For people with ADHD across the lifespan, the co-occurrence of other disorders is generally the rule rather than the exception. Experts estimate that at least 60-80 percent of children, adolescents, and adults with ADHD have at least one other condition. Conduct disorders, oppositional defiant disorder, learning disorders, and anxiety and mood disorders are the most common comorbid disorders in childhood and adolescence. In adults, personality disorders are also highly prevalent. Likewise, there is a significant association between ADHD and substance use disorders, constituting one of the most common forms of dual diagnosis, a term used for the co-occurrence of an addictive disorder and at least one other mental disorder.

ADHD is associated with increased risk of substance use initiation as well as of developing a substance use disorder (SUD). Children and adolescents with ADHD are significantly more likely to try alcohol, tobacco, and a range of substances during their lifetime compared with their non-ADHD counterparts. Indeed, a study by Steve Lee and colleagues (2011) reports that individuals with ADHD are:

● twice as likely to have ever smoked cigarettes and nearly three times more likely to become addicted to nicotine,
● almost twice more likely to develop an alcohol or a cocaine use disorder
● approximately 1.5 times more likely to meet criteria for cannabis use disorder
● more than 2.5 times more likely to develop any form substance use disorder
● more vulnerable to develop a gambling disorder.

Experts estimate that approximately 15 percent of adolescents and young adults with ADHD have a concurrent substance use disorder. A large meta-analysis revealed that almost one in every four patients seeking treatment for a substance use disorder also have ADHD (van Emmerik-van Oortmerssen, 2012). In the vast majority of these cases, ADHD remained undiagnosed and consequently untreated. Clinical evidence and findings from multiple studies show that the bidirectional overlap between these disorders is not random. Several explanations have been posed for their link.

The link between ADHD and substance use disorders
The mechanisms underlying the increased risk of substance use and SUDs among individuals with ADHD have not been fully established. The increased risk is most likely due to a combination of several vulnerability factors, including:
● shared neurobiological mechanisms
● the difficulties in psychosocial functioning or certain traits and characteristics that are common to both disorders
● the comorbidity with other psychiatric disorders
● the underlying neuropsychological deficits, or what has been termed as the self-medication hypothesis.

Several neuroimaging studies show that individuals with ADHD display motivation and reward deficits characterized by a failure to delay gratification and preference for small immediate rewards over larger delayed rewards, mediated by altered dopamine transmission in certain brain areas. These deficits have been proposed as an underlying mechanism for impulsive behaviours associated with ADHD and the increased vulnerability to substance abuse. Researchers also hypothesize that ADHD and addictive disorders could share common familial risk factors due to shared genetic risks between the two conditions. In addition, several studies indicate a threefold-increased risk of ADHD in children of women who smoked cigarettes or used alcohol or other drugs during pregnancy.

Initiation of substance use in adolescence commonly takes place within social and peer contexts. Therefore, some studies indicate that the psychosocial problems and poor academic functioning frequently seen in ADHD may contribute to the development of an SUD. Alternatively, the increased vulnerability to addictive disorders in people with ADHD may also be related with some of the core symptoms of this neurodevelopmental disorder, such as impulsivity, which is also a significant feature of substance abuse. Likewise, some personality traits and symptoms that are generally genetically determined and are frequently associated with both ADHD and addictive disorders– such as novelty seeking, sensation seeking, harm avoidance, low self-esteem, and altered executive functions– may also increase the link to developing a dual diagnosis.

Another key factor in understanding their increased vulnerability to substance use and abuse is the high comorbidity with other psychiatric disorders in children, adolescents and adults with ADHD, including depressive and anxiety disorders, bipolar disorder, or conduct disorders. Of particular relevance is the coexistence of a conduct disorder. Among individuals with ADHD, conduct disorder not only increases the risk of developing a substance use disorder, it is also associated with an earlier onset of substance use, a greater severity of the addictive disorder, and an overall worse outcome of both disorders.

Researchers suggest that some individuals with ADHD use substances in order to attenuate or alleviate some of their symptoms or dysfunctions in an attempt to “self-medicate.” Indeed, for some people with ADHD, cocaine has a paradoxical effect of increasing attention span and decreasing motor restlessness. Some adolescents and adults with ADHD, particularly those with more prominent hyperactivity and impulsivity symptoms, experience a decrease in psychomotor activation with marijuana use. For others, however, marijuana use can mimic the symptoms of ADHD and has been associated with worsening in sustained attention, deficits in problem-solving, or difficulties in organization that may persist even after several weeks of abstinence.

