Adult ADHD and Nature-Sufficient Syndrome

My husband (pictured above, with San Francisco in the background; more photos below) and I had just parked the car last Sunday and were headed for the trail on San Bruno Mountain when I remembered, "Oh! My first-Tuesday blog post is due this week. What shall I write about?"

"Well," he said, following close behind, "you could write about how most of us are too attached to our electronic screens and devices. And how the industry is exploiting human vulnerabilities." 

This came as welcome news, especially since it wasn't that long ago that between the two of us, it was only me issuing frequent warnings about "cyber addiction" in our house and in society. A great uncontrolled experiment is being conducted our collective brain, and aside from a few researchers raising the alarm, few seem to care.

My husband was an early adapter of personal digital devices, being one of the first Apple Newton users and buying each successive iteration. 

When we finally purchased a flat-screen HD TV, the effect on him of watching even mediocre commercials was impressive: lounging on the sofa almost slack-jawed and reminding me of a listless opium-den habitué. The rapture lasted only a few weeks, though. Then one night I noticed him looking at my iPad while watching TV. 

Did I mention that we live smack-dab in Silicon Valley, where the ante is constantly being upped in the digital-distraction game?

Fortunately, living here also means we have a rich variety of hiking trails in every direction. Getting out for a trek together at the coast, in the redwoods, through the inland valleys has been a great unifying thread throughout our married life. 

No matter what else was going on when either of us suggested a hike, the other one always said, "Yes, let's go." These outings have been our salvation in more ways than one.

Living with ADHD, in oneself or a partner, the threat always lurks of being distracted from self-care and relationship-care by the easy stimulation. 

So it was that on a beautifully foggy and cool day, as we started up the trail, I nixed the idea of talking about the blog post in favor of savoring the sights, smells, and sensations.  And my husband gratefully agreed. 

Wildflowers still bloomed in abundance. Fog rolled over the hills. Birds chirped and swooped. The chaparral smelled fresh and sparkled from the light mist. We found a funnel-web spider's hole (see photo below). 

 My husband, a great forager, picked so many wild blackberries for me (the only time he does the "cooking") I had my fill. The heavy fog had kept most hikers away and we felt like we had the entire mountain to ourselves.

In hopes of inspiring you, too, to heal any lingering "nature deficit disorder" in your life or relationship, I share below some photos of our hikes over the last year or two.

I also invite you to share with other blog readers how you recharge your batteries in the great outdoors -- perhaps with a sport, a bicycle, regular walks in the neighborhood, or lazing in the hammock and listening to the wind or the birds.

Communicating ... Mindfully

This month's guest post comes to you from Mark Bertin, MD, a developmental pediatrician and author of The Family ADHD Solution: A Scientific Approach to Maximizing Your Child’s Attention and Minimizing Parental Stress. – G.P.

 

If you know you have ADHD, you’re probably aware of how distractibility, impulsiveness or difficulty “keeping track” of everyday life affects you.  But are you aware of how it affects your communication style with loved ones?
 
To address this aspect of ADHD’s potential effect on interpersonal relationships, let’s consider a few examples:  

• Distractibility may cause you to miss what's being said or being asked of you – or to even appear disinterested.
• Impulsiveness and reactivity may change your tone in ways you don’t intend  –snapped responses or flares of anger  – leaving your loved one feeling hurt or confused. 
• A busy mind drowns out the details of the conversation for a few minutes, or plans rebuttals for what it anticipates coming next, or doesn’t fully wait to hear out another person’s perspective.  

None of this is intentional, of course, but all of it influences how you come across and engage with others. 

Whether speaking or listening, we can hone our ability to communicate as we would any other skill. One proven method is through the practice of mindfulness. Think of mindfulness simply as getting out of “autopilot” – that habit of automatically acting and reacting while mentally we are somewhere else entirely.  On the outside, we’re smiling and nodding to someone but inside we’re lost in thoughts of the future, past, or anywhere our mind travels. 

"Our Weekend Without Meds"

The most common question I am asked about Adult ADHD (other than "Is it real?") is this: "Does the medication really make a difference?"

I used to recite the facts and figures. After all, double-blind research should provide rock-solid persuasion that yes, for some people with ADHD, the medication is positively life-changing.

Wrong. After only a few times of watching eyes glaze over during my recitations, I got wise: I started answering the question by sharing before-and-after stories of real-life adults with ADHD.

