Why their son’s ADHD divided these Couples Therapy stars

Fans of the Showtime and Paramount+ series Couples Therapy spent a whole season getting to know Marjorie and Jason Caffrey. One of the most memorable episodes centered on a heated disagreement about their son, Ryan. Marjorie had taken him to the pediatrician for an ADHD evaluation without telling Jason first. Jason felt shut out of a huge decision about their child.

More than a year after their sessions with Dr. Orna Guralnik ended, the couple joins Juice Box host Jessica Shaw on a new couch to talk about where things stand now.

It turns out their reactions to Ryan’s diagnosis have a lot to do with their own stories. Marjorie was diagnosed with ADD in her late 20s, and it helped everything click into place. Jason was diagnosed as a child and put on several medications — a painful experience for him. Same diagnosis, very different memories.

Jessica asks how those histories show up in their parenting today. They talk about why Ryan’s homework turns into a marathon with Mom but not with Dad. They talk about whether to get a second opinion, and why Jason wants to be part of the process this time. And they share how they’re working toward a plan that’s about Ryan, not about them.

Plus: The simple listening exercise from Dr. Orna that the couple calls their North Star, and why they say it applies to their kids, too.

Footage of Couples Therapy courtesy Paramount+.

• Watch: Her daughter wasn’t “defiant.” She had an ADHD skill gap.

• Listen: Managing conflict with a partner with ADHD

Marjorie Caffrey: What is the biggest lesson that's helped us with Ryan that Dr. Orna told us for you and I?

Jason Caffrey: I don't know.

Marjorie: Listening!

Jason: Oh, yeah, yeah.

Marjorie: I'm calling her. Someone call the doctor! Call the doctor!

Jessica Shaw: Fans of the reality TV show "Couples Therapy" will probably remember Marjorie and Jason, who we met in the latest season.

Dr. Orna Guralnik: So what troubles the two of you?

Marjorie: We fight every day.

Jason: Well, we don't fight every day.

Marjorie: Well, we argue every day.

Jason: Well, we have different levels of disagreement.

Jessica: Marjorie and Jason tell Dr. Orna, the couples therapist, that they disagree about politics, they disagree about the role Marjorie's mom should play in their family's life, and about lots of other stuff, too. But one of the biggest conflicts that comes up in the series is their different views on how to help Ryan, their eight-year-old son who's struggling in school and at home.

Jason: Marjorie had an inclination that Ryan, our son, had ADHD. So Marjorie went to a doctor and had him diagnosed.

Marjorie: Didn't go out like that, though.

Jason: And I didn't know.

Marjorie: I didn't go to get him diagnosed. Went to the pediatrician on his yearly eval.

Jason: All I got was hit yesterday with, "Ryan got a diagnosis. They want to put him on medicine, yay or nay." And I lost my mind!

Jessica: As the episode unfolds, we learn that underpinning this heated argument are deeply held beliefs about diagnosis, medication, and parenting. And those beliefs come from their own personal histories. As Leo Tolstoy wrote — and I'm paraphrasing here — no two families are alike in their unhappiness. But I think some version of this argument felt familiar to many of us who have had to navigate this journey with a partner who doesn't always see things the way we do.

It's been over a year since Marjorie and Jason finished working with Dr. Orna, and since the season ended, I've been thinking about these two. Where are they with their son and his diagnosis now? Does conflict still arise? What lessons did they take from Dr. Orna that might help the rest of us with this tricky terrain? I had so many questions, so I asked them.

This is "Everyone Gets a Juicebox." I'm Jessica Shaw.

(02:28) Marjorie and Jason reflect on Ryan's ADHD diagnosis and their initial reactions.

Jessica: Marjorie and Jason Caffrey, thank you so much for being here.

Marjorie: Thank you so much for having us.

Jason: Thanks for having us.

Jessica: What a joy to see you on another couch, though sitting in the reverse order. Just shaking things up, Marjorie and Jason.

Marjorie: We are always shaking it up.

