When a Child’s Diagnosis Is an Injury to the Self

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In my private practice, I support many parents on their journeys after their child receives an autism or attention-deficit/hyperactivity disorder (ADHD) diagnosis. Reactions are varied and can often bring relief in the validation of a hunch that a parent already had. Depending on the level of impact on the child's development, there may be grief in the loss of an easy life, of goals once thought to be a given: college, marriage, employment, and all the things we have been raised to expect.

A diagnosis entails getting one's mind around an entirely different life that may be full of struggle, and operating within systems that present uphill battles. In addition, the medical and therapeutic community colludes with the idea that the child needs to be fixed. This can add incredible pressure and fear.

But for a subset of parents, the diagnosis itself is taken as an injury to the self. There may be unprocessed trauma and ways in which one's own struggles were not embraced and where we hold "bad parts" of our self that are now exemplified in our children and must be rejected. When we have parts of ourselves that weren't deemed acceptable or lovable to our own parents, we can repress and then project these parts onto our children. The intergenerational transmission of trauma is the handing down of these disowned parts through a process called projective identification.

As infants, we cannot differentiate what comes from inside and outside the self. Projective identification, originally coined by Melanie Klein, involves a lack of a stable psychological boundary between the self and the world. In a projective identification process, the person projects internal objects (parental figures) and unwanted experiences or aspects of the self and then induces the other to take on those aspects and behave like those objects.

This process becomes a self-fulfilling prophecy. As psychoanalyst Thomas Helscher states,

“The point of projective identification is that it is a primitive defense designed to deal with overwhelming and psychically threatening feelings and perceptions by a phantasy of unloading them into someone else.”

Dan and Ally were a couple in my practice with an 8-year-old autistic son, James. Ally tended to see their son's struggles and could hold them with an even hand with all his wondrous strengths. Dan had a harder time accepting his son's eccentricities and would minimize and sometimes deny that there was much to acknowledge at all. When an environment was overwhelming, James would "stim" by flapping his hands and making loud vocalizations as a way to manage the incoming sensory overload.

In these moments, Dan's denial could no longer hold, and he would scold James to quiet down. Dan would feel embarrassed by his son's behavior and felt inadequate and helpless that he couldn't help him regulate. Instead, he projected his own shame onto his son, leaving James to feel something was wrong with him.

The struggle in our culture to let children be who they are applies to all parents, not just those with neurodivergent kids. However, this struggle gets amplified with a disabled child because their "imperfections" are more visible. Raising a neurodivergent child brings challenges that are sure to make us insecure in our parenting and raise the likelihood of rejecting aspects of our children. We may feel contempt for those who are less "able" as a projection of our own helplessness.

Culture can play a huge role in making certain traits shameful, adding to the pressure families feel to conform. Where we are wounded is a reflection of the context and culture in which we live and can determine which parts of ourselves go underground.

Julie was a teenage ADHD client. She presented as exuberant and highly creative, with a dark sense of humor and above-average intelligence. Her culture encouraged modesty, however, and being loud and fast-speaking was considered obnoxious. Her mother often complained that Julie wasn't feminine, and she saw her personality as performative rather than her true self.

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This led to frequent lectures and critiques aimed to pressure her daughter into conformity. The high cost of masking one's innate nature is well-researched, and the price this client paid came in frequent depressive episodes and suicidal ideation. Her fear of the loss of her mother's love led to her internal turmoil around meeting her mother's expectations by trying to suppress her true self.

Alice Miller, in her book The Drama of the Gifted Child, elegantly depicts the core needs of the child and the costs of being deprived of a parent who respects and tolerates all the emotions in their children. When a parent is dependent on their child to fulfill their own unmet needs, the child does whatever is in their power to accommodate the parent and secure their love.

The child adapts by disavowing feelings in themselves that may not be acceptable, such as jealousy or anger. Donald Winnicott talked about the development of the "false self" as the accommodation to parental needs, which leads to a sense of emptiness, depression, or, on the flip side, grandiosity, which serves as a defense against depression. When a child senses they are only loved for particular qualities they possess or roles they play for the parent, they may never develop their true sense of self and feel loved for being just as they are.

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Since most of this process is unconscious, what can we do about it as parents?

Mourning what we did not get at the crucial time we needed in childhood is the only way through our unhealed wounds. Doing the work to uncover our own unwanted parts and embracing what has been disavowed within us is a courageous and loving act. Noticing our triggers is one road to observing the places where we may be repressing unwanted parts. What bothers us most in our children is often a good clue as to what may have been exiled in ourselves.

When we are perfectionistic, we may hold our children to the same unrealistic standards we hold for ourselves. When we have contempt for our flaws and defects, they get projected onto others around us. It is the way we disavow the shame of being insufficient, weak, and "inferior."

When we can own our limitations, we no longer need to project them. Self-compassion is one practice that teaches us to be gentle with ourselves and allows us to embrace our common humanity.

Learning to let go of what others think of us is a gift not only to ourselves but to our children. When we are beholden to others' judgments, we may judge or control behavior in our children that we find uncomfortable or embarrassing. Instead of being our child's advocate, we align ourselves with the critical other and betray our connection to our child.

This is long and difficult work. Ideally, we can work with a therapist to unearth our neglected and disowned parts that need nurturing. But even without this resource, our attention to self-reflection and learning to love ourselves can have a meaningful impact on embracing our children.

To find a therapist, visit the Psychology Today Therapy Directory.