As one of my college journalism professors used to repeat: "Show, Don't Tell." In other words, don't tell your readers what to think by laying out tedious facts and arguments; instead, provide richly detailed stories and let the readers decide for themselves.

With that in mind, I offer you this "as told to" tragicomedy from a friend named Jason about the weekend that Robert, his partner, ran out of medication. (It's not a typo; Jason and Robert are both men, a reminder that ADHD's effect on relationships is not a "Mars-Venus Thing" and that ADHD does not discriminate on the basis of gender, age, or sexual orientation.)

It's important to note that Jason did not know Robert before he was diagnosed with ADHD and started taking medication. In fact, he had assumed Robert was making "too big of a deal" of his ADHD by taking medication. This "lost weekend" made him a believer.

It seemed like no big deal when my partner, Robert, said he’d forgotten to call his doctor and would run out of medicine over the weekend. "I'll just pick it up on Monday, no problem," he’d said. With hindsight, I should have packed a bag and gone to Vegas. He missed only three days’ medication but the downhill effect was dramatic.

I first noticed the difference on Saturday when it took him three hours to pick up cleaning supplies. On Friday, he’d planned to clean out his home office on Sunday. Unfortunately, he made the plans while on his medication and the event took place while he was off.

Sunday I sat down to enjoy some basketball games on TV in peace while Robert cleaned the office. Eight hours later, he asked me to come see how it looked. I didn’t know what to say. Yes, the office was cleaner. But the hallway was lined with junk and massive quantities of cleaning supplies.

Then he checks his e-mail. Two hours later, at midnight, I wander in to tell him goodnight. He is staring at the computer. I asked him what’s the matter. "I don't know." He is a born geek. Turns out, his PC was fine. He couldn't remember what he was trying to do! It wasn’t easy, but I finally got him to recognize it was because he had not had his medication in nearly two days.

On Monday, he found out that he couldn't get the prescription until Tuesday. He spent the evening on EBay shopping for things we didn’t need. Tuesday morning, he asked me to pick up his prescription; he didn’t have time during lunch hour. But he’d transposed two numbers in the address, and without the doctor’s name, I couldn’t find the office.

Luckily, he went by after work, got it, and had it filled. But he’d gotten lost trying to find his own doctor! He called me for directions, extremely frustrated and blaming me because I couldn’t find the doctor’s office earlier. Huh? He slammed down the phone, saying he would call back.

Two hours later, he arrives. When I asked why he hadn’t called back—I was worried— he didn't remember saying he would call. Where had he been for two hours? “Shopping.” But all he had in his hands was the prescription. "Oh, I forgot the things in the car.” He brings in groceries and more of the same cleaning supplies he purchased Saturday! Now, we have two of everything, including the world’s largest bottles of Simple Green!

When we finally got the air cleared over who was responsible for him being lost, we sat down to relax by watching TV. He picked a show about terrorist training. After all the bad news on this topic, not to mention the last three days' tension, I didn’t consider that relaxing. “But it’s really good!” he insisted.

After 20 minutes of watching him “self-medicate” by seeing torture victims suffer atrocities, I said, "No, I don't want to watch this," but he stubbornly left it on. I left the room. He said, "If you don't like it change the channel!" He had forgotten that he was holding the damn thing in a death grip. Argh!!!

He took a dose of the medication this morning. Hopefully, we will be headed back to a more even keel shortly. Hopefully, he will remember to fill his prescription next time before he runs completely out. In fact, I think I’ll put it on the calendar.

How about you? Can relate to these examples? Do you have others to share? What's the biggest difference medication has made in your or your partner's life?

ADHD and "Cyber Junkies"

Once my boyfriend starts on the Internet, there's no turning back. It seems the perfect trap for people with ADHD: He can drift aimlessly from topic to topic with just the click of a mouse. I just wish he could use all that internet time for something useful.   –Beth

My wife was supposed to turn in her masters-thesis outline by Tuesday. After doing nothing for six months, she worked at the computer all night in a last-minute attempt and still spent half the time playing games on Facebook. I think a typewriter would have presented fewer distractions.  –Marco 

My husband seems very addicted to the computer.  Ours is downstairs, and if I ask him to get something from down there it takes him 20 minutes because he stops to play a game or do some "social-networking." When I finally call down to see what is taking so long he yells back in anger. He was addicted to porn at one point. Who knows. Maybe he still is.   –Kim


It's not only the partners of adults with ADHD who report concerns about computer addiction. The adults themselves  curse electronic gadgets' mesmerizing hold over them. In this previous post, for example, Glen says he staves off sleep by scanning every news headline worldwide on the Internet. And he is not alone.