Jessica: Well, we all got to know you on this season of "Couples Therapy," a show I love dearly, on Paramount+, of course. While we were all so invested in your story and your relationship and how Dr. Orna talked to the two of you, there was one episode in particular that really had my ears perk up. It was about your son, Ryan, and an ADHD diagnosis.

So, for anyone who did not see the show, Marjorie, can you just say briefly what happened?

Marjorie: In a nutshell, Jessica, I knew for a while that my son was showing signs of something.

Jessica: What were the things that you were seeing?

Marjorie: Ever since he was in pre-kindergarten, every single teacher's conference, they would always say, "He has a lot of problems focusing. I have to reel his attention back in."

And then I saw it at home — the hyperactivity, he'll forget things all the time. We talked about that on the show.

Jessica: Because you had taken him —

Marjorie: I had taken him, I guess behind his back, to the doctor to get a diagnosis. And I felt safe in front of Orna to bring it up in therapy, and Jason had a reaction.

Jason: Yeah.

Jessica: So, Jason, what was it that bothered you?

Jason: I wasn't upset about him being diagnosed or addressing any of his behaviors. I was more upset that I felt like that is a pretty big decision to make about your child, to have them diagnosed, and I was upset that I wasn't included in that decision-making process. That's basically it.

Jessica: And Marjorie, you took him to a pediatrician. What was the outcome of what the pediatrician said?

Marjorie: I guess there was some sort of assessment, and I wish I remember the name of what it was. And he said, "Yeah, he has ADHD." And that's when they recommended even medication at that time.

Jessica: Jason, I see you having a reaction even just hearing that word.

Jason: Yeah, definitely. It could be particularly because of my experience with being diagnosed.

(05:04) Jason shares his traumatic childhood experience with ADHD diagnosis and medication.

Jessica: Tell us about that, because you were diagnosed as a kid and you talk about it on "Couples Therapy."

Jason: Yes, I had major problems. I had anger problems, focus problems. I can always pass tests without studying. I always had the brain, but I just didn't have the behavior, and it caused me to get in trouble in school.

When you get in trouble at school, you go to the guidance counselor, and then they want you to go get an assessment outside of school. Then you have a file from the child study team, and that file follows you. No matter what school you go to, that file goes with you. So that was my experience with being diagnosed.

Then obviously they gave me medicine. They started me off with Ritalin. I was on Ritalin. Ritalin had some side effects, so then they prescribed Vistaril. And then Vistaril had side effects, so then they prescribed Mellaril.

So now I'm on Ritalin, Vistaril, and Mellaril at seven or eight years old. I remember looking at myself in the mirror, and I remember seeing myself very thin, bags under my eyes, very sedated-like. My appetite wasn't good, and it was a really bad experience for me.

And then I just remember one time my father — he wasn't really in my life, but this one particular time when I was that age, I was on the phone with him, and he knew that I was being prescribed that, and he told me to spit it out, don't take it. I remember spitting this medicine out over the side of my porch at my house into the bushes, and never took it again. And then I never went on any medicine after that. That was like seven or eight years old, you know?

Jessica: Jason, that is a very powerful story. In the moment while you were shooting with Dr. Orna, do you feel like that came up as well? It was one thing of Marjorie not telling you, and another part of it was tapping into this part of your childhood?

Jason: It's experience. It's something I lived through, right? I lived through that. So hearing this situation with my son and Marjorie and the diagnosis, it reminds me a little bit of my experience with life, you know?

But I was really upset that she didn't include me because I thought that I could add to that diagnosis and add to his treatment. Pretty valuable. I feel like my perception and my goal and what I want for him, and the way that I would do it, I feel like I would add to it. And I feel like I didn't get the chance to add to it. I was just cut out.

Because this is important. We're talking medicine here. We're talking his life, his behaviors. This needs to be handled with the utmost care and have to be properly researched. It's not a willy-nilly thing. This is serious, you know?