Treatment for ADHD and comorbid substance use disorders
Treatment of ADHD with or without a concurrent substance use disorder requires a multidisciplinary approach that integrates therapy and medications. Psychotherapy is always recommended, often in conjunction with any medication. Psychoeducation, motivational interviewing, and cognitive behavioural therapy are among the most useful intervention strategies for ADHD and concurrent SUD. An adequate treatment plan needs to consider the trajectory and severity of both disorders, the number of substances used, the presence of withdrawal symptoms, the stability of ADHD symptoms during prolonged periods of abstinence, and the occurrence of other comorbid psychiatric disorders.

Several studies have assessed the efficacy of stimulant and non-stimulant medications in individuals with ADHD and SUDs. The majority of these studies have shown that the different ADHD medications are equally effective and well tolerated, generally in combination with psychological interventions. The effects of ADHD medications on craving or abstinence is more limited. Nonetheless, none of the studies has shown a detrimental effect of stimulant or non-stimulant medications on substance use outcomes.

Clinical practice reveals that treatment of ADHD may help individuals to remain and benefit from treatment for the addictive disorder. The good tolerability and safety profile of psychostimulants or atomoxetine (Strattera) in dually diagnosed individuals and the scarcity of significant interactions indicate these medications can be easily associated with pharmacotherapies commonly used in the treatment of specific substance abuse or dependence (Martínez-Raga et al, 2013).

Medication treatment for ADHD is often deferred until the individual reaches a protracted period of abstinence from the addictive substance. However, there is limited empirical evidence supporting such practice, and clinical guidelines recommend deciding treatment order based on the severity of ADHD and the comorbid disorder. A recent study evaluating the effects of stimulant medication in individuals with co-occurring ADHD and cocaine dependence (Levin et al, 2018) reported that abstinence is most likely preceded by improvement in ADHD, which tends to occur early with medication treatment. This suggests that treatment of ADHD should not be postponed.

Medication concerns
Several concerns often arise on the use of medications for ADHD and their relationship with drug abuse. Many parents fear that prescription of psychostimulants during childhood may increase the susceptibility to subsequent drug use in adolescence or adulthood. As mentioned earlier, the fact is that untreated ADHD is a significant risk factor for substance abuse in adolescence and adulthood. Solid basic and clinical research shows there is no evidence that stimulants increase substance use or the risk of addiction. It remains to be established if they protect against the risk of later developing an addictive disorder, however.

Another frequent concern relates to the potential risk of abuse or misuse of psychostimulants prescribed for ADHD. This is one of the arguments against prescribing these medications in individuals at risk or who have a concurrent SUD. However, the majority of cases of medication abuse or misuse are related to short-acting stimulants, whilst there is little evidence of abuse or misuse with long-acting formulations, more so with nonstimulants. In any case, careful assessment of potential abuse of ADHD medication is warranted.

Although psychostimulants are considered first-line treatments for adults with ADHD, a common concern is whether they can be safely and efficaciously used in those with both ADHD and a substance use disorder. In these dually diagnosed adults, long half-life or slow-release formulations are preferable, as they maximize treatment adherence and minimize the risk of abuse due to their pharmacological characteristics. A growing body of research and clinical practice indicate that long-acting stimulants are as effective on symptoms of ADHD and well-tolerated in individuals with and without a concurrent SUD. Often considered a second-line option for adults with ADHD, atomoxetine (Strattera) may be considered a first-line treatment alternative for adults with SUD– especially those for whom treatment with stimulants previously failed and those with a history of prescription stimulant abuse.

José Martínez-Raga, MD, PhD, heads the psychiatry department at the University Hospital Doctor Peset, one of the major teaching hospitals in Valencia, Spain. He is also a lecturer at the University of Valencia Medical School. Dr. Martínez-Raga received his medical degree from the University of Valencia Medical School and completed an MSc Degree in Drug Addiction. Later, he completed a PhD, having conducted a study as a research fellow in Psychiatry at McLean Hospital and Harvard Medical School. He completed his specialist psychiatric training at the Bethlem and Maudsley Royal Hospital School in London. Then, he returned to Spain and worked as a psychiatrist within the Spanish National Health Service. Until 2012, he was the coordinator of an outpatient addiction behaviours unit. Dr. Martínez-Raga has coauthored over 100 peer-reviewed scientific journal articles, as well as over 40 book chapters and 12 books and monographs. He has been invited to present at national and international psychiatry and addiction conferences and meetings. Currently, he is vice president of the Sociedad Española de Patología Dual (Spanish Society of Dual Disorders or SEPD).
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I spent the bulk of my adult life as an undiagnosed individual struggling with ADHD. Unfortunately, I didn’t realize that there was anything different about me, I just thought I was never enough.