Clearly, many of us recognize this potential problem. But what to do about it? Below, national cyber-addiction expert, author, and support-group leader Kevin Roberts offers pro-active strategies.
                                                                                     –Gina Pera                                    

Are you a Cyber Junkie? 

Five Steps to Take Back Your Life

 

By Kevin Roberts

Author and cyber-addiction expert Kevin Roberts

Do you, like many adults with ADHD struggle to regulate the amount of time you spend online?  Has “social networking” on Facebook turned into real-time isolation?  Is the cyber world sabotaging your chances for success and happiness? If these questions hit home, you’re not alone.

I am an ADHD adult who also suffers from anxiety.  In addition to these challenges, I spent 14,000 hours over ten years wasting my life on computer games, endless Facebook sessions, and random Internet surfing.  The problem is now under control, but it is a daily effort to keep it that way.

We know that somewhere around 50 percent of untreated ADHD adults will, at some point in their lives, turn to substance abuse.  Data has started to mount that an even greater percentage of people with ADHD struggle with excessive, or even addictive, use of the cyber world.  In both cases, people who do not get treatment usually attempt to self-medicate, meaning that they engage in substances, or behaviors, that temporarily ease the discomfort or the disorder.

Reaching Out to Your Community

How can we best reach adults with ADHD who have no idea they have it? Based on my 12 years of advocacy, I'd say it is through people with ADHD talking about it openly and honestly with others in their day-to-day communities. In this way, others hear the facts about ADHD from people they already know instead of thinly drawn profiles in the media.

I jokingly refer to our Adult ADHD CHADD group in Palo Alto as  "ADHD without Borders," because the meeting routinely draws transplants from many countries, including China, India, Vietnam, Israel, Germany, and Brazil.

These people often express great relief to finally find a group who understands them, because their friends and family back home typically do not. Realizing the genetic connection, they cannot accept that ADHD is an "American invention." They clearly see that extended family members also have ADHD and they need to be educated. They vow to take the message back home and put ADHD in a context their friends and family can understand.

Q & A: When to Disclose – And More

Dear readers - I hope you like this blog's new, cleaner design!

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). Participants had so many questions, we had no room for the overflow, so I am sharing them here.

Question: When beginning a new relationship, at what point do you suggest disclosing that you have ADHD and what is a good way to do it?

Hi Rebeca,

Well, I wouldn’t mention it on the first date!  Or perhaps even the third or fifth.

I’d give the person time to get to know you first, so you can avoid the risk of letting that person’s possible misconceptions about ADHD filter perceptions of you. 

Then again, if despite your best efforts, you still have a tendency to “blurt” or “mishear” or some other common ADHD-related trait, it might be good to provide a little education first, so the person won’t misinterpret your behavior as, for example, rude or uncaring. Even then, though, you don’t have to say “I do this because I have ADHD.” Because, again, you don’t know the person’s level of understanding of ADHD. Instead, you can say something like this: “Sometimes I have trouble arriving places on time. I just want you to know that if I’m ever late to meet you, it’s not because I don’t care. I’m working on strategies, but sometimes I slip.”

Wearing “ADHD Eyeglasses” with Care

Maybe this has happened to you. As soon as you started learning about ADHD, you suddenly saw it all around you. No, it's not that new people with ADHD suddenly started popping up in your midst; rather, you started seeing oh-so-familiar behaviors in a new light, through the lens of ADHD knowledge.

Thanks to 21st century brain-science breakthroughs, we’re developing enlightened attitudes about the organ linked to everything we do, feel, or think: the brain. Yet resistance remains, so we can't expect everyone to openly embrace what, after careful study, we've come to accept: ADHD is real, it is more common than anyone knew, and, when left unacknowledged, ADHD symptoms can limit the options and self-realization of those who have it—and their loved ones, too.

Is there a parallel in history, when knowledge that promised to vastly expanded human potential somehow gained acceptance only slowly and amid great opposition? Yes indeed, and now we can’t imagine how our ancestors didn’t immediately “see” the benefits of one such invention: eyeglasses.

Eyeglasses debuted in the 13th century, though crude attempts date back to ancient Rome. It took a few hundred years to perfect the design but much longer to erase the stigma. That’s right, the stigma from wearing eyeglasses. To avoid making “spectacles” of themselves, many people preferred stumbling around.