(07:54) Marjorie reflects on Jason's personal growth and explains her perspective on seeking help.

Jessica: Marjorie, what do you think when he says that?

Marjorie: You want to know my honest reaction hearing him talk? I am thinking like, what a different man I married now talking than even a year and a half, two years ago. Because if I had that man a year and a half, two years ago, that never would have happened. I would have been not as frightened to come talk to him.

So that's my honest reaction. I'm really impressed and I feel that's great. But honestly, I feel so terrible that I maybe did it the way I did. But I was just a mom trying to — I knew what he had. The conversations at home were like, "He doesn't have it," completely denial, dismissing anything. "You're a nurse, you're not a doctor."

And honestly, I really wanted an official diagnosis because it's one thing for a mom to just think you have it. No, I wanted an official diagnosis because it will help him also in school. It helps him if he needs a little bit longer for test-taking. This kid is smart. Our son is as smart as a whip.

But why not give him the tools for success if they're there? Even if it's not medication, I compromise. I said, "All right, let's try it without meds first and see." And you know what? He's doing great. He hasn't been on meds, and he's doing great.

If we ever at the time think that he does, because as he gets older, it's fluid. Who knows what's going to happen with this behavior.

Jason: I definitely feel like there should be a progression. There should be identifying the behavior, finding the proper person to help us navigate through that, maybe do some behavioral things. Maybe he meets with a therapist once a week. Maybe he learns some tools and some coping skills how to do that kind of stuff.

And medication is reserved for the last resort. I mean, this is just my opinion. I think you should exhaust all avenues before you introduce the substance. That's not to say that doesn't do wonders for people, and that doesn't say that I'm totally against it. I just feel like some things should be done first, you know?

Marjorie: I mean, that's valid, hearing we just heard your experience with it. So I totally understand where you come from. See, I got diagnosed —

(10:16) Marjorie shares her experience of being diagnosed with ADHD as an adult.

Jessica: I was just going to ask you, because, Marjorie, I think it's so interesting to hear just the different ways that how we were raised and our childhood, and whether or not we as parents got diagnoses, how that impacts our parenting or even what we see in our child. You got diagnosed with ADD as an adult.

Marjorie: Correct, in my late twenties. I always just thought I was impatient. Like, "Oh God, I can't do this. I don't want to do that."

When the doctor talked to me about it and I got that diagnosis, oh, it all kind of clicked. The difference between Jason and I, Jason was the focus in his family. He was the problem child, right? And then he was the child that developed addiction and all of this stuff, and you think that maybe because that was the ADHD.

That was completely the opposite of mine. My mother still thinks to this day that I self-diagnosed myself, because she says I was fine as a kid.

Jason: I've seen ADD come clean out of her before, plenty of times. We'd be food shopping, spend the whole time shopping, filling the cart up. And then we get online and there's a long line, so there's some waiting involved. She couldn't cope with that waiting, and we ended up abandoning the entire shopping cart right in the aisle.

Marjorie: Not my finest moment, but I suffer from ADD, amongst other —

Jason: She's gotten better, though.

Marjorie: Amongst other things! So after that diagnosis, I started therapy because I needed to figure that out. How can I manage this a little bit better? It's affecting my life. It's affecting me raising two babies, two baby girls at the time. So I went to therapy. I had an amazing therapist, and she also was helping me through my first divorce and —

Jason: Heather?

Marjorie: Yeah, she was amazing. So she really helped me through that after that diagnosis.

Jessica: I think it's so interesting what — I mean, we all as parents bring our life experience to something. But Ryan is in the middle and he has this diagnosis, and, Jason, you have your own experience with getting a diagnosis, which is involved with a lot of trauma and intertwined with a lot of trauma, and it's a negative thing. And Marjorie, you have your experience with a diagnosis that is like all light. It opened things up for you. It ultimately led to you getting out of a bad relationship. It improved your life so much.

Those are such opposites. And then here you have Ryan getting it, and do you feel like you just brought your own experience and bias — I don't mean bias in a bad way, but just we all have bias — as far as what you went through to hearing about his ADHD?