Post-secondary education is where it really caught up with me. I couldn’t focus on lectures. I struggled to complete homework. Being on my own and having to look after laundry, cleaning, shopping, cooking, and keeping on budget along with my homework just felt impossible. I had a ton of self-doubt regarding if I should even be in school. I felt far to dumb to be there. Everyone seemed to have their stuff together and I was struggling to keep up with the simplest of things.

The school did notice that there was something wrong. They suggested I take a learning strategies course. It helped a little. I know now that it wasn’t aimed at people who have ADHD, so their organization, prioritization, and time management strategies never worked for me because I wasn’t struggling in the ways they thought I was. Proper identification is very important.

Eventually, I dropped out. It took me far more years than I wish to disclose here to obtain my degree.

Initially, my work life ended up successful. I spent 15 years working in theatre across Canada. Being in a fast paced, creative, flexible environment really helped me to shine. Although, I struggled to fit in and always felt like an outcast. Looking back, I realize that I was immature compared to my peers. I imagine they saw me as incredibly awkward and very inappropriate at times. I couldn’t see any of this in the moment, but I felt it and my self-esteem suffered. So did my decision making.

I flitted through many relationships, both long and short term throughout my life. I couldn’t maintain a good relationship with anyone, particularly as a life partner. I really wasn’t a good partner to myself, let alone trying to support or stand beside anyone else. My saving grace was that I was able to establish and maintain very long-term friendships. Today, I was reminded by one of my good friends that we have known each other for 30 years!

When I first started working with Artemis, I wasn’t sure that this was my thing. It was incredibly different than theatre and didn’t hold much interest for me. Until I was assessed, and it opened my eyes to what I had been struggling with all along. Finally, there wasn’t something wrong with me. My brain was built differently. It became my mission to help others see themselves and their struggles in a better light.

My interpersonal relationships also improved after diagnosis and treatment. I have a close family relationship with my husband, children, and extended family, and we are compassionate about all of our unique struggles. Sure, we still have difficult times and don’t always see eye to eye, but we are solid, overall.

I had some grief over what could have been had I been recognized early. My path would have been so much easier. The thing is, I wouldn’t change anything at this point. I am who I am because of my struggles, and I am happy with me.

How can we help make you happy with you? A

The symptoms of ADHD can create challenges for adults in the workplace, just as they do for children in school. Some adults with ADHD have very successful careers. Others may struggle with a variety of challenges, including poor communication skills, distractibility, procrastination and difficulty managing complex projects. Seeking assistance from a career counsellor, psychologist, social worker or other health care worker with career counselling training can be helpful in understanding and coping with ADHD on the job. Each individual with ADHD has a different set of challenges. Therefore, it is important to consider your unique picture, as you go about designing strategies, accommodations and modifications for the workplace. Below are suggestions for coping with many of the symptoms or impairments associated with ADHD.

1. Distractibility. Problems with external distractibility (noises and movement in the surrounding environment) and internal distractibility (daydreams) can be the biggest challenge for adults with ADHD. The following strategies may help:

• Request a private office or quiet cubicle, or take work home or work when others are not in the office.
• Use "white noise" earphones, classical music or other sounds to drown out office noises.
• Work in unused space, such as a conference room, where distractions are few.
• Route phone calls directly to voicemail and respond to them at a set time every day.
• Jot down ideas in a notebook to avoid interruption of the current task.
• Keep a list of ideas that come to you during meetings so that you can communicate more effectively.
• Perform one task at a time. Do not start a new task until the current one is done.

2. Impulsivity. Adults with ADHD may struggle with impulsivity and temper outbursts in the workplace. Try the following strategies:

• Learn to use self-talk to monitor impulsive actions.
• Work with a coach to role-play appropriate responses to frustrating situations.
• Ask for regular, constructive feedback as a way of becoming more aware of how impulsivity might manifest in you.
• Practice relaxation and meditation techniques.
• Anticipate the problems that regularly trigger impulsive reactions and develop routines for coping with these situations.