These days we call eyeglasses “eyewear”—chic accessories for those who need them and vanity items for some who don’t. Eye exams take place routinely, and nobody questions the necessity of "vision correction." More relevant to our analogy, no one suggests that if you can’t see well enough to read then you’re probably not smart enough to understand what you’d be reading. Three cheers for progress.

Vision: A Function of the Brain as well as the Eye

The example of eyeglasses offers a practical application in explaining ADHD. Consider this fact: Vision is only partly a function of the eye. Yes, the eye receives sensory input in the form of light hitting the retina.  But those light patterns are then converted into electrical signals, which travel along brain pathways to a visual processing center. That’s where your brain tells you what you’ve seen and makes sense of it. Or doesn’t.

Q: How to Deal with "Meds Roulette"?

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!

Question from Nina:  How do you deal with a significant other who just got diagnosed with Adult ADHD and is trying out new medications with all different types of side effects?

Hi Nina,

Okay, so you’re at the stage that we sometimes call “Meds Roulette.” By the time some adults with ADHD are diagnosed, there can be intense pressure to "get better FAST."  Unfortunately, tweaking medications is not a fast process. So, it's important that you both show some patience and use a thoughtful approach. Most of all, it's important that both of you be educated.
 

We are extremely lucky to have many medication options today. Just a few years ago, choices were few and side effects much more problematic. Today’s wide range of options increases the odds that each person can find one that works with their unique biochemistry. We hope that some day, genetic research will help indicate which medication will be most effective for an individual. But we’re not there yet. In the meantime, that means lots of trial and error.

That said, a careful prescribing physician and a pro-active patient can take steps to avoid/minimize potential side effects or cut them short when they do occur. Noting side effects can be an important part of the process; side effects can provide clues as to the underlying neurophysiology and the next direction to consider. Unfortunately, many physicians aren’t so careful in their monitoring or don’t know how to read such clues.
 

The fact is, 75 percent of late-diagnosis adults have a co-existing condition, such as depression or anxiety. A stimulant alone can intensify the depression or anxiety in some people, who might need an antidepressant or anti-anxiety medication in addition to a stimulant. There are many possible concerns and options.

Overall, though, the problems I hear most often involve physicians following no logical plan or method. Instead, they use a more haphazard “pin the meds on the ADHD” approach. For example, some prescribe a medication at too high a dosage, when they should be “starting low and titrating slow.” (This means beginning with a low dosage and increasing it by small increments over time, noticing the effect at each stage.) A most regrettable result is the person deciding that "the cure is worse than the disease" and gives up. That’s a sad waste of opportunity.

Dr. Margaret Weiss is a top ADHD researcher and clinician. She was kind enough to share with me,  so I could share with my book’s readers, the recommended protocol for achieving optimal results with ADHD medication treatment. I am hoping that readers will share it with their doctors, so we can all work together to raise treatment standards.
 

Based on the best experts' advice, I also recommend that the partners of adults with ADHD get involved with the process, taking a team approach, unless it is clear that your ADHD partner can handle it well on his or her own. Throughout treatment, the physician should be asking for your feedback. This is recommended for several reasons:

• Some ADHD adults don’t always notice the changes (positive or negative) or remember to share the details with the physician.
• Some might half-hear or half-forget instructions from the physician. (It’s amazing to me how many ADHD-treating physicians, knowing ADHD challenges, don’t write down instructions for their patients.)
• Some might not notice that the physician is not acting in a methodical or thoughtful manner.

Some people bristle at the idea of a "team approach" when pursuing ADHD treatment. They might say, "My partner is an adult; why should I be involved?" I wrote about the reasons for it in this post, Partners in Life, Partners in ADHD Treatment.

Of course medication is only part of the physical treatment process.  It’s also important to pay attention to diet, sleep, food sensitivities, and exercise.  No medication can offset poor health and lifestyle habits.

When the medication is right, however, it can make life so much easier for everyone. I’m constantly astounded by the positive reports from the adults in our Silicon Valley Adult ADHD discussion group  and the online “partners of adult with ADHD” group as well. It’s an awe-inspiring transformation to witness.  So, if you want best results from medication, know that it takes an educated, pro-active approach!  Here are more resources to help you do just that:

• Adult ADHD Treatment guidelines from the National Resource Center on ADHD
• An overview of ADHD medications, including dosage availability and common side effects, presented by ADHD specialist Ted Mandelkorn, M.D.

