Tuesday, March 1, 2011

Adult ADHD Question-and-Answer: on ADHD and "Denial"

A few years ago, I participated in an Ask the Expert Chat on "ADHD and Relationships", sponsored by the National Resource Center on ADHD. In this free forum, the public is invited to ask questions of a top ADHD expert in a live online chat. This text-based Q&A is later stored in the CHADD Ask the Expert archive (you can view the topics at that link but access is limited to CHADD members). Among CHADD membership's many benefits, I consider this one of the best!
The Internet is chockablock with information on ADHD, but some of it is unreliable. You can count on these Ask the Expert chats to be solid. (The latest one was with Dr. Russell Barkley.) Moreover,  back issues of CHADD's excellent Attention magazine are stored in the archives for members' access. So, if you're not a CHADD member, I encourage you to sign up now (it's tax-deductible, too!).

During my Ask the Expert chat, the questions came in massive quantities!  So many that I didn't have time to answer them in the chat itself. Fortunately, I saved the file. In the coming months, I will be sharing the most topical questions and answers with you.  This month: What do you do when an adult in your life is "in denial" about what seem obvious ADHD-related challenges?



Question: How do I help my husband understand he needs help for ADHD? Our son has AD/HD, we need stability. Our life is chaotic, and we would have a more stable life if his father sought treatment. Any advice to a man not willing to change? It’s very destructive to our lives, I have lost my patience with him.   Michele

Hi Michele,

That’s the million-dollar question for so many people dealing with a loved one who has ADHD. According to a survey I conducted a few years ago, one of the top reasons the partners of adults with unacknowledged ADHD seek couples therapy is to gain help in reaching through their partner’s denial. Unfortunately, most therapists simply lack the knowledge or skills to help. 

It might help to know that denial can have both a psychological as well as a less-talked-about physiological foundation. I devote a few chapters in my book to “Getting Through Denial,” including an in-depth interview with psychologist Xavier Amador, the leading authority on denial and mental illness whose research has shed a pivotal light on a long-ignored phenomenon. He addresses the topic comprehensively in his book I'm Not Sick, I Don't Need Help.


So much animosity can build up around the misperception that someone is "refusing" to see reality, rather than being lost in their neurocognitive dysfunction. So it’s quite an important subject – and one rarely discussed. Thanks for asking!


First Identify the Reason for Denial

Most experts would agree with you, I think:  Children need stability, especially children with ADHD, and a parent’s unaddressed ADHD symptoms can be destabilizing. In fact, some research indicates poorer outcomes for children with ADHD who are also dealing with a parent’s unaddressed ADHD symptoms. (Personally, I cringe when encountering a family wherein one or both parents have problematic ADHD behaviors yet only the child with ADHD is being treated. Over time, I've seen that many of these children finally rebel and reject treatment entirely.)

At the CHADD conference a few years ago, a young father attending my presentation (on ADHD and couples) said his wife finally got through to him by saying, “Can’t you see how you are hurting the children and me?”  In fact, he hadn’t seen it. And that’s the problem: ADHD symptoms themselves can impair one’s ability to  “connect the dots” – seeing how ADHD-related behaviors and actions negatively affect themselves and others. 

The adult with ADHD can be so “in the moment” that they just don’t notice it – or remember it long enough to make an impact. Their attention and focus is just too fleeting, not to mention empathy is often impaired. Moreover, unless there is a swift and significant consequence to their actions, they often don’t see the import. I hear from so many 50-something adults with ADHD who said they never appreciated the gravity of their spouses’ complaints until divorce court. That's when they started taking spousal complaints seriously, especially if it was the second or third divorce.

Even if these “in-denial” adults notice problematic behaviors and feel badly about the fall-out, they don’t always know what to do. So the tendency is towards "shutdown" and "head in the sand syndrome." In fact, there is often a certain amount of resignation with these adults. They tried dealing with their challenges their whole lives, they will tell you, and they’ve given up on being able to change. It does little good to give these adults ultimatums; it typically only alienates. For these adults, offering hope and optimism that true change is a possibility might help you get through – as long it doesn’t sound simply like more of what they tried in the past, without success. 

In other cases, however, the response from the "in-denial" ADHD adult is, “Nothing needs to change; I’m just fine. It’s YOU who has the problem.”

To Get Through, Get Clear



In general, the first step towards getting through a loved one’s denial is getting very clear in your own mind about the nature of ADHD and the way it might be manifesting in your loved one. 

