The "Gifts of ADHD": Transforming Humiliation into Humility

A big obstacle faced by couples dealing with ADHD is denial -- that is, either partner refuses to concede that ADHD exists, that it is causing challenges, or that effective strategies truly exist.

The reasons for denial around ADHD are myriad and complex. For some who arrive at the diagnosis in adulthood, though, it's simple: ADHD feels like one more negative label, right down there with lazy, unmotivated, and careless. The temptation then might be to wholly reject the label and instead cling to a more "positive" spin: ADHD is a gift. In this month's guest post, San Diego-based psychotherapist and ADHD expert Lew Mills, Ph.D., MFT (pictured below), offers a nuanced way to reconcile "gift" and "disorder." I look forward to your comments! -- Gina Pera

(To learn more about denial's psychological and even physiological foundations, check out the August and October 2008 issues of CHADD's Attention magazine, which excerpt my book's chapters on the topic. If you missed these issues, remember that CHADD members can access an online treasure trove of past Attention articles.)


You can always start a debate amongst a group of people with ADHD by asking whether ADHD is a "disorder" or a "difference." Is it a curse or a gift? It's everyone's favorite topic, and everyone has an opinion. Actually, I have two opinions. Like many big questions, the answer lies somewhere not just in the middle but at both ends.

On the positive side, if treated, ADHD doesn't usually have to ruin your life. What's more, there are lots of skills, abilities and characteristics that routinely come with ADHD, and which most people find appealing. This is why in debates about treating children, we always hear warnings about "taking the spark" out of some "Huck Finn" type of child. Never mind that Huck is a fictional character, and that if you had to raise him as your own, you would be a rather frustrated parent. Still, Huck has a charming perspective on the world, a winning way with people and an infectious enthusiasm for life. These qualities often do translate over to the real life people with ADHD.

But at the same time, ADHD is defined by symptoms. In the book of diagnoses, a person doesn't even qualify as having ADHD without "significant impairment." If it doesn't get in your way, it's not ADHD. This is literally "by definition." There also doesn't seem to be a "fully treated" ADHD yet. Treatments are clearly not fully "normalizing." We can just reduce symptoms. Usually a person comes upon the diagnosis because things have been going significantly wrong. The person who is being diagnosed is not naive about what they are up against. Hopeful "gift" sermons might meet with skepticism.

I suspect that virtually always, the person with ADHD has experienced significant shame in their life, about things that they were not able to do, and which came easily to others. One part of the difficulty is that the disorder is largely "hidden." ADHD adults say things like, "If I were in a wheelchair, people would understand how hard I have to try, but nobody gets it with ADHD." Furthermore, the debilitating aspects of ADHD are usually also confusing for the person who has it. As children, we cannot figure out on our own that we are disabled by ADHD. Instead, we erroneously attribute our own behavior to "bad character," lack of motivation, or worse.

Because of this, a central experience of ADHD is humiliation and shame. That sounds harsh, but it is crueler to ignore that, to date, the experience of shame is nearly inevitable. The depth to which our culture condemns the incapacities which ADHD brings remains largely unfathomed.

So why do I insist that ADHD is still "a gift" as well? It could be sentimental compensation for enduring what is clearly a big problem. But I have two other much better reasons.

It does bring gifts. I have frequently heard people with ADHD say that they know they see something in the world that nearly everyone else is missing. I don't think this is just a cheap self-aggrandizement, to make up for their pain. I think it is often true.

There are two more bits of good news here. I don't think that treating the ADHD makes these go away. And second, these really are the gifts that we find idealized in children like Huck Finn, or maybe like Harry Potter. They are hard to explain to the "muggles" who don't live in this wizard's world, but they are intuited and revered there, even as the wizards of ADHD suffer them like a secret scar.

My second reason for seeing ADHD as a gift may be a harder sell. I once quipped, "ADHD is God's way of teaching you humility." I think I came up with this after having to apologize for and explain something that I did which was indeed inexplicable. I slowly realized that there is some benefit in knowing that you can't control all the aspects of your life. This is despite the fact that you would like to and that society demands it of you. You have limits. You make mistakes.