I welcome your comments and advice on finding effective medical treatment for Adult ADHD!—Gina Pera

Q & A on Adult ADHD: What Is Personality, What Are Symptoms?

Continuing with last month's theme of sharing questions and my answers from CHADD's Ask the Expert chat, here is a two-part question from a reader named Matt. 


I welcome your responses to both Matt's questions and my answers.

—Gina Pera

1. How do you separate ADHD from the person? Because it is neurological, it just doesn't seem possible. It would be like separating sexual orientation from a person.

Hi Matt,

Boy, that’s a question for the philosophers! But I’ll give it a try. It’s true that, especially with late-diagnosis adult ADHD, you often hear comments such as “I don’t know if I have ADHD or if I am ADHD.”

A 30-something man with ADHD recently told me that his personality is the Life of the Party. But, I asked him, is that really his personality? Or, could it be a behavior developed many years ago because he was unable to follow the many conversational threads at a party? 

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!

      

Reprinted courtesy of "Kev" 
http://www.kevscartoons.com

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?

Adult ADHD and "Time Blindness": Dr. Russell Barkley's Tactics for Taming That Trickster, Time

Time.  That's one word that always makes the top of the list when I ask adults in our local CHADD discussion group to name their top ADHD-related challenges.

• Keeping track of time.
• Estimating the time it will take to complete a project.
• Planning for future time instead of getting totally wrapped up in present time.

Managing time is a constant challenge for most humans, especially in our speeded-up age. Yet, for people with ADHD, time can be a particularly shape-shifting trickster. 


No one knows this better than psychologist Russell Barkley, a preeminent researcher, lecturer, expert, and author in the field of ADHD. And no one better explains to the layperson why this is and what to do about it than does Dr. Barkley in his new book, Taking Charge of Adult ADHD. 

The following excerpt, from Chapter 10, offers tips for taking charge of your time. Earlier chapters build a strong foundation for understanding ADHD neurobiology and guidelines for medical treatment; remaining chapters offer straightforward but in-depth strategies for tackling your particular issues in various areas of life. 

The "Invisible Ropes" of Adult ADHD, And How A Special Type of Therapy Can Help Set You Free

Introduction:  When I'm asked about the best kind of therapy for Adult ADHD, I explain that the research thus far points to cognitive-behavioral therapy (CBT), in combination with medication.  Then I emphasize a critical point: not just any CBT but that with a special focus on ADHD. 

      Standard CBT that does not acknowledge the neurobiological role of ADHD can be counter-productive, at best.  How do I know this?  Because I listen to the top experts who make this study and practice their life's work. 

      I'm pleased to offer a guest essay this month from one of these top experts: J. Russell Ramsay, psychologist and co-director at the Adult ADHD Clinic at the University of Pennsylvania. (Please see bio at the end of this post).  In preparing my talk for the upcoming CHADD 22nd International Conference on ADHD ("Adult ADHD Symptoms or Poor Coping Skills?"), I relied heavily on the book he co-authored with Dr. Anthony Rostain (see below).  

      The conference will be held in Atlanta this year, Nov. 11-13.  I cannot overemphasize the wealth of knowledge, validation, and support to be gained at this conference. If there's a possibility that you can attend, try your hardest to get there!  Sign up by September 15, and receive the early-bird discount!   --Gina Pera

By J. Russell Ramsay, Ph.D.

Circus elephants are trained while secured with ropes until they are subdued. Trainers then teach them to perform tricks for audiences without the use of restraints. No less powerful than when they were in the wild, these elephants are held back by the invisible ropes of their training.

      Growing up with ADHD, particularly when it has gone undiagnosed until adulthood, makes it very likely that adults with ADHD have encountered their own “ropes” in life, such as academic trauma, ongoing troubles handling the demands of daily life, or hurtful criticisms made by others. Although their circumstances may change in their adult lives, these experiences may have trained them to hold negative attitudes about themselves and their future.

John and Abby: Solving the "Problem with No Name"

This July 4, my husband and I celebrated our 12th anniversary.  Compared to couples married 30, 40 or even the 50 years of my parents' marriage, 12 years is hardly remarkable unless you figure in unrecognized ADHD.

     As I joked to my friends on Facebook: "We can credit the fact that we're still married—and happily so—to equal parts brutal honesty, teeth-gnashing, affection, shared interests, sense of humor, and inertia."  

     Mostly, though, we can credit keen ADHD awareness. To see our wedding photo and read my interview with a reporter from Health.com, click here. (Notice in the photo that I am clearly in the dripline of the double-umbrella my new husband is holding; let's just say that is rather symbolic of the early days of our marriage, when his ADHD was flying well beneath the radar screen yet still having an impact.)