The more you can step off the "ADHD roller coaster" and find solid ground, the less you risk being spun around in confusion and talked out of your perceptions by your less-than-insightful ADHD partner.  The less you’ll feel pressured to capitulate to poor business schemes and risky investments, for example, or other exercises in poor judgment, lest you be called "negative." (This more “realistic” economy is hitting many people hard, but especially some people with ADHD. Because money flowed so freely previously during the “go go” economy, consequences were rarely faced, just postponed.)

Getting clear involves educating yourself about ADHD and getting validation for your perceptions. You can read books, attend a support group, or talk with an ADHD-savvy therapist. The point of ADHD education is not to “accept” problematic behaviors, as so many people mistakenly believe; the point is to learn why they happen so that you develop empathy for your partner instead of locking horns, and then work on realistic strategies for change.

If your partner has ADHD (or you think it's a possibility and want to learn more), you can access free support through the ADHD_Partner yahoogroup, sponsored by Northern California CHADD and moderated by a dedicated team of longtime members, including  me.


Gina Pera



13 comments:

  1. My GF is 22 years younger than me and has ADHD but has never been formally diagnosed. Her father had it. I sometimes think our age difference helps with the Patience required to deal with her In The Moment lifestyle and decisionmaking...In the Moment is very Zen...something it takes other people LOTS of practice to achieve...the problem is my GF doesn't STAY in the moment but moves quickly to the next. I have taken to asking her "what are you thinking now" just to stay on her radar and know where she is. She is pretty unable to Go Back in Time ever. She recently agreed to talk to a counselor at her school. I hope she HEARS...she is totally wonderful in many many ways.

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  2. This is where our roller coaster is stuck...in denial. My DH can't separate the ADHD symptoms from his personality because he lived undiagnosed for the first 40 years of his life, developing negative coping strategies and accepting the fact that he can be an immature jerk. That's just who he is, and if people can't accept him for who he is, it's their problem, not his. Never mind that a day doesn't go by when he doesn't have at least one angry outburst with a stranger or friend or family member who "wronged" him for no reason. Never mind our kids act out and get "overly-emotional" when he gets inappropriately angry or defensive with them. Never mind the messes and chaos he creates at home, at work, in his car, anywhere he goes, because other people's standards are unrealistic. He is who he is, he doesn't have to put up with the criticism and doesn't care if people are reacting to his "different" way of thinking/living.

    Seeking medical treatment has been a frustrating process due to his high tolerance for drugs, addiction tendencies, and ignorant doctors (we've been through 3 psychiatrists who supposedly specialize in ADHD) who don't take the time to ask the right questions or listen to his needs. His only solution now is AVOIDANCE, which is such a familiar fallback position for pwADHD. The result for our family has been separation. So, the spiral downward continues to be passed down through the generations in our family as he models the irresponsible behavior for our young children.

    If you suspect ADHD in your family, educate yourself and get help ASAP! Gina's book is an excellent resource.

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  3. All the tests I've done on-line just prove what I've known for a long time. I have Audult ADD. When I was 14 I had a head trauma. While riding my bike very fast on N.A.S. Lemoore, the front wheel was caught by a rock and sent me over the handle bars and head first into a fire hydrant. This comes from the report by the Navy because from that day to today I have no memory of the first 14 years of my life. Now here is my question. Did the head trauma give cause to the ADD or does the ADD inhance my memory loss, or none of the above or, are they both big pains in my life on thier own? The memory loss has caused no end to problems for me, including masking early ADD symptoms. Where should I seek help, witout narcotics?

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  4. Hi Tom,

    I hope she HEARS, too. "Being in the moment" is great when it's a conscious, controllable choice instead of a biological imperative. ;-)

    Gina

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  5. Anonymous,

    I'm sorry to hear that far-too-common storyline. When someone doesn't see a way to change problematic behaviors, I imagine it is tempting to "spin" the behaviors as somehow being positive.. In some ways, this is kind of a healthy adaptation, it seems, because it allows the person to keep plugging along instead of downspiraling into despair.

    So many people with ADHD have developed this attitude because their medical care has been less than optimal. It's completely logical, IMHO, but can be such a lamentable situation.

    g

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  6. Hi Loyd,

    Your (painful!) story brings up several excellent points.

    Yes, brain trauma can create ADHD-like symptoms. Often, the same treatments work in both cases.

    Yes, kids and adults with untreated ADHD are more likely to suffer brain-trauma in the first place. Taking undue risks. Seeking thrills and ending up in spills.

    Yes, you can have both!