"ADHD has the wickedly strange ability to
force the understanding of our challenges.
With luck, we then turn to studying our strengths."

In these modern times, when the concept of hubris is considered quaint in some quarters, a touch of humility may be a great gift indeed. But the trick, of course, is how to transform experiences of humiliation into the wisdom of humility. Often enough, they instead lead to greater defensiveness, arrogance and the hubris we would like to avoid. I think that the secret is to learn to accept our limitations, even at the moments when everyone else continues to condemn them. With acceptance of our limitations comes a new hope for our realistically appraised capacities.

Nothing takes a person further from him or herself than trying to perfect the challenged parts of him or herself that he or she doesn't understand. And nothing brings a person home as much as discovering his or her true strengths. ADHD has the wickedly strange ability to force the understanding of our challenges. With luck, we then turn to studying our strengths.

As we find our limitations, I think we are also more inclined to find the interdependencies we have with other people. ADHD will enforce asking for help. My personal goal is to say "thank you" at least as many times to those who help me out as I am obligated to say "I'm sorry" to those whom I disappoint. Once a person has to acknowledge that they cannot master everything by themselves, the door is open to seeing how universally we need to consider each other's strengths and challenges. In that, I believe, is a truer dignity than we might have gained otherwise. It can also lead to deeper and more rewarding relationships.

Gift or curse? Sometimes a gift feels like a curse. Sometimes a curse is a gift in hiding.
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Your comments welcome!

Is It "Miscommunications" – or ADHD?

With a warm smile and a kiss, Diane welcomed fiancé George at her front door and then noticed fresh mud on his shoes. Using a pleasant tone of voice, she asked, "Will you please leave your boots on the stairs?" Puzzled, he said, "Your suits stare? Huh? What do you mean?" Despite her clarification, George remained convinced that Diane had said exactly that. Moreover, she'd said it with that tone (presumably, the disapproving kind).

It wasn't this pair's first tangled communication. In fact, it happened so often, George had his hearing checked but it seemed fine. Their couples therapist suggested that George might bear deep-seated psychological resistance to listening to Diane.

Can You Hear Me Now?

Fortunately, George's ADHD diagnosis came just as these "miscommunications" reached fever pitch. He and Diane felt relief when the cognitive therapist explained how ADHD has a common traveling companion called Central Auditory Processing Disorder (CAPD). Briefly, it can cause a person to misinterpret content and even tone of voice (more details about CAPD in a minute). She provided the couple strategies for enhancing communications, noting that stimulant medication can often help "strengthen the signal."

What signal is this? The one that travels from Point A (the ear, where sound waves enter) to Point B (the brain's auditory processing cortex, where sounds are interpreted and given meaning). (See illustration right.) This journey is made possible thanks to brain chemicals called neurotransmitters. If certain neurotransmitters are in short supply, messages won't get through or arrive intact. (It's sort of like using a dial-up modem when you're trying to transmit a big file: Data-corruption happens.)

In addition to weak signal strength, consider other ADHD-related neurobehaviors that might be contributing to your Tower of Babel Twosome: Distractibility, inattention, poor working memory and even difficulty reading social cues, including facial expressions. As one young man with ADHD put it (in a video produced by ADHD educator Chris Dendy): "It's like living life listening to people speaking a language that you don't understand, with no translation available."

The stress of knowing that communications are going badly only makes things worse for the adult with ADHD, especially when it comes to talking about personal issues, according to my friend Carl, who along with his wife was diagnosed eight years ago. "With stress, ADDers tend to get 'brainlock' and realize there's no hope of expressing themselves and having a 'real' conversation the way you want," Carl says. "So, they frantically search for the right thing to say to make it go away, since they can't express what they're really feeling. They can't even define or focus on what they're feeling, let alone talk about it to anyone else."