     In many ways, we are like the couple whose story I share below, John and Abby, excerpted from Is It You, Me, or Adult A.D.D.?:

Thirty years ago, at age 13, John set his sights on becoming a computer scientist. Despite almost flunking out of high school, he went on to earn his doctorate. It required Herculean effort, though, and tanks of ulcer-inducing coffee, not to mention a tunnel-vision focus that eclipsed a social life and other healthy habits. [Note: That's a caffeine IV in the illustration at left.]

      Sure, John noticed that other students, many less intelligent than he, didn’t suffer concentration problems like his. But he thought it was just his nature, something unchangeable. Upon finally leaving academia’s structure for the business environment, John found himself constantly on the outs with managers for missed deadlines, miscommunications, and an uncooperative attitude.   

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.

Pt. 2: When a "Good News" Diagnosis Means Bad News for the Relationship

Years ago, when my husband first agreed to be evaluated for ADHD, he did it on one condition: that I be evaluated for it, too.  

Whether he simply disliked being singled out or truly thought me ADHD'ish remains lost in the mists of time and perhaps distorted perception. 

My guess: He simply wasn't connecting the dots between his actions and my reactions. From his perspective, my reactions seemed to come irrationally flying out of nowhere. 

From my perspective, of course, my reactions were entirely justified. But could I be sure? No.  

Beside, something had to be up with me if I continued to "ride the rollercoaster" of miscommunications, conflict, agreements gone kerflooie, and so on.  So, I happily agreed to join him in a professional workup.           

Two lengthy evaluations later, my husband was diagnosed with ADHD and I was not. Instead, the psychiatrist pronounced me "complex" and said, "We usually recommend that our patients with ADHD have partners who are organized and can take care of practical matters."

It took me a minute to comprehend: Wait, you're prescribing ME for my husband? 

(What might this nationally known clinic prescribe if my husband didn't already happen to be married to an organized  person. Divorce? A professional organizer love-match-making service? I was too stunned to ask.)

For the next few years, we endured some head-spinning confusion as we struggled to understand and smooth out the dynamics between 

1. Our "personalities"
2. Our respective neurons, and 
3. Various permutations thereof 

During that tumultuous time, an outside observer might have been tempted to diagnose us with a smorgasbord of conditions. And, at some points, we certainly would have agreed. 

Fast forward several years. My husband still has ADHD, though most of the time it's now more of a "difference" than a big deal. I still don't have ADHD, as my husband will confirm. 

I'm not perfect. Who is? But these days I'm much less confused, anxious, depressed, and reactionary than I used to be—back when the ADHD Roller Coaster ran full tilt and neither of us knew why. We've both made big changes.

Our story will resonate for many couples affected by unrecognized ADHD. That is, once the ADHD was diagnosed and addressed in a cooperative way, the rest of their challenges were more easily targeted and resolved. That truly made ADHD a "good news" diagnosis. 

For other couples, though, reaching the ADHD diagnosis creates more questions about the relationship's dysfunction than it answers.  That brings us to Part II of why the good-news diagnosis of ADHD sometimes means bad news for the relationship.

Recap Pt. I: Good News/Bad News

To recap Part I on this topic from last month (click here to read the entire post):

       Newly diagnosed adults with ADHD begin treatment, often including medication, and soon the "fog" of distractibility, impulsivity, and inattention begins dissipating.  With newfound clarity, many of these adults start re-examining their choices – job and career, friendships, health habits, and sometimes even their mates.

      Frequently for the first time in their lives, adults feel solidly optimistic about their ability to evoke permanent changes; after all, they finally have the right answers and right tools. As they excitedly embrace new competencies and confidence, though, inevitably the "balance of power" in their relationship starts shifting.

            

Jack provided our case study in Part I. Newly on board with ADHD treatment, he expressed bitter resentment over what he felt was his wife's abject lack of appreciation for his stellar progress. He concluded she had unacknowledged problems of her own,  including a drinking habit that had grown increasingly problematic over the years. Last I heard from him, they were headed to divorce.   

Last month, I offered a few reasons why Jack might not be seeing his wife's side of things and might even be misperceiving his level of progress. 

The post-ADHD-diagnosis phenomenon is a big and complex topic, full of surprising twists and turns.  