    ADHD is not treated with narcotics. The first-line medical treatment for ADHD (whether of neurogenetic causes or brain trauma) is the neurostimulant medication, which acts to modulate the action of dopamine molecules (and others) in the brain.

    But for anyone with ADHD, the first step is education. Learning how ADHD might be affecting your life (in more ways than most of us knew possible), from sleep to eating habits.

    Once you start separating your "personality" from neugocognitive challenges, you can start working on behavioral strategies, too, such as regulating bedtime, getting exercise in the morning, eating protein with breakfast, and so forth.

    Good luck!
    Gina

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  7. I am ADHD, and my husband is ADD. I have no idea how we've lasted 16 years. He did not come out of denial until two years ago, and when I saw this article I was interested because of my experience with him. Reading the comments, however, I realized that even though I acknowledge the ADHD, and I see the damage I do to my work life because of it, I haven't acknowledged how difficult it is to live with me. I constantly feel wronged, probably for no real reason; I live so in the constantly-changing moment that my own head spins. I'm irritable and unpredictable and that has to be very tough to live with. Thanks for opening up my eyes. I'll have to spend more time watching myself now, instead of constantly monitoring him.

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  8. I've only been riding the ADHD rollercoaster with my boyfriend for less than 3 years, but I'm already so disillusioned that I feel like I just have to sever the relationship. It's gotten so tough to communicate with him about how I'm feeling that my only solution ever is to immediately call out what I think is the obvious, "We need to break-up." In fact, he hears it so much that he's grown desensitized to it. He'll just agree with me and throw it back in my face. But I know that at the heart of everything we both truly do love one another and we both want to desperately be able to understand one another and communicate well, but we both just can't seem to reach common ground.

    But that's where his ADHD kicks in and my overwhelming frustration builds. Even though we both agree on this, he won't ever move forward with what I think are the only solutions, seeking therapy and seeking help for his ADHD. I know what you're thinking, what about me? What am I contributing? Well, I've been in weekly therapy for two years now, I've bought your book and started reading it, and I've begged him repeatedly to go to couples therapy with me. We went for a few months once and it helped (it's where I got him officially diagnosed), but he found every possible way not to go.

    He also finds every possible way to not talk about anything. The idea of me talking about anything or sharing my feelings drives him crazy. But the idea of spending my life with a man that can't even work at fixing his credit makes me want to keel over. I've spent a month now begging him to create a budget and that I would help him with it. Every day I've given him the simple task of just writing down everything he owes, what he makes and due dates for bills. And nothing. Every day. Nothing. Until I finally explode, like I did last night when I found out that instead of creating a budget he took half a day to go to an arts & crafts store to get materials for something that has no urgency whatsoever. Our cable bill's 4 days late, and he needs art supplies.

    Sorry, that turned into venting really quickly. I guess it gives you a glimpse into my mind and how frustrated I feel right about now. I know I'm supposed to go in and do research and learn everything there is to learn about ADHD, but it's so hard to do when he's doing absolutely nothing on his end. It seems unfair. I get he may be somewhat in "denial" but where does that leave me in getting what I need out of the relationship?

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  9. Hi Anonymous,

    I hear your frustration. It's very similar to the frustration I've heard for 11 years now among many partners of adults with ADHD. And, it's a big reason why I wrote my book. Exactly for people in your situation.

    I suggest that you finish reading my book and then start making some decisions.

    Some questions to consider:
    If your boyfriend does have ADHD, when why would you expect him to not behave like he has ADHD?

    Why would you assume that therapy is THE answer and somehow the next logical step? Especially before you've finished reading my book?

    Why would you think it's a "simple" task for someone with untreated ADHD to sit down and make a budget that includes all unpaid bills and due dates?

    Why do you think the problem is one of "communication"? Is it you who is in denial of his ADHD, or him? :-)

    You ask why you're expected to "go in and do research and then learn everything there is to learn about ADHD." Okay, you've started reading my book, but you haven't finished it. What other books on ADHD have you finished? And who is "expecting" you to do this? You, if you want to keep this relationship. You and only you. It's entirely your choice.

    By the way, what exactly do you know about therapy for ADHD? Have you gotten to the part in my book where I talk about how the wrong therapy can make things worse?

    We've gotten a bit kneejerk in this country about therapy, thinking that it's always the first response to relationship/ individual problems. But really, maybe your boyfriend's instincts are better? He might know that therapy probably won't help him and could make things worse, especially if it simply keeps calling attention to his shortcomings or attributing ADHD symptoms to childhood experiences. In other words, you better be an educated mental health consumer before you even choose a therapist. Because therapists are all over the map.