Then there's my friend Mary, who is heartbroken about the state of her marriage: "I just don't know how to talk to my husband anymore. If we make an agreement, he forgets it or complains about it, makes an excuse to break the agreement, or accuses me of remembering it incorrectly."

An Ears-On Demonstration

Recently, I attended a lecture where a psychiatrist (who both has ADHD and treats it) demonstrated how ADHD can challenge one's ability to retain verbal information. First he asked for a show of hands from everyone diagnosed with ADHD or entertaining the possibility. The entire group of about 25 raised their hands. Then he reeled off a short bio (note: details have been changed):

“My name is John Michael Smith. I was raised in Philadelphia, Pennsylvania. Later, I attended medical school at the University of California, Los Angeles. Now I live in Palo Alto.”

“Okay now,” he said. “Who can tell me my middle name?” Two raised hands.

“Who can tell me where I attended medical school?” One hand.

"Where do I live?" Six hands shot up. (It might have helped that the meeting was held in Palo Alto.)

“Who can tell me where I grew up?” Two hands raised, tentatively.

"So you see," he concluded, "when you think you are having communication problems, what you are possibly having is a hard time remembering details from one sentence to the next."

CAPD and ADHD: One and the Same?

Given all this, I can't figure out why these challenges are commonly identified in children as CAPD yet when it comes to adults with undiagnosed ADHD, the challenges are typically called …. what exactly? Passive-aggression? Obstreperousness? Oppositionality? Sometimes. Until you grow old enough to be evaluated for hearing problems and fitted with a hearing aid. Trouble is, your "hearing" might be just fine.

Read these characteristics of CAPD (from the National Institute on Deafness and Other Communication Disorders), and notice how similar it is to ADHD (some experts doubt that these commonly co-existing conditions are, in fact, separate entities):

• Has trouble paying attention to and remembering information presented orally
• Has problems carrying out multi-step directions
• Has poor listening skills
• Needs more time to process information
• Has low academic performance
• Has behavior problems
• Has language difficulty (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)
• Has difficulty with reading, comprehension, spelling, and vocabulary.

In this short blog post, I've touched only the surface of how, when it comes to ADHD, hearing well doesn't always mean being able to listen well.

Listen Up! Sound Strategies for Clashing Couples

Some couples find these practical strategies useful.

For Partners of Adults with ADHD:
• Turn off distracting noises before speaking (TV, radio, computer, etc.).
• Touch your partner and make eye contact before speaking, allowing sufficient transition time.
• Ask your partner to repeat what you’ve said, to make sure it was understood.
• Speak simply and concisely without a lot of superfluous background detail, whys and wherefores, etc. (granted, this is not always possible for more complex communications).
• Don’t discuss important matters “on the fly”—while your partner is involved in another necessary activity or as you’re going out the door.

For Couples:
• For some topics, e-mail works best. The ADHD Partner has time to focus, reread, and mull over a response without feeling the pressure of needing to respond immediately.
• Take a walk together when discussing important issues (exercise activates blood flow to the brain and alleviates stress).
• Use a whiteboard at a household “command center” to target 1-3 important messages, simply stated.

For Adults with ADHD:
• Recognize what good listening means for your partner: that you value his or her opinions and care about your partner.
• Listen first. Respond second. Exert the extra mental effort to really listen. Set aside what you were just doing, what you will do when your partner finishes, your response, or unrelated topics. If you need more time to shape a response, ask for it.
• Use relaxation techniques to clear your mind before having important conversations.

When Symptoms are Moderate to Severe
Sometimes, strategies are simply not enough; medication might prove most helpful in kicking the "transmission signal" up a few notches. Consider this before-and-after story:

"My boyfriend has been taking a neurostimulant medication for about a month now, and the biggest difference we've noticed is that we are able to discuss things without the big explosions of emotion. He's much less dramatic in his expressions of self-hatred or anger, which we've learned came about mostly because he was losing focus and subconsciously boosting adrenaline to re-capture focus, plus feeling badly that he couldn't keep paying attention. He used to lose the thread so quickly and then automatically go off on a more stimulating (to him) tangent, leaving me in the dust and getting angry if I tried to bring him back to the subject.

