In this chapter, I use a transdiagnostic approach to describe family relationships of children and adolescents with neurodevelopmental disorders (NDs). I provide a model that describes the associations between family dynamics and child and parent characteristics, parent cognitions and affect, social supports, positive and negative parenting behaviors, and child outcomes. I use two case studies to illustrate the components of the model and to elucidate factors associated with family resilience. Consistent with the model, the research shows that ND symptoms and the challenges that ND youth have with self-regulation, adaptive skills, academic achievement, and social skills are risk factors for parenting stress, parent-adolescent conflict, and negative parenting behaviors that, in turn, exacerbate their children’s difficulties. The risks due to child ND are increased when parents also have an ND or mental health challenges such as depression, have biased causal attributions for their children’s challenging behaviors, have limited financial resources, do not speak the societal language, and have inadequate social support. Although NDs in children are clearly a risk factor for problematic family relationships, some families of ND children are resilient. These families are cohesive and access support from extended family, friends, and the community.