Marjorie: Talking it out loud, yes. Hearing it out loud, that's exactly what we did.

Jason: What you said is great, because she is a little bit of projecting her onto that, and I'm also projecting a little me onto that. So I guess the trick is how do we come to the middle and come up with Ryan's process — not mine, not hers, but Ryan's process?

Marjorie: He needs a treatment plan. Really, he does. He would need a treatment plan, because what worked for you or didn't work for you, really, and what works for me — Ryan's different. Every little kid is different, and they need their own plan.

(13:46) Comparing how Ryan's ADHD manifests differently with each parent.

Jessica: How do you see, Jason, his ADHD manifest at home?

Jason: With me, not too much with me, more with her. And I also see him kind of — he's sometimes a little forgetful. He forgets he leaves something somewhere. His temper tantrums with Marjorie, not with me so much. I do see that behavior. I do see a little anger problem with him, a little bit with her. And that's about it. But as far as like —

Marjorie: With her! It's all her fault!

Jason: No, it's just weird, it's like —

Marjorie: But don't forget that also interacting with other people, you see it. It's not — he's just very different with you.

Jason: With me, it's just different. I don't know what it is. But I know that I had a little joke. I said, "If he ever reminds me of myself, he will be in the car and we will be going somewhere immediately, because his behavior can't be like my behavior was, because that behavior almost killed me."

So it's very important that he doesn't remind me of myself in that area.

Marjorie: And we talked about that. He looks — he also pins Ryan's behavior against what he presented as a kid.

Jessica: Does Ryan remind you of you?

Jason: He does, but thank God, not as intense. Not in the negative ways. He reminds me of his ability to focus when he needs to. He can hyperfocus, because that's one of my superpowers of doing that. So he reminds me of that. And he also reminds me of the way that he treats you, how I treated my mom, kind of.

Marjorie: It's funny, his mom laughs when she hears stories about Ryan. When he's like, "Oh, you know what Ryan did?" She laughs. She's like, "Haha, it's your turn now! It's your turn now!"

Jason: Yeah, because I put her through the wringer.

Marjorie: And I said, "What did I do as a child that it's my turn now?"

Jessica: Do you see yourself in Ryan as far as ADD and stuff?

Marjorie: I don't, because mine is so different. It's just so different. I don't. I see Jason. I see Jason and I get worried. Honestly, because I know your stories and I know that type of childhood Jason had led him to wrong friends, drugs, heroin, almost died.

So — 20 years clean in six days, by the way, okay? Huge! I'm so proud of him for that.

So I get — I'm really worried. As a former ER nurse, I'm worried for Ryan in the future. But I will do everything I can. I'm trying to do everything I can in my power to make sure he has a great childhood and good friends around him.

Jessica: Right, which is — yes, which is very interesting, because do you think your ADHD diagnosis was accurate as a kid?

Jason: Yes, but I feel like I developed it from trauma. It wasn't like I had a peaceful, happy home and all of a sudden I just had trouble in school and behavior problems. I think that my behavior problems — because I put my mother through the wringer, too — was due to trauma: the broken home, no father, seeing my mother upset. All that kind of stuff contributed to my misbehavior.

Jessica: So it sounds like you equate these two things: misbehavior, ADHD.

Jason: Yes.

Marjorie: That's interesting. That's exactly —

Jason: But that's my experience. I know other people have other kinds of symptoms, like loss of focus and daydream and things like that, or forgetful. My experience with it was more like I chose not to focus on the things I need to focus on. I chose to focus on the things that I shouldn't be focusing on, you know?

(17:40) Navigating daily challenges like homework and differing parenting styles.

Jessica: What is day-to-day with Ryan when he shows some behavior, let's say, that Marjorie, you think is definitely ADHD, Jason, you're like, "Not so sure that's ADHD, that's just him misbehaving"? How do you navigate that situation?

