ADHD Couples Therapy
Do you and/or your partner experience Attention Deficit/Hyperactivity Disorder (ADHD) symptoms? If so, you can expect very predictable (and painful) patterns to emerge in your relationship.
If the underlying issues are not addressed, it is likely that both of you will end up angry, dissatisfied, lonely, frustrated, and exhausted. These feelings typically arise from a pattern of mismatched or unrealistic expectations, lack of follow-through, nagging, constant conflict, and occasionally loud blow-out fights. If this dynamic continues long enough, one partner emotionally and physically pulls away, making the connection in the relationship even more tenuous.
Fortunately, with awareness and knowledgeable help, these patterns can be interrupted and relationships can be restored. On this web page, we will cover the basics of ADHD-diverse relationships but we invite you to connect with one of our neurodiversity specialists who would be honored to work with you.
QUICK BACKGROUND NOTE:
ADHD is most commonly diagnosed during childhood. While some percentage of children "grow out" of their symptoms or find effective ways to cope, many do not. In fact, some studies show that 50 percent of those who are diagnosed continue to have symptoms throughout adulthood.
Prevalence of adult ADHD is generally accepted to be 4% (ranging from 2% to 7%). Depending on the study, the diagnosis rate in men ranges from 1.5 times to 3 times that of women. Many professionals believe that women are under-diagnosed in both childhood and adulthood. It is also worth noting that ADHD in women normally presents as difficulty concentrating and can look similar to anxiety whereas it is more common for men to experience hyperactivity.
For easy of writing, the following is written assuming the male partner is the ADHD partner and the female is the non-ADHD partner. Please know that ADHD can show up in either spouse (or both) and we do not mean to perpetuate any stereotypes.
UNDERSTANDING THE ADHD RELATIONSHIP PATTERN
Consider each partner's part in an ADHD-diverse relationship:
Feelings: Angry, frustrated, sad and disappointed.
Behaviors: Controlling, nagging, criticizing and complaining.
Internal narrative: “I have to constantly remind you if I want anything to get done!“
Feelings: Worthless, resentful, sad and disappointed (in himself).
Behaviors: Defensive, making excuses, avoiding, lying and withdrawal.
Internal narrative: "How could you expect me to respond to you when you talk to me that way?“
IS YOUR MARRIAGE IN AN ADHD TRAP?
If you are curious to see if your relationship fits the typical ADHD neurodiverse pattern, consider how many of the following symptoms exist in your relationship:
Constant arguing, seemingly over inconsequential topics
One partner in the “parent“ role and the other partner in the “child“ or "teenager" role
Responsibilities feel uneven
Difficulty in negotiating reasonable expectations
Poor follow through on tasks
Lack of consequences for unmet expectations
Inability to discuss unmet expectations without arguing
Arguments get stuck on whose memory is right
Feeling that screens (phones, iPads, computers...) are more important than the relationship
Infrequent or non-existent sex life
The partner in the parent role becomes the bad cop and the ADHD partner becomes the Disney parent, particularly in the eyes of the children
Children get caught in parental struggle
BOTH PARTNERS STRUGGLE
As we work with ADHD-diverse couples, we find that both partners struggle but in very different ways.
ADHD Partner's Struggle
For the ADHD partner, daily life can feel overwhelming. These feelings start off hidden but quickly emerge under stress. Unfortunately, they emerge as yelling at the family member who is close by, usually a spouse or child. Alternatively, the feelings get buried deep inside. Then, coping mechanisms (such as playing video games, alcohol or drug use, work, and/or porn) take over to keep the feelings from surfacing.
Furthermore, feelings of inadequacy, which were often present in childhood, become magnified. As the non-ADHD spouse takes charge of the household and the children, the ADHD partner believes that he will not be accepted or loved unless he changes. Sadly, he does not believe this change is possible!
As this pattern gets locked in, the ADHD partner begins to walk on eggshells, just waiting for the next time that he lets his partner down. Being under this kind of stress only makes the ADHD struggle worse. His ADHD mind was already racing; feeling cluttered, fuzzy and/or noisy. Now it gets worse. With the stress of the relationship on top of all the other daily stress, it becomes impossible to think clearly, especially when dealing with his spouse.
Non-ADHD Partner's Struggle
The non-ADHD partner starts out over-functioning because she loves her husband and wants to help. But this quickly leads to a feeling of being overburdened. Her first attempt to deal with this is to ask for help but then she is accused of "being a nag" or "being uptight". This just feeds into her resentment. When she resists nagging and asks just once, he forgets. Although he apologizes, she feels let down and that he doesn't really care.
As she becomes convinced that she can not count on her spouse, she stops asking him to do things (which he could probably do well if their dysfunctional pattern did not exist). So she continues to over-function and soon feels lonely and ignored by her withdrawn husband. Her narrative of being "the responsible one" in the marriage is expressed through complaints to the kids, friends and other family members. Inevitably, the shame and struggle in the relationship spreads through the whole family system and hopelessness can quickly set in.
