step 2: Expand outward (the right people, at the right time)

Then we add people when it’s clinically useful.


That can include:

  • Kids (young kids, teens, adult kids) 

  • Parents and step-parents 

  • Siblings 

  • Co-parents in blended situations

  • Sometimes extended family (aunt/uncle/grandparent), when they’re a major driver of stress or misunderstanding


This isn’t about attendance


Step 3: Invitation-only, with a private on-ramp

Let’s say this plainly: bringing a family member into therapy can feel intimidating.


People worry:

“They’ll judge me.” 

“They’ll gang up on me.” 

“I’ll get blamed.” 

“I’ll get exposed.” 

“I don’t even know what to say.”


So we do it differently.


Any new family member is invitation-only. And they meet with the therapist individually first.


That first meeting is about safety, context, and voice. It’s where they get to say what they’ve been holding back—without being interrupted, corrected, or pathologized.

Only after that do we consider joint sessions, and only if it actually serves the goals.


Step 4: One lead clinician orchestrates the plan

Many families already have support in place.


A child has their own therapist. 

A parent has a coach. 

A teen has a skills group.


Great.


But without coordination, families can end up with:

  • Mixed messages 

  • Competing strategies 

  • Different “truths” in different rooms 

  • Accidental undermining of progress at home.


So we provide one primary clinician who holds the big picture. That clinician helps the family align the work so the home environment becomes coherent instead of chaotic.


What changes when the system is treated

When family therapy is done well in neurodiverse families, you start seeing shifts like:


Less blame and more accuracy 

Fewer explosions because triggers are anticipated earlier 

Better transitions because the family plans for nervous systems, not just schedules 

Fewer “character verdicts” (“lazy,” “dramatic,” “cold,” “controlling”) 

More repair after conflict, not just avoidance or escalation 

Kids feeling less like the family problem and more like part of the family solution


And over time, the biggest win is this:


The family becomes safer for everyone’s brain.


Ready to explore this?


If you’re realizing “this isn’t just one person,” you’re probably right.




 

Harry name in script. Resonance breathing therapy

Harry Motro



© 2025 New Path Family of Therapy Centers Inc. All rights reserved. No portion of these statements may be reproduced, redistributed, or used in any form without explicit written permission from the New Path Family of Therapy Centers.



Want to learn more about yourself?

Explore our sister site, Adult Autism Assessment, and take a deeper dive into your journey of self-discovery. Click the links below to get started!



Resources & Further Reading

 

 

Chen, Q., Brikell, I., Lichtenstein, P., Serlachius, E., Kuja-Halkola, R., Sandin, S., Larsson, H., & D’Onofrio, B. M. (2017). Familial aggregation of attention-deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry.

 

 

 

Sandin, S., Lichtenstein, P., Kuja-Halkola, R., Larsson, H., Hultman, C. M., & Reichenberg, A. (2014). The familial risk of autism. JAMA, 311(17), 1770–1777.

 

Neurodiverse Couples Counseling Center. (2026). Integrated neurodiverse family therapy

 

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