Marjorie: We struggle. It's not easy!

Jason: I hear her screaming in the other room. She's screaming in the other room, going, "What is going on here?" And then I have to get up and go, "What is going on here? Okay, you stop that, and you stop that, and let's stop this," you know?

Marjorie: I have an example. Doing homework. I cannot sit there with him after school and do his homework, or even in the evening after dinner if we let him do it then. It has to be Jason.

I know because it's his ADHD. Like three pages, three worksheets for school for second grade or whatever, third grade, will take over an hour. And it's this: "I have to get a new pencil," and then up and down. And then, "Oh, no, no, I just want to get a snack." And then he gets up, and then he gets down. And then he's doing this, not doing what he has to do.

Meanwhile, it's like five questions on the page, and I get frustrated. I get so frustrated! And he will be able to handle it, but it still takes time.

Jason: That's another example of the behavior with you is different than the behavior with me, because he'll do that with her. He'll lollygag, he'll not pay attention. But with me, I will label: "1, 2, 3, 4, 5. Do it."

And then he ends up doing it, and we're done and we're out of there. But with them, it is a rigmarole. It is a scene, you know? So I don't know —

Marjorie: But I'm not alone. I have had conversations with my friends whose kids have, and they are like, "I have the same issue. I cannot do homework. I cannot sit there and do homework with them." But, you know, some have more patience than I do. This is where I guess my diagnosis comes in and I'm like, "I'm out of here."

Jason: Hearing all that, how the behavior is different, and then when I look at myself, I'm wondering if my dad was there, that would be effective to me when I was Ryan's age? You know what I mean?

Jessica: That's very intense.

Jason: And I wonder if that's true. Because when I'm there, he does his stuff, and when he kind of runs mom through the blender. Then I think back into myself, "Wow, was I like that? I wonder if my dad was there, if I would have listened to him, too?" Could be a chance, but it's in the past, so what are you going to do?

Jessica: It's so hard, because I think as parents we project so much about our childhood and our lives onto our kids. And we also do the reverse, Jason, like you were saying. We look at our kid and we have their behavior or diagnosis or whatever inform how we think about our own childhoods also.

Jason: Yes. It's like a whole learning process. It's a circle.

Jessica: It really is.

Marjorie: And even just sitting here having these conversations with you, light bulbs start going off. Just having conversations about it, like, "Oh, yeah, maybe it was this time. Oh, I could have done a little bit differently."

Everybody's special, and Ryan is a special little boy. And I guess I am bringing a lot of my stuff into him — sorry about that — stuff into his little life. And you are, too.

(21:06) Discussing future steps, second opinions, and key lessons from therapy.

Jessica: So you said earlier that you thought about getting a different evaluation or someone, an expert or whatever. Did you, Jason, ever want — since the show aired and everything, did you seek that out? Or how do you feel about his diagnosis now?

Jason: The whole situation after the show kind of got tabled. We're still aware of it, and we still are paying attention to his behaviors. And super sensitive where if we see something that he's doing like, and we need to really turn that up and go down that road again, we're ready.

Marjorie: I do think this: I do think he may still be a little denial with the diagnosis because it's not from someone — it's his pediatrician. So, and that's fine. I know we have it, and if you want to go seek somebody else out, you know I will. But you do it! I did my part.

Jason: It could be a great idea. We just have to pull the trigger. We have to find the guy and pull the trigger, and just do it.

Marjorie: I'm happy that I got a diagnosis from a physician, but if you really wanted a second opinion diagnosis, I'm on board with that. You know I am, but you can do the homework and find it yourself.

Jason: Yeah, I mean —

Jessica: Do you want one? A second opinion?

Jason: Well, I wouldn't mind one, being involved in the process. But I wouldn't want it because I'm trying to prove the first guy wrong or something like that. I would want it because now I'd be included in the process this time.

Jessica: Has there been something that you, in your communication about Ryan and about ADHD, that you feel like you took from things that Dr. Orna said about how to relate and how to talk and how to communicate and how to navigate challenging situations?