"Mind you, previously our discussions wouldn't be particularly demanding of most people; they were normal discussions that couples have every day. Now he's no longer stomping out of the room mid-conversation to sulk. No more 'misremembering' later the agreements we made. No more going completely silent while ignoring what I'm saying because he's busy obsessing about how he's such a terrible person and how he's letting me down."

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Can you relate? Can you share some strategies? We'd love to know about them! Please share your comments below.

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Note: Psychologist Arthur Robin and I will present a workshop on October 10, called, "Relationships: How To Succeed in Marriage with AD/HD" as part of the Annual CHADD conference taking place in Cleveland in October. I hope to see you there!

And, to the kind gentleman who introduced himself to me at the CHADD Anaheim conference as a fan of this blog, thank you so much! Wonderful to meet you! And please keep passing along Adult ADHD awareness to your friends. :-)

Gina

ADHD and Sex: No Shame, No Blame

"Gina, sex is difficult for people with ADHD; it's tough to stay focused!" says a female Facebook friend, responding to my query on this topic.

What, you say, ADHD affects sex? Who knew? Yes, it's one of those areas, like sleep, where we often fail to connect the dots to ADHD symptoms.

The truth is, ignorance about this critically important connection creates so much unnecessary hurt. Left with no other rational explanation for intimate difficulties, partners sometimes blame themselves—or each other. In a blog post on Sex and ADHD at Jeff's ADD Mind, the author first considers it as the “problem with no name” and finally “the problem that carries a lot of shame.”

Consider these comments I've collected over the years:

• “My wife is so easily distracted that boom, in the middle of a romantic interlude, she's suddenly talking about the cat! Talk about a mood killer."
• "Both my brother and I have ADHD, and what we've concluded is that thinking about sex is pretty exciting. But the reality? More often than not, boring. That's a hard thing for a guy to admit."
• "Who knew so many women were begging their male partners who have ADHD for sex?"
• “My husband, who was just diagnosed with ADHD, has always said I had to have sex with him twice daily in order for him to know that I love him. But we’re married 20 years now. I’m getting tired! In fact, I don’t it's about love at all. I think it's about self-medicating."
• "Our sex life is great! If only everything else in our life together was so easy."
• "If ADHD presents known challenges to 'self-regulation,' it makes sense that some of us could have a problem with regulation of intensity here along with everything else in life? My wife and I both have ADHD and are living proof of opposite ends of the ADHD spectrum when it comes to sex."

These quotes speak to just a few of the ways that ADHD might affect sexual intimacy. For the record, though, almost one in five ADHD Partner Survey respondents report having a great sex life. Moreover, many of them are in long-term partnerships that are challenging enough to send them scurrying to a support group. In fact, almost half say their ADHD partner is a skilled and considerate lover. I offer these findings not as scientific evidence but as a reminder that, as with most things ADHD, "your mileage may vary."

For those whose sex lives aren’t so sexy or lively, though, it might help to know that brain function can affect sexual expression. Though not in itself a solution, knowledge can at least relieve psychological pressures, hurt feelings, and unnecessary blame and shame on both sides. Moreover, knowledge paves the way to realistic problem solving.

Briefly, let's consider how these ADHD-related traits might pave a bumpy path to bliss:

Hyperactivity and Impulsivity
People with a high degree of hyperactivity or impulsivity might rush to start—either the relationship or sexual engagement—and quickly grow bored.

Distractability and Inattention
These two traits can generate challenges in getting the party started, paying attention to details, avoiding distractions (air-conditioning hum, scratchy sheets, dog barking, menacing thoughts of uncompleted chores) and maintaining interest through to, um, completion.

