Adult ADHD is Real: But How to Convince the Unconvinced?

Living with unrecognized ADHD, in a loved one or in oneself, can feel like being lost in the fog—often on a roller coaster.

      “I hope others can be spared from stumbling through the fog like my husband and I did,” Edith says. “For our first 25 years together, I thought Joe was lazy or selfish or both.”

     Edith also wondered if she was failing as a wife because she had so little success in motivating Joe to be more cooperative and thoughtful toward her and the children. At times she chalked it up to she and Joe marching to the beat of different drummers. “For years, I went back and forth in confusion, with no idea that adult ADHD existed,” she says. “Then he was diagnosed at age 55.”

     Adults with ADHD also use the fog metaphor, including this woman, who was diagnosed at age 52:

I don’t quite know how to describe my life to people who haven’t experienced ADHD the way I have. Imagine driving a car in heavy fog. You get tense, because you can’t see the edges of the road or what’s in front of you. In other words, you often can’t see how your actions will result in predictable consequences, which instead seem to come out of nowhere. 

So you inch along, gripping the wheel, anxious that you’re going to crash into something.That’s how my life was for a half century, until I figured out ADHD. Few people other than my family members would have guessed I had ADHD just by looking at me or talking to me. I worked hard to “pass for normal,” had earned some impressive college degrees, and had tons of plausible excuses for my goof-ups.

When I started taking the stimulant medication, though, the fog suddenly lifted and the road ahead was clear. I could relax my hold on the wheel and enjoy the drive. I could even appreciate the scenery without worrying that I’d get distracted and run off the road. The things most people take for granted, most people with ADHD struggle over for years until they figure out they have it.

Until now, perhaps you have been slogging through serious mental fog, not understanding how your life got so confusing. Even if you have learned about ADHD, maybe you harbor concerns or misconceptions about the validity of the diagnosis or the safety of the medication that help treat it. You are not alone. Everything about ADHD seems to cause confusion, including its name, until you get the facts.
      Below are five statements or questions I sometimes hear from skeptical partners of adults with newly diagnosed ADHD (and, phrased slightly differently, from some adults with ADHD themselves). So, let's take some time to debunk each one.

Q: My Partner Has Lots of Attention—for Some Things!

That’s true for most people with ADHD, and that’s one big reason why unrecognized ADHD symptoms can cause hurt feelings between partners. “You can pay attention when you want to” is the tiresome phrase that has echoed throughout the lives of adults with ADHD. Chalk it up as more unfortunate fallout from the misleading words Attention Deficit Disorder. It has nothing to do with attention deficits or even short attention spans.

      “ADHD is really not so much a disorder of attention as it is a disorder of self-regulation,” says psychologist Russell Barkley, who detailed his theory in 1997 in the landmark book ADHD and the Nature of Self-Control. Recent brain science discoveries have indicated that ADHD affects specific brain areas, including the frontal lobe, the basal ganglia, and the cerebellum. These areas show less activity and less reactivity to stimulation than in people without ADHD symptoms.
      What does having “less reactivity to stimulation” mean? And how does it relate to regulating attention? All humans need stimulation. It engages us in life and helps us meet our goals. Our mere interest in something—an appealing object, thought, or event and even potential danger or risk—triggers the release of brain chemicals that help arouse and maintain attention until the goal is met.
      Given genetic differences in people with ADHD, you might say they sit at one end of the human spectrum, the end that requires higher-than average stimulation in order to trigger interest and release those chemicals.  That’s why one psychiatrist calls ADHD Search for Stimulation Syndrome.
      For example, these adults might find themselves doing “stimulating” activities (such as talking on the phone or playing video games) when they should pursue “boring” activities (such as falling sleep and paying bills). In fact, one support-group member jokingly suggests a name much more explicit than ADHD: If It’s Boring, It Ain’t Gonna Happen Unless You Make Me Disorder.
      These adults know that the “more mature” pursuits are important, but knowledge alone cannot fuel motivation or attention; the payoff is simply neither sufficiently immediate nor rewarding. (In fact, it’s the mere anticipation of a reward that our brains find most stimulating; in comparison, the actual reward can feel like a letdown.) Moreover, what might feel boring or tedious to you might feel unnerving and undoable to your partner—like physical and mental “static” or even pain.
      Once you understand this, it’s easy to see why many adults with ADHD flock to highly stimulating activities that offer quick rewards—driving fast, spending money, smoking cigarettes, picking fights, eating junk food, jumping out of airplanes, playing video games, being the life of the party, or even pushing themselves into a workaholic frenzy, to name a few. These activities produce initial feelings of focus and a paradoxical inner calm, but over time, over-the-top stimulation typically makes everything worse.
      The challenge: Finding healthier ways to get sufficient stimulation and feelings of being rewarded.
      In fact, given what you’ve learned about ADHD and stimulation, it should come as no surprise that the first-line medical treatment for ADHD is called stimulant medication.