Jason: I would say we definitely learned a lot there. It's kind of — I mean, obviously, it's a small period of time, but it was very concentrated. So then now as time goes on, we're processing what happened then and starting to apply some of these things. It works.

Marjorie: What's the biggest lesson that's helped us with Ryan that Dr. Orna told us for you and I?

Jason: I don't know.

Marjorie: Listening!

Jason: Oh, yeah, yeah.

Marjorie: I'm calling her. Someone call the doctor! Call the doctor! We have to listen to Ryan, too.

Jason: Oh, yeah. That's definitely a major lesson.

Marjorie: So we have to start listening to Ryan, and I think we do, but we need to do more of that. Because he has a voice, he has an opinion, and we oftentimes — I know me, I get annoyed with him very easily and I don't listen to him.

Just like I did with Jason, shut down when I don't want to hear his nonsense. A seven-year-old, eight-year-old, nine-year-old is going to have nonsense, too, but I have to listen to him more. We have to take that more in with him, even with the girls.

Jason: Yeah. I think we have been.

Marjorie: I think so, too. But we're saying it now out loud, it makes sense that we have, but we could do a better job with that.

Jason: Yeah.

Jessica: Is there anything you feel like that with Dr. Orna that you were like, for the two of you, was there something that you said, "This is our relationship North Star," or, "This is something that like, ignoring that"?

Jason: Well, kind of like with the listening, because she had did an exercise with us where the other person was supposed to just listen and then repeat back what the other person said, instead of formulating a response as the other person was talking, which we have a huge problem doing that.

But ever since we went there, when we actually practice that, listening and not formulating a response, things get good. Things get better. We hear each other. So I would say that that would be probably the North Star in the situation.

Marjorie: She saved our marriage. I think, 100%, she saved our marriage. I was going there for therapy with my husband, like I was really about to pull the plug. On top of having a rambunctious kid at home, can you imagine? All of this and a rambunctious kid!

It was a lot, and she just gave us so many tools that we will always take with us.

Jessica: I loved watching you on the show. I'm ride-or-die for "Couples Therapy." It's really so nice to talk to both of you about your experience and also about Ryan and about parenting. And I wish you a very good third-grade year.

Marjorie: Yes! Your lips to God's ears.

Jason: I'm excited. I can't wait to what it brings.

Marjorie: To be continued. Let's see what happens with him. I think he'll do great.

(25:48) Jessica reflects on Marjorie and Jason's progress and closes the episode.

Jessica: It's extraordinary to me that in such a short, concentrated amount of time with Dr. Orna, Marjorie and Jason were able to reshape their relationship and break down so many walls. They obviously still have disagreements — all couples do — even about how to approach their son's diagnosis. But it's remarkable how different this conversation was from what we all saw in "Couples Therapy." I absolutely loved hanging out with them.

Now I'm curious to hear from you. If you're co-parenting a neurodivergent kid, how do you get on the same page? What have been the sticking points, and what strategies have worked?

That's it for this episode of "Everyone Gets a Juicebox." See you in two weeks.

Thanks for listening to "Everyone Gets a Juicebox." The show is hosted by me, Jessica Shaw. It's produced by Julie Subrin, and Anna Rothschild is our senior podcast producer. Video is produced by Max MacKenzie and edited by Lance Johnson. Our associate director of content development is Calvin Knie. Briana Berry is our production director, and Neal Drumming is our editorial director.

If you have any questions for us or ideas for future episodes, write me an email or send a voice memo to podcast@understood.org.

This show is brought to you by Understood.org. Our executive directors are Laura Key, Scott Cocchiere, and Jordan Davidson.

Understood is a nonprofit organization dedicated to empowering people navigating neurodivergence. If you want to help us continue this work, donate at understood.org/give.

That's it for this episode of "Everyone Gets a Juicebox." Subscribe or follow the show so you never miss a conversation, and send this one to someone who needs to hear it.