Low initiation and motivation
“My wife is always willing to have sex with me and seems to always enjoy it,” says Alex. “Yet, she never initiates. I’m sure this isn’t social or gender conditioning. She simply initiates very little in life and tends to respond to what's in front of her.”

Hypersensitivity to sensory stimulation
If you find a shirt label irritating, imagine how foreplay involving delicate areas might feel unnerving, if not downright irritating. It's called sensory integration disorder (also tactile defensiveness). Consider it a “filtering” problem within the nervous system.

Difficulties in cooperating and taking turns
Lovemaking is sometimes described as a dance that depends on following subtle back-and-forth cues. But what if you have trouble "transitioning" from one activity to the next or "sequencing" steps (that is, first comes this and then comes that, not vice versa)? This can create obstacles not only in your work life or at four-way stops but also in romantic pursuits.

The boredom factor
"Sex is boring," Bryan Hutchinson announces on his blog, AdderWorld. "We’d rather be doing something else while in the act of having sex, something more exciting, like, well, fantasizing about sex, putting together a good story about our sex life, and while we do that we miss out on something important: the reality of sex."

If any of these points resonate for you, know that there are strategies for overcoming their adverse impact on your relationship. For starters:

Adults with ADHD:
Learn about how ADHD symptoms might be affecting your experience of sexual intimacy. That way, you can avoid

• trying to hide the fact that your attention is wandering
• unfairly blaming your partner for your attention wandering
• deciding that you are an inept lover
• avoiding sex entirely without ever explaining why (but still feeling a certain amount of shame about it)

Next, be forthcoming with your partner about what's going on in your head. Otherwise, your behavior can lead your partner to feel sexual rejection, and that can be extremely destructive to a person's self-esteem, not to mention the relationship. It helps to be tactful, though. For example:

Don't say this: "For some reason, I just find debugging software code in my head (or, thinking about the half-yearly Nordstrom sale coming up, etc.) so much more compelling than having sex with you."

Say something like this: "Honey, you know I love being with you and want to please you, but I don't know what to do about this darn distractability. It hits when I least expect it—or want it. Will you work with me on finding some solutions that work for both of us?"

Partners of Adults with ADHD:
Don't make a difficult situation worse by translating your partner's ADHD-related bedroom issues into "You don't love me!" That line of thinking simply doesn't end well.

Both Partners:
1. Set aside time for intimacy
Consider this both a logistical strategy (schedule romantic weekends away or a weekly date night) and a mental one (leave your unfinished to-do list at the bedroom door).

2. Turn off the distractions
Robbie complains that her ex-husband was so distractible and hyperactive that he simply couldn't stay in bed long enough to have sex: “He was constantly jumping up to turn off distracting things—the lamp, the clock radio, the heater, and, eventually, me! I was very turned off!” Anticipate these ambient noises being a problem before getting started and counter them.

Please share your strategies, experiences, and "a-ha" moments on this topic. Reader comments to the previous blog on sleep and ADHD were so helpful to other readers. Thanks!

Gina

To Sleep, Perchance to Turn Off That *&$@# Computer

Being new to the area, my husband and I got lost on the way to our first adult ADHD discussion group in downtown San Francisco. Some heated bickering later ("You said to turn left!" and "I didn't mean that left!"), we finally arrived and caught our breath. That's when a worn-out looking man across the table said something that sticks with me, ten years later:

"I've blamed a lot of people in my life for my troubles, but when it comes down to it, I finally realize that I am my own worst enemy. For forty years, I've not only opposed what other people want me to do, I've opposed what I want to do."

We've all heard that adult ADHD can create problems in relationships, but this man's epiphany struck some foundational truth: Having ADHD can create problems in your relationship with yourself, never mind someone else.

No matter how much you want that healthy diet, that uncluttered home, or that comfortable bank account, unaddressed ADHD symptoms mean you can't always initiate and maintain the necessary steps to get there. Add another person to the equation, and the potential for misunderstanding and hurt feelings reaches dizzying proportions.