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  10. My wife has ADD. She has been to 3 psychiatrists without me and she ends up telling "her side of the story" which I'm guessing doesnt include a lot of facts about our life. We have piles of stuff all over the house that she will get to someday. All of our closets are filled 3' high with "stuff". Our kids are 11, 10, 5 and we have all of their toys since they were born. She is a stay at home mom and they are in school all day and she hyperfocuses on Facebook and other websites during the day. Piles of dishes and clean unfolded clothes lay in our bedroom daily. Vaccuming is out of the question. I pay all of the bills, take care of 90% and sometimes 100% of our kids extracurricular activites. Every night its the same argument about why she hasn't started dinner and why our 5 yr old goes to bed at 9 or 9.30. Our older kids have "caught up" to age appropriate bed times but she can't get organized if I'm not at home. I'm so tired all of the time. I am trying to run my business while getting her motivated daily. I coach our kids teams and she barely makes it out to watch them. I thought things would get better once my youngest got to school but it hasn't really changed and she is just filled with excuses. Every day there is a new reason for why things didn't get done. She'll say "I had to send out emails" or I had to call doctors offices and this is supposed to account for 7.5 hrs a day with no kids. Every thing in our house gets done the day before its due. EVERYTHING! She stays up late every night "making the kids lunches". We dont spend time together after the kids go to sleep because she has to "make lunches". The idea to make lunches while they kids are doing homework after school is out of the question. She doesn't invest in our relationship and she doesn't realize where this is leading. Its a constant circle of her missing responsibilities and me complaining about it. She doesn't want to go to counseling because she is afraid of what she'll hear. Last year when we went, she told the therapist that "she likes to get down and play with the kids and doesn't want to realize when they were older that she was spending all of her time with home responsibilities that she missed this time". When the therapist asked if she thought this meant she never had to do chores around the house, she never wanted to go back and talk w/the therapist or see any others. She has promised to get on meds, get a therapist etc but then she never follows through. I dont know what to do.

    Scott

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  11. Hi Scott,

    Does it feel better to know this isn't an entirely uncommon situation?

    It's hard to understand how a person with ADHD can be so unclear about the dire nature of their challenges, so unmotivated to seek outside help, and even so unaware that change is possible. But it happens all the time.

    Many years ago, I noticed that few experts in the ADHD community were talking about "denial" -- the kind that comes from ADHD symptoms itself, along with "defensive" denial. So, I devoted three chapters of my book to it. I suggest that you read them to understand how best to meet your wife on common ground.

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  12. Five years ago, following a major life crisis and personal breakdown at age 31, my sister was finally diagnosed with ADHD, thanks to the desperation and perseverance of my parents, and a serendipitous web-search. This diagnosis was a life-altering event for our family. My parents got tested, and my father was also diagnosed, those as ADD with inattentiveness, as opposed to my sister's hyperactivity/hyper-focusing.

    My parents have embraced my father's diagnosis and both work hard to improve the quality of their relationship and life together by conscious living and working together.

    My sister, however, is a different story. She does not have a partner or a social circle -we, her family, are her sole source of support, yet she refuses to include us in her treatment. She takes the meds, but does nothing else to help herself.

    And while my parents bear the brunt of her anger and aggression for being 'controlling', they continually assist her in managing her life, from cleaning out her fridge, to helping her catch up in her taxes, to bailing her out of financial debt. They have even offered to pay for an ADD coach, which she has refused.

    In the mental health system, we have very little rights (less than a spouse), but a lot of responsibility when things go wrong.

    I love my sister, but dread my future role of what seems to be a care-taker, particularly since she seems to be unable or unwilling to help herself. There seems to be very little support, or even acknowledgement, out there for people in my and my parents situation.

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  13. You are right. There are very little rights for people in your situation. Many treating physicians do not understand that ADHD can involve just as much "denial" as other frontal-lobe conditions. And so they do not realize that they should involve the parents or another family member in treatment strategies.

    Of course, these are tricky waters; you don't want to trample an individual's rights. But there has to be some common sense and a willingness to understand the complexity.

    The good news is that your parents are on board with your dad's diagnosis, which at least helps them maintain more clarity when dealing with your sister, I would imagine.

    I would encourage them to keep trying to optimize your sister's treatment. Anger and aggression can be symptoms amenable to treatment.

    And limits. Always limits. Though I know it is hard for some parents to impose them.

    Good luck to you and your family.

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