Partners in Life, Partners in ADHD Awareness

You share a life together – maybe even a bed, a checking account, and human offspring, too. It might sound surprising (especially to some less-than-savvy physicians and therapists), but ADHD evaluation and treatment outcome also typically benefits from a shared "team" approach. Let's examine the reasons why.

Elaine finally decided to seek professional help for her long-ago diagnosed ADHD. But it still took her three months to actually book the appointment. Unfortunately, that therapist ended up knowing little about ADHD, and Elaine gave up on finding another one on her insurance plan.
     “She gives up easily with most obstacles," boyfriend Brian explains, "and then she also quickly forgets why her ADHD is a problem -- until she loses her next job." For a long time, Brian didn’t push her because he didn’t like the idea of "acting like Big Daddy." Intervening just didn’t seem healthy.

Then again, Elaine's problematic ADHD symptoms presented fertile ground for a bumper crop of unhealthy behaviors on both their parts. Nagging on his part. Denying and blaming on his part. Just to name a few.

     Finally, Brian realized it wasn’t a question of Elaine learning to be a "more responsible adult" or him being a "dominating male" if he stepped in to help. “If she suffered from allergies or maybe a knock to the head that resulted in cognitive impairment similar to that of her ADHD symptoms, I wouldn’t expect her to go it alone, would I?”

     Once he clarified this in his mind, he could think about collaborating in finding a more qualified professional. "With all the hoops we have to jump through – first of all, finding a competent clinician and then finding someone who accepts insurance – Elaine really needed my help in planning and persevering."
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Genevieve had worked patiently for months to encourage husband Larry to talk to a professional about his chronic “monologuing” in social situations, forgetting important details about important clients, and creating one costly fender-bender too many.

     Moreover, Larry's brother was recently diagnosed with ADHD and their two children have it as well, so Genevieve thought Larry was good candidate for an evaluation. That's why she was flattened by the doctor’s assessment of her husband: “Well, you probably have ADHD, but if you made it this far in life, you don’t need to worry about it now.”

    The physician had not conducted a full evaluation—more like a quick eyeballing with questions like, “How’re you doing?” And he did not ask for the perspective of a spouse or other loved one, which ADHD experts recommend (more about that soon). As a result, this doctor had no clue about Larry's actual impairments—the ones he doesn’t remember, never notices, or didn’t think relevant to tell the physician—or the exhausting amount of compensation Genevieve provided for her husband.

     Unfortunately for this couple, Larry decided that physician's word was gold and he admonished Genevieve never to utter "ADHD" again in his presence.

     These stories are true, gleaned from hundreds gathered over my years of moderating Adult ADHD discussion groups (separate groups for the adults and for the partners of adults with ADHD), and they describe two common obstacles to achieving an accurate diagnosis and positive ADHD treatment outcomes:

    1. ADHD symptoms themselves – poor working memory, distractibility, inattention, low initiation and motivation, and so forth.

 
ADHD symptoms can obscure a person's ability to clearly perceive the full negative impact of his or her challenges (often called "denial"). Moreover, ADHD symptoms can inhibit the ability to initiate and follow through on pursuing an evaluation and treatment—typically no trivial task, given the managed-care hoops we all must jump through.
     As Ted explains, “My wife read an article about ADHD in relationships and said, ‘Wow, this is us’ but then she’d forgotten all about it by the next day!”
  

2. The physician failing to solicit the perspective of an interested third-party—typically a partner but also a family member or close friend.
 

Even if invited by the clinician, some partners of adults with ADHD initially balk at becoming involved, but their reasoning isn’t always logical. 

     For example, they bitterly complain that they are tired of their ADHD partners acting like children, leaving them to pick up the mess, do all the reminding, all the prodding. Yet, when it comes to helping their partners pursue an ADHD evaluation and then treatment—in other words, gaining the tools to finally start acting more like more mature adults—they might say, “Oh, that’s too much like parenting.” Unfortunately, their therapists often encourage this attitude, by calling such assistance enabling or codependent.
      Jazmin had a similar resistance when she entered the psychologist’s office exhausted by propping up her husband of six years, only recently diagnosed with ADHD. She bristled when the psychologist suggested that she needed to help just a little more. Then the psychologist explained that her husband’s unaddressed ADHD symptoms (procrastination, distractibility, and so forth) meant he was unlikely to successfully follow through on the psychologist’s recommendations. Jazmin agreed to try.
      She found a psychiatrist qualified to treat ADHD, made the appointment, and went with her husband to the doctor. With that help, her husband was finally able to start on the path to success. The psychologist in Jazmin’s case was ADHD expert Michele Novotni, coauthor of  What Does Everybody Else Know That I Don't?: Social Skills Help for Adults with Attention Deficit/Hyperactivity Disorder.
      Novotni fully admits that asking Jazmin to intervene sounds like unorthodox advice. After all, aren’t adults supposed to be responsible for themselves? “I know it isn’t supposed to be this way with couples,” Novotni concedes, “but this is often necessary in order for the individual with ADHD to get the help that’s needed.”
      This type of support, she emphasizes, should not be confused with codependent caretaking. To be clear, accepting that your partner’s ADHD-related deficits might impede treatment does not absolve him or her of responsibility. “It’s very important that the ADHD partner actively participate in the treatment process,” Novotni urges. “Over time, the ADHD partner will be able to assume more responsibility for his or her own treatment. That, however, should be a goal in treatment, not a demand for beginning it.”
      Of course, it must be emphasized: Not every adult with ADHD needs a third party's involvement. ADHD is a spectrum condition, after all, with many points on the spectrum. Some people are more aware of their challenges than others and better able to take notes in sessions with care providers and follow up on suggestions.
      In recent years, it’s also become easier to find therapists and physicians who are highly qualified to evaluate and treat ADHD, yet it still takes some detective work. Oftentimes, two heads remain better than one, especially when it comes to assessing the professional’s thoroughness and competence during office visits.
      Below, leading ADHD experts and some partners of adults with ADHD explain why they consider a team approach critical to the evaluation and treatment process.