Q: My Partner Gets the Fun, and I Get the Drudgery?

Unfortunately, this is a common scenario when ADHD remains both undetected and unaddressed. Understanding why these disparities exist marks the first step toward rectifying them.

      For example, no one enjoys cleaning out the garage, but most people without ADHD can drum up the motivation to complete this tedious task. Why? Perhaps because they remember how annoying it is to search for items in a messy garage or park the car on the street in the wintertime.
      Moreover, they can integrate information from both the past and future and keep it in mind as they temporarily put the brake on fun distractions and bite the boring bullet. Simple, eh? Not quite.
     People with ADHD can possess challenges in each of those critical areas that most of us take for granted:

• summoning motivation
• thinking of future consequences
• remembering past difficulties
• “putting on the brakes” and
• following through on tasks that aren’t immediately gratifying or stimulating.

     What about the consequences they know will take place—for example, the utilities being shut off mid-winter for lack of payment or arriving at retirement age without savings? That’s where challenges occur in what psychologist Barkley calls cross-temporal organization. It might sound like a term from Star Trek, but it actually means that people with ADHD tend to view two kinds of time: Now and Not Now. And if you can’t possibly imagine yourself in the time of Not Now—where the consequential chickens come home to roost—it might as well be a million years in the future. Something that irrelevant to Now simply doesn’t kick the attention machine into gear.

Q: My Partner is Consistent—at Being Inconsistent!

Congratulations. Your observation matches that of most ADHD experts. That’s why some prefer the term Variable Attention Syndrome.

      Some people with ADHD might find only a few subjects or activities highly stimulating or rewarding, and they lock on those targets to the exclusion of all else. (This is often referred to as hyperfocus, a phenomenon touched upon several times in this book.)
      Others find so many things interesting that they can’t pick out the most relevant.
      This man, diagnosed with ADHD at age 42, describes what it’s like to constantly deal with both challenges:

The way I experience ADHD is like being at a loud party where everyone’s talking and the music is blaring, and you’re trying to hear what one person is saying but you can’t because you’re seeing, feeling, and hearing everything happening around you—at the exact same time.

Then five minutes later, it’s like you’ve finally locked into what that one person is saying, but the focus is so intense you’re no longer aware that the rest of the universe exists and so you miss your ride home. Repeat this situation 100 times a day.

Q: So My Partner Can’t “Try Harder” to Pay Attention?

Now you’re catching on. In fact, trying harder can make things worse. Here’s why. One thing our brains need in order to sustain attention is glucose. Glucose fuels our brain cells, and because they cannot store it they demand a steady supply.
      Groundbreaking research in 1990 using brain-imaging techniques showed lower than average glucose metabolism in the brains of adults who had been hyperactive since childhood.8 The largest reductions were in brain areas known to be involved in the control of attention and motor activity.
      The fun doesn’t end there, though. Typically, when we need to concentrate, more glucose flows to our brain. Yet, when a person with ADHD (remember, who already has lower glucose levels) tries harder to concentrate, the brain activity slows even further. Some describe it as “brain freeze.”
      The bottom line is this: People with ADHD typically can’t just decide to find an activity interesting or to perform on demand. Their brain chemistry must cooperate, and no amount of your crying or pleading will help. In fact, it usually makes things worse.