Take sleep, for example. More than half the respondents to the ADHD Partner Survey identified their mates' ADHD-related challenges with sleep as a big problem, almost as challenging as difficulties in listening, remembering, and organizing.

In fact, an amazing number of my friends with ADHD tell me that they fight sleep—actively, resentfully fight it. As Brad explains, "Gina, going to sleep is about the most boring thing a person with ADHD can do—just lie there in the dark waiting for something to happen." Miranda says she pushes herself to cross an impossible number of to-do items from her impossibly expanding list each night until she finally collapses into bed, too tired to fight it any longer.

Glen says that, by age 45, he'd grown weary of the mental battles he'd wage with himself about going to sleep. Of course he knew he needed a decent night's sleep in order to function the next day; he's not stupid. But just the thought of going to bed at a decent hour triggered the infamous "ADHD oppositionality." He staved off sleep by watching TV while scanning every news headline worldwide on the Internet.

Finally, he started trying to sneak up on himself, so as not to trigger the opposition. "So," he says, "now I tell myself, at about 10 each night, I'm not going to bed now. I'm just going to put on my sleep shirt. A few minutes later, I'll turn on the bed-stand light, all the while assuring myself, I'm not going to sleep now, I'm just turning on the light." In his heart of hearts, though, he fiercely rejects the illogic of spending precious hours sleeping when he is so behind on… everything. Finally, he's started to accept that more hours won't make a difference; it's a sea change that's needed.

Until recently, these three adults assumed that their difficulties around sleep were their own insoluble personal quirk or flaw. Finally, they learned about ADHD, did their research, and discovered they weren't alone in their challenges, including the nocturnal kind. ADHD neurobiology itself seems associated with higher-than-average sleep disorders—such as sleep apnea, delayed sleep phase, and restless leg syndrome. Moreover, these are often compounded by other ADHD traits such as disorganization and stimulation-seeking habits that keep many such adults glued to their computers or TVs when they should be dozing.

If you are romantically involved with someone who has ADHD but neither of you recognizes it—or how it affects sleep, finances, communication, and so forth—it's easy to take the behaviors personally. Miranda's husband, Jeff, used to feel rejected when she'd delay coming to bed. He missed her company, missed enjoying sex with her. Moreover, "I felt like she was avoiding me, avoiding intimacy—running herself ragged all day, doing chores at weird hours,” Jeff explains. “She couldn't explain why she did these things, and, what's worse, she resented my even asking about it. Her defensiveness made me wonder if she might be having an affair."

Such "couples troubles" could even bring you to counseling, where the clinician might completely miss ADHD and instead find deep, dark reasons why one of you refuses to come to bed. Fortunately, Jeff and Miranda figured it out: Lifelong struggles with undiagnosed ADHD had left Miranda feeling not only defensive but ashamed of sharing, even with her husband, her embarrassment about not being more organized, more efficient. So, she shut down and shut him out.

As for Glen, he is not even currently in a relationship. So, he can't be opposing a partner's desires for him to come to bed; he’s opposing his own desires! If he doesn't start getting more sleep, he risks losing his job Finally, after talking with other adults with ADHD at a local meeting, he's decided to follow up on that long-ago diagnosis; perhaps getting help for his ADHD symptoms will help him gain better control of his day—and night.

When you're living with adult ADHD—yours or someone else's—accurate information and solid support are absolutely essential. I hope you'll join me in future columns as we explore positive strategies and solutions. In the meantime, these five guidelines should help get you started:

1. Learn all you can from reliable sources. ADHD symptoms are highly variable and can turn up in the most surprising ways.
2. Practice empathy and forgiveness for yourself (and each other) for not discovering ADHD earlier.
3. Pursue evidence-based treatment strategies. With the right help, life can improve tremendously.
4. Nurture optimism. After years of trying and failing to alter problematic patterns, hoping for a different outcome can feel like a setup. It really does make a difference when you’re dealing with solid information (the ADHD diagnosis).
5. Get a good night's sleep—it will make everything easier!

Gina