Leading ADHD Experts Weigh In:


"Most psychiatric patients will come in and say there are changes. The person with ADHD doesn’t complain of any changes at all. They have been like that all their lives. They aren’t often objective. When they hear others describe their behavior, they feel it is someone else being discussed. One handles that clinically by not being accusatory. Yet, it’s essential, when possible, to talk with the partner. I find it mandatory for an evaluation of a patient’s status. Besides defining the problem, which the patient might not recognize, the partner is also able to recognize changes as the treatment progresses. It’s essential to have that information."
—Paul Wender, M.D., pioneer in the diagnosis and treatment of pediatric and adult ADHD, in a 2007 interview with Gina Pera

 "What is one of the cardinal symptoms of ADHD? Failing to pay attention to both outer and internal phenomena. Psychologist and ADHD researcher Russell Barkley has followed up on the children with ADHD from a study he conducted in the late 1980s. These subjects are now in their early twenties. How many of them still have ADHD? It depends on whom you ask. If you ask those young adults, it’s 5 percent. If you ask their parents, it’s 50 percent. Moreover, if you loosen the diagnostic criteria to measure the adult manifestations of ADHD, as opposed to those of children, it is nearly 70 percent. The moral of the story: Even for the diagnosis, much less for the treatment plan, you need another person’s corroboration."
 —Stephen Hinshaw, Ph.D., ADHD research investigator, Professor and Chair of the Psychology Department at the University of California, Berkeley, in a 2007 interview with Gina Pera 

"Part of the reason why adult psychiatrists have not previously identified ADHD in adults may be that, unlike their child counterparts, most adult assessments focus on the patient rather than other informants. This means that the psychiatrist only has access to information about family complaints or employer frustration to the extent that the patient is aware of those perspectives. With ADHD, insight is variable…. By comparing the reports from two different informants, the clinician has access to multiple informants and a sense of the compatibility of the patient’s report with that of others for the full range of comorbid diagnoses. For example, the clinician may observe that the patient does not identify difficulties such as lying, defiance, or poor social skills, but these are major areas of concern for his or her spouse. On the other hand, both patient and informant may show good agreement on report of ADHD symptoms. This feedback is in itself helpful to the patient."
—Margaret D. Weiss, M.D., Ph.D., and Jacqueline R. Weiss, M.D., “A Guide to the Treatment of Adults With ADHD,” The Journal of Clinical Psychiatry 2004;65




Partners of Adults with ADHD Speak Out:

"Whoa! I looked at my husband’s partially completed ADHD evaluation form. It asks if he can concentrate when he reads. He wrote, “yes.” But he can’t even finish one short newspaper article! What if he answers all the questions inaccurately and I’m not there to set the record straight? From what I hear in the support group, some doctors and therapists are easily fooled. Yet I know if this doctor says, 'No, you don’t have ADHD,' my husband will say, 'Case closed!' Then what do I do? —Leslie

"My boyfriend doggedly tried to find help for years but he didn’t know he had ADHD, and the doctors never asked the right questions and never asked for input from family or friends. Consequently, they had him on antidepressants, anti-anxiety pills, and you name it—plus therapy—none of it working and some of it making things worse. I finally figured out he might have ADHD, but his HMO had no ADHD specialists, and my boyfriend didn’t have the mental stamina to battle with them. Plus he lacked the judgment to know if a physician was well qualified. If I hadn’t gotten involved, I’m sure my boyfriend would have given up or done something tragically desperate. He was at that point." —Dana


"After two years of so-called ADHD treatment, my wife casually mentioned how she feels like crap most of the time—”fuzzy,” disorganized, and unmotivated— until she visits her physician. Then the excitement of having the doc’s focused attention perks her up and she feels good. As a result, she’s been telling him that she’s doing great! That means her entire treatment has been based on how she felt while she was in the doctor’s office, with the facts of yesterday lost in the mist of time. No wonder treatment hasn’t helped!" —Hank


"Part of the reason my boyfriend didn’t get better for so long, despite his wanting to, is that he was too embarrassed to talk honestly to the doctor about whether the medication was helping and how his life was really going. He always just said, “Things are fine.” So now either his brother or I go with him. He says he’s relieved to have our help articulating his challenges and his progress because, on his own, he gets 'brain freeze' when he walks in the office door." —Tammy


"Your partner might not be able to accurately describe or recall the problems experienced or the impact of medication on behavior—or remember the physician’s or therapist’s instructions. If your partner is highly defensive, explain that you want to go so that you can learn how to be more patient and understanding. It might sound manipulative, but when you’re dealing with a person in denial of his or her challenges, that’s often what it takes to help them to a point of clarity."—Susanna


When it comes to seeking an evaluation or treatment for ADHD, what has been your experience? 

• If you're an adult, did you "go it alone" and did that work for you—or could you have used a partner's input? 
• If you're the partner of an adult with ADHD, what are your reasons for wanting to be involved—or having nothing to do with your partner's ADHD evaluation or treatment?


I look forward to your comments!

Gina Pera