Q: Maybe My Partner Just Needs to Grow Up!

It’s true. Adults with ADHD often catch flak for being irresponsible and immature. After all, we commonly associate maturity with establishing and meeting priorities while still managing to pay bills, perhaps earn a living or take care of the house and children, and tend to our own health and relationships.
     But, in fact, these are a few of the ways in which ADHD’s core challenge in self-regulation can, when left untreated, thwart mature behavior.
      We’ll use a simple, everyday metaphor to explain. Consider three key areas in which a person’s poor self-regulation impairs the ability to drive an automobile:

Challenge #1: Stepping on the accelerator

In psychological lingo, this is called motivation or arousal. People with ADHD can have difficulty getting started on a task. Instead of initiating the first step, they might procrastinate, waiting until the last adrenaline-spiking moment to step on the gas. (Or they never begin, vexed by all the planning and distractions and lacking the motivation to overcome them.) Then, even once they gain forward motion, they might fail to regulate acceleration, which brings us to:

Challenge #2: Putting on the brakes

“My boyfriend just doesn’t know how to stop,” says Linda. “Stop talking. Stop spending. Stop to think of consequences. Stop to think about me for a change.”
      At their core, many ADHD symptoms reflect an inability to stop, or inhibit, undesirable behavior, as born out by more than 200 studies in the literature. The “mental brakes” just don’t grip very tightly. “When you put the brakes on your actions, you’re inhibiting, or controlling, behavior,” says one leading ADHD authority, private-practice physician Patricia Quinn, author of the classic book for children with ADHD: Putting on the Brakes: Young People’s Guide to Understanding Attention Deficit Hyperactivity Disorder.
      In fact, the “big three” common ADHD traits—inattention, impulsivity, and hyperactivity—each relate to the act of braking. A concise summary comes from pediatric neurologist Martin Kutscher, assistant clinical professor at the New York Medical College and author of Kids in the Syndrome Mix of ADHD, LD, Asperger’s, Tourette’s, Bipolar, and More!:

• Inattentive—Unable to put the brakes on distractions

• Impulsive—Unable to put the brakes on thoughts

• Hyperactive—Unable to put the brakes on acting upon distractions or thoughts

Braking plays a pivotal role in self-regulation because a lot of what we do in life is based upon what we don’t do.  Drivers must also know when to move forward and prepare for doing so, which brings them up against:

Challenge #3: Shifting gears, steering clear, changing routes

Driving from point A to point B efficiently, enjoyably, and safely requires self-regulation. The driver must coordinate a delicate balance of braking and accelerating, turning and going straight, and watching the road and avoiding obstacles while taking in the scenery (not to mention taking rest stops and refueling).
      With challenges in self-regulation, some adults with ADHD might find it tough to create balance in any activity, behavior, or thought, much less coordinate many things at once. To the outside observer, it might look like the person is living at the extreme of any behavior. For example, he or she might be super frugal or super extravagant, super productive or super slothful, the super fun parent or the super disciplinarian.
      In fact, if the adult with ADHD was not diagnosed until well into adulthood, the scene in the rearview mirror might resemble this, from a man diagnosed at age 40:

I now see how I spent much of my life veering down a highway where only a cliff on one side and a guard rail on the other kept me on the road, bouncing against one to the other and back again. It seems that I was always either overshooting or undershooting, overworking or underworking, overdetailing or underdetailing, and never doing anything consistently right.

Stopping something when they should stop. Starting something when they should start. Not underdoing and not overdoing, but finding the middle ground in being a mature adult. That’s the challenge for all of us humans, but it looms even larger for people with ADHD.

      The good news: Whether you have ADHD or love someone who does, this road trip called Life needn’t feel like being whipped around on an out-of-control roller coaster. The first step off the coaster—and out of the fog—is getting the facts.

Adapted from Is It You, Me, or Adult A.D.D.? Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder.


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