BUT THERE IS HOPE!!!
The path to healing needs to be customized for each couple; however, one of the fundamental interventions is to separate the symptoms of the ADHD from the message the partners are taking from it.
In other words, the struggle to follow through with a task does not mean that the partner does not care. It also does not mean that the ADHD partner cannot institute compensating strategies to address the needs of the spouse or family.
Our work in therapy is to break the negative cycle, address the underlying feelings of anger and sadness, and then make new meaning of what is happening and what can be done going forward.
Please know that we are not suggesting that the actual solutions are simple. The tactics need to be carefully customized for the couple and must be “ADHD-sensitive“. In other words, we can NOT just try HARDER to do the things we’ve been doing; rather, a couple must be inventive and willing to experiment with new approaches.
When working out the new couple dynamic, a couple of points must be emphasized:
Take a team approach. If one person is the "down" position, constantly being blamed, the change will not work. Both partners must honestly recognize the work that each one must do to break the negative cycle. Focus on changing yourself, not your partner.
Treat your partner with kindness even when he or she fails.
Be open to medication if that is suggested by your physician and other approaches are not working.
WORDS OF ENCOURAGEMENT
We have seen couples who have struggled with ADHD completely transform their marriage. Although it is not guaranteed, reshaping your painful patterns in a relationship can do wonders for your lives together. We would love to help and look forward to hearing from you.
Many of our clients do NOT seek to receive a diagnosis. It is often more effective to treat the unique characteristics which present themselves and avoid the negative effects of labeling and having a fixed mindset.
On the other hand, it can be INCREDIBLY helpful to receive a diagnosis if it can help a couple reinterpret behaviors as a way of experiencing the world as opposed to a sign of bad intent.
In such cases, clients start by taking the following on-line assessments (not definitive tests):
Scale of 0 to 100. Higher scores indicates higher ability to pay attention. Qualitative results given. Please print them out and share with your therapist.
0-20 ADHD unlikely
20-39 Attention Deficit Disorder Possible
40+ Attention Deficit Disorder Likely
When a formal diagnosis is requested and both partners agree that it will be helpful, we use a collaborative process and involve the non-ADHD partner in the process as long as this can be handled in an emotionally safe way. This often helps build an understanding of what the diagnosis actually means.
When performing a formal diagnosis, the steps include:
review of DSM 5 ADHD criteria,
history of past educational experiences,
recent occupational and relationship functioning,
information about medical conditions from a medical professional,
review of other disorders frequently occur with ADHD (such as Autism Spectrum Disorder), or can mimic the symptoms of adult ADHD,
input from other family members such as a spouse
if deemed necessary, formal assessments such as the Conners’ Adult ADHD Rating Scales (CAARS) can be administered
OVERLAP OF ASD AND ADHD
ADHD and autism spectrum disorders (ASD) are neurodevelopmental conditions that frequently co-occur. Although twin studies suggest that there are shared genetic influences that lead to both, researchers have yet to find a clearly identifiable neurological reason for these to exist together.
Nonetheless, the overlap is significant. ADHD is present in 30–80% of individuals with ASD, and ASD is present in 20–50% of individuals with ADHD. The main areas of neurological overlap for ASD and ADHD are in the areas of attention processing, performance monitoring, face processing and sensory processing. Furthermore, people with ADHD and ASD are often considered to have a lack of concern or inability to react to emotions or feelings of others. Please talk to our therapist to help you explore the differences and make sure your condition is fully understand.
SOURCES FOR THIS PAGE
Sex and age differences in Attention-Deficit/Hyperactivity Disorder symptoms and diagnoses: Implications for DSM-V and ICD-11, Dr. Ujjwal P. Ramtekkar, M.D., M.P.E., Dr. Angela M. Reiersen, M.D., M.P.E., Dr. Alexandre A. Todorov, Ph.D., and Dr. Richard D. Todd, Ph.D., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101894/
The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps, Melissa Orlov
NIMH (August 2021) Obsessive-Compulsive Disorder. From. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/
Overlaps and distinctions between attention deficit/hyperactivity disorder and autism spectrum disorder in young adulthood: Systematic review and guiding framework for EEG-imaging research
Alex Lau-Zhu,⁎ Anne Fritz, and Gráinne McLoughlin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331660/
Very Well Mind (July 2021) ADHD In Women. From. https://www.verywellmind.com/add-symptoms-in-women-20394
American Journal of Psychiatry (June 2007) Worldwide Prevalence of ADHD. From. https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2007.164.6.942?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
ADDITUDE (April 2020) ADHD Statistics: New ADD Facts and Research. From. https://www.additudemag.com/statistics-of-adhd/
Springer Link (August 2018) Sex Differences in Predicting ADHD. From. https://link.springer.com/article/10.1007/s00787-018-1211-3