For example, sometimes the partners of adults with ADHD go a bit ballistic when the diagnosis finally is made. This typically occurs when they've long struggled to, as I explain in my book:  "Explain the inexplicable" and "manage the unmanageable" around a partner's unrecognized ADHD symptoms. 

When these "partners of" finally learn that not only did their mate's problematic behavior have a name, it also had a solution, their reaction might be akin to a psychological pressure-cooker blowing its lid. 

They think back to all the years of 

• Frustrating therapy sessions
• Futile and ever-changing "accommodations" for their partners
• Being blamed by their partner for being "too controlling" or  "fill in the blank."  

They might finally understand how they developed a drinking habit to compensate, or why they developed an "anger-management" problem.

The resentment might ratchet up by an order of magnitude if the psychiatrist or therapist suddenly expects them to continue being their ADHD partners' executive assistant without ever acknowledging past hurts or their own need for help.  And if they don't immediately get on board, they are labeled "uncooperative." All of these are common scenarios.

Yet There Is Another Scenario

Another equally possible scenario for Jack is that his wife's dysfunctional behaviors had long flown under the radar screen. Those behaviors had in fact been lifetime problems for her. He simply had been too "disconnected" to notice before marriage or after.  With treatment, though, he was noticing and dynamics were shifting.

Last month's post drew a comment from Katy, who writes about Adult ADHD at the 18Channels blog. She explained how her ADHD diagnosis had a similar bad-news effect on the relationship but a good-news effect in the end:

Bad news: It was one catalyst for the end of the relationship I was in when I was diagnosed...but that relationship wasn't a good fit for me or him anyway. 

He was a nice guy with a little toxic caretaking streak that even pre-diagnosis I didn't need imposed upon me. And frankly, some of my ADHD quirks were a little stressful for him to live with...duh :) He was far too rigid in his routines for me to be able to accommodate.

My diagnosis process made him appreciate me as someone who was working hard to take responsibility for their whole selves...but that didn't change the fact that my whole self wasn't a good fit for his whole self. Plus, he was using my eccentricities to hide behind, so he didn't have to deal with his own...!

I think we're both better off having split up. I got tired of being "the person with the problem" and he got tired of stepping over the garbage can to get to the front door. (Hey, what can I say, I need visual cues).



Good news: I met the love of my life (sappy, sappy, sappy...but TRUE!) after breaking up with the other dude. He has ADHD too. We absolutely adore each other, and aren't one bit annoyed with each others' ADHD quirks. Half the time we don't even notice each other's ADHD quirks, the other half of the time we're delighted with them.

I find it highly amusing to watch him wandering around doing some of the exact same funny things that I do to myself all the time, it's so funny to see it from the outside! Ex: today he tore the house apart from top to bottom, looking for his W-2. 

He says "I just know that I put it somewhere allegedly safe, and I have no idea where that might be!" Every year I lose my W-2's, tear apart the house, and say exactly the same thing. We really need to stop putting things in safe places! I just gave him big hug.

As Katy's story illustrates, one person's ADHD diagnosis and treatment can "level the playing field" in the relationship.  In other words, it allows the couple to more clearly assess compatibility beyond the obvious level of, for example,  "I'm disorganized and he's very disorganized." 

Moreover, the diagnosis ups the ante on the other partner "copping" to any dysfunctional behavior of his or her own instead of, as Katy points out, hiding behind a partner's dysfunction.

Katy made those observations several years ago. As time went on, her joy at being with someone who shared her challenges instead of judging her for them—or trying to control her—was tested. She still loves her husband. Yet, while she has expended considerable effort in managing her own ADHD symptoms, her husband came to the diagnosis more slowly, with  more resistance. And, with more household chaos and tension along the way.  

In other words, a dual-ADHD household doesn't get along magically, because the couple understands each other's challenges. Rather, each can intensely feel the impact of the other's ADHD-related challenges, if not actively managed.

When The "Partner Of" Has ADHD, Too

Using the term non-ADHD partners to describe the partners of adults with ADHD  never made sense to me.  For starters, what if they have ADHD, too?  Happens all the time.

[That is one reason I asked my friend Taylor J, who is in a dual-ADHD marriage, to lead the discussion in the "You, Me, and ADHD Online Book Club."]

But what if these folks don't know they have ADHD? 

Given the millions of adults with  undiagnosed ADHD, of course it's possible. Moreover, it figures that the partner with the most obvious or extreme ADHD symptoms will be diagnosed first while the other might come to it only years later. Or never.

Over the years of moderating support groups for partners of adults with ADHD, I've often wondered if certain members themselves have ADHD. They are the ones who, over long periods of time, continue to report no progress on the home front. Of course, they could be dealing with particularly difficult partners.  But they also tend to be the ones who keep repeating the same problems and asking me the same questions, never seeming to internalize the information and take action. Yes, they quite possibly could have ADHD, along with their partners.

[Side note: I also see this phenomenon among some parents of children with ADHD who don't seem to notice they might have ADHD, too. Or, they minimize their challenges.]

Some eventually do figure that not only they, but their partners as well, have ADHD. But, in my observation, it typically happens  months or even years after a partner's treatment starts to stabilize. 

In other words, when the dust finally begins to settle—when they're not constantly being drawn into a partner's ADHD-related crises and dramas—they (or their therapists) can more clearly perceive their own contributions to the problems in the relationship. 

Finally, they can start separating years of poor coping mechanisms (in reacting to a partner's unrecognized ADHD symptoms) from their own lifelong challenges.  

I receive many letters from readers of my book, Is It You, Me, or Adult A.D.D.?  As you would expect, many are written by the partners of adults with ADHD. Surprisingly, though, most letters come from adults with ADHD. 

Peter started out in the former category but over time also found himself in the latter. To read excerpts from his series of notes to me (posted with his permission), click here.

What The Research Tells Us

The anecdotes from Katy and Peter above are just that: anecdotes. They are not statistical probabilities; they are simply possibilities. When it comes to the mental health of partners of adults with ADHD—newly partnered or in longstanding relationships—anything is possible. 

That hasn't stopped the pundits, however, from issuing often-repeated stereotypes about the partners' psychological makeup or personality, including

• They have ADHD, too
• They have low self-esteem (because they stay in a troubled relationship or can't seem to improve it)
• They are "sadistic and controlling" (in the words of a well-known psychiatrist who himself has ADHD)
• They are boring "muggles" (in the Harry Potter book series, a muggle is a person who lacks any sort of magical ability; the implication being that people with ADHD are magical and people without are boring)

Trouble is, such certainties are based purely on bias and conjecture even when issued by alleged experts, as they regrettably often are.
  

First, consider these  facts:

1. ADHD affects an estimated 10 to 30  million adults in the U.S. alone.
2. ADHD is a syndrome with highly variable traits and myriad co-existing conditions
3. There's much more to a person's complexity than variable ADHD symptoms.

In short, we cannot make any one-size-fits-all pronouncements about adults with ADHD. How then can we possibly do that for their partners, past or current?

      
Second:  We cannot assess the partners' psychological characteristics without also considering the end result of living with a mate's undiagnosed or untreated ADHD symptoms—sometimes for decades and sometimes while also raising children with ADHD. 

Sure, we can make anecdotal observations how the partners typically seem now, a few months or a few decades into these often high-stress relationships.  But what were they like before a few spins around the ADHD Roller Coaster? And what about the partners we don't even see in support groups?

Research is extremely limited on this topic, yet there are two small but important published studies from well-known researchers that shed some light. And there is the ADHD Partner Survey, which examined this topic from several angles.  

First, the published research:

1. The psychosocial functioning of children and spouses of adults with ADHD found that "overall, spouses of ADHD adults show no more lifetime and current psychiatric disorders than spouses of comparison adults, challenging the concept of selective mating. They do, however, report more psychological distress on the SCL-90-R and less marital satisfaction."
2. The marital and family functioning of adults with ADHD and their spouses – found that the spouses of adults with ADHD did not differ from the control group in terms of psychiatric health.

      The ADHD Partner Survey queried respondents about the state of their mental health both before and during the relationship. The goal for this part of the survey was to differentiate between baseline mental health-conditions (prior to relationship) and the psychological impact of living with a partner's unrecognized ADHD symptoms. 

The picture that emerges (see chart below; for larger image, click here) is of a diverse group who bring to these relationships very different backgrounds and mental states. No surprise there.

It seems the only accurate description we have for the partners of adults with ADHD is this: They live with (or used to live with) a partner who has ADHD. After that, anything is possible and no one-size-fits-all characterizations are useful.

How about you?  Are you in a "mixed" relationship  -- meaning, for example, one of you has ADHD and the other depression or bi-polar disorder? 

Or maybe you both have ADHD but different sub-types? If so, when were you diagnosed -- before the relationship, during, or after? Please share your thoughts and experiences.

—Gina  Pera