3. Hyperactivity. Adults with the hyperactive presentation of ADHD often do better in jobs that allow a great deal of movement, such as sales, but if you have a sedentary job, the following strategies may help:

• Take intermittent breaks to do photocopying, go to the mailroom, or walk to the water fountain.
• Take notes in meetings to prevent restlessness.
• Move around, exercise, take a walk, or run up and down the stairs.
• Bring lunch―instead of going out to buy it―so the lunch hour can be a time for exercise.

4. Poor Memory. Failing to remember deadlines and other responsibilities can antagonize coworkers, especially when working on a team. To improve memory, try the suggestions below:

• Use tape recording devices or take copious notes at meetings.
• Write checklists for complicated tasks.
• Use a bulletin board or computer reminder list for announcements and other memory triggers.
• Learn how to use a day planner and keep it with you to keep track of tasks and events.
• Write notes on sticky pads and put them in a highly visible place.

5. Boredom-blockouts. Because of their strong need for stimulation, some adults with ADHD become easily bored at work, especially with detailed paperwork and routine tasks. To prevent boredom, try the following tips:

• Set a timer to stay on task.
• Break up long tasks into shorter ones.
• Take breaks, drink water, get up and walk around.
• Find a job with stimulating responsibilities and minimal routine tasks.

6. Time management difficulties. Managing time can be a big challenge for adults with ADHD. Here are some guidelines for improving time management skills:

• Use timeline charts to break large projects into smaller pieces with step-by-step due dates.
• Reward yourself for achieving each due date.
• Use watch devices with alarms, buzzers, planners or computer planning software.
• Program your computer to beep 5 minutes before every meeting on the calendar.
• Avoid over-scheduling the day by overestimating how long each task or meeting will take.

7. Procrastination. Putting things off not only prevents the completion of tasks but also creates problems for others on the team. Here are some strategies for success:

• Break the task into small pieces, rewarding yourself along the way. (Rewards need not be grand; they might be a new CD, a long walk with your dog, dancing or whatever you enjoy.) It may be helpful to have a coach or someone else to whom you can report and be accountable for achieving each piece of the task until you learn to overcome your tendencies to procrastinate. See the National Resource Center's information on coaching for more information on how a coach can help.
• Ask the supervisor to set a deadline for tasks.
• Consider working on a team with a co-worker who manages time well.

8. Difficulty managing long-term projects. Managing complex or long-term projects may be the hardest organizational challenge for adults with ADHD. Managing projects requires a range of skills, including time management, organizing materials, tracking progress, and communicating accomplishments. Try the following guidelines:

• Break projects up into manageable parts, with rewards for completing each.
• Strive to shorten the time allowed on a project to better utilize "sprinting abilities."
• Ask a coach to assist you in tolerating longer and longer projects, a bit at a time.
• Find and partner with a co-worker who has good organizational skills.
• Look for work that requires only short-term tasks.

9. Paperwork/details. The inability to find important papers, turn in reports and time sheets, and maintain a filing system can create the impression of carelessness. If paperwork is a significant part of the job, try these tips:

• Make it a rule to handle each piece of paper only once.
• Ask an administrative assistant to handle detailed paperwork.
• Keep only those papers that are currently in use; purge the rest.
• Make filing more fun by colour-coding folders and using catchy labels.

l0. Interpersonal/social skill issues. Individuals with ADHD may unintentionally offend co-workers by interrupting frequently, talking too much, being too blunt, or not listening well. If social skills are a challenge, try the following strategies:

• Ask others for feedback, especially if there is a history of problems with colleagues and supervisors.
• Learn to pick up on social cues more readily. Some adults with ADHD have a hard time picking up nonverbal cues that they are angering a co-worker or supervisor.
• Work with a coach to determine what types of settings often lead to interpersonal/social issues.
• Seek a position with greater autonomy if working with others is challenging.

 
Making a Career Change
Sometimes, no matter how hard they try, adults with ADHD find that their initial career choice does not play to their strengths, and it is necessary to make a change. The following categories reflect aspects of an individual that impact effective functioning on the job. Collect data about each of these categories as it applies to you. This data will permit you to see yourself as a unique, complete person and to evaluate better the careers that match your characteristics.

1. Interests (professional & leisure). Since individuals with ADHD work better in fields that interest them, it is important that they identify their interests. After the interests have been identified, a consultation with a trained career counsellor, who can provide a list of occupations or jobs that correspond to their interests, should be considered. The list of occupations that correspond to the individual's interests will provide the basis for the steps that follow.

2. Skills (mental, interpersonal, and physical). Identifying skills and accomplishments can reveal marketable skills that can be used in various work settings. Generally, skills fall into three categories: skills working with data, people, or things. People do best when their skills correspond to the job requirements. Skills can be assessed through standardized tests or through checklists that trigger knowledge of success in past accomplishments.

For example, you might ask yourself the following questions:

• What subjects were easiest for you in school?
• What strengths do you think others see in you?
• What skills do you possess that enabled you to succeed in something?
• What strengths do you think teachers saw in you?
• What things about your job performance set you apart from others?

In addition, using a skill word list provided by a career counsellor or published in a career book may be helpful in identifying skills that may not have been considered important or considered at all.

3. Personality. What type of personality are you? Personality preferences can be measured by standardized testing or by checklists that force you to choose between two situations. Knowing personality strengths can help improve work habits, increase career options, and achieve a more successful path to a career future.

4. Values (work and leisure). People value different things. It is generally agreed that people work harder and with more focus when the task at hand is in line with their values. Leisure values are also important because a personal passion can often turn into a career. Career counsellors and other professionals who work with career issues or checklists in career books can help isolate these values.

5. Aptitudes (verbal, numerical, abstract reasoning, clerical speed and accuracy, mechanical, spatial, spelling, and language). An aptitude is defined as the ability to acquire proficiency in a specific area. It often seems that these are innate, but this is not necessarily true. Aptitudes can also be learned. While a skill is a current ability, an aptitude is the potential to acquire a skill based on natural talents or training.

Aptitudes can be formally assessed by a professional or by using informal checklists. When you understand what your strengths are, you can compare them to the requirements of any given job. The Dictionary of Occupational Titles and The Occupational Outlook Handbook are two sources for such information. Doing these comprehensive assessments ensures that you have a clear knowledge of the essential tasks of a job for which you are applying and how your strengths match up with the requirements of the job.

6. Energy patterns (Is there a pattern that's reliable?). All jobs require differing amounts of energy. Are you a sprinter or a plodder alonger? While those are not real terms, they define the types of people who can either go through each day with the same amount of energy output or sprint through a job, depleting their energies and thus feeling "spent." Some people have a pattern to their energy output, while others do not.

To figure out if there is a pattern to your energy output, keep an energy log for 1 or 2 months. Rate yourself on a scale from 1 (very low energy level) to 10 (very high energy level) three times per day -- at the beginning, middle, and end of the day. Record these ratings in a log book or day planner. Periodically review the log to see whether there is any pattern in energy level across the day, week, and month. If a pattern is not noticeable, then it will not be difficult to sustain energy at most jobs. However, if a fairly reliable pattern exists, then it may be necessary to learn how to harness energy to do difficult tasks at times when energy is high and do more "automatic" tasks when energy is low or depleted.

7. Workplace habits (what is expected vs. how we measure up). Job success often depends on personal characteristics, such as dependability, reliability, commitment, and attitude. Consult a career-related book on the reference list for a list of the qualities that employers most often look for in employees. Decide how you measure up to these qualities, and determine whether it is necessary to improve these workplace habits.

8. A complete history of all previous jobs (useful for extracting valuable information). People learn the most from their mistakes and successes. Look back and explore such things as:

• What you liked most about each job
• What you liked least about each job
• The dates of employment (did you leave after a few months?)

Look for patterns that might help to plan for a future career.
 
Using the Data
After collecting this data, follow these three steps to maximize the chance of success and minimize the chance of failure:

• Read about the jobs you plan to pursue to get a reality check. The Dictionary of Occupational Titles, Occupational Outlook Handbook and related online sources can help give a realistic view of any given job and dispel any fantasies.
• Talk to others already doing the job through a series of informational interviews. These will allow you to open your eyes to reality and to "try the career on for size." It's a good idea to speak to three to five people in a given career to get more than one viewpoint.
• Observe the job for an hour, a day, or a week, or in a volunteer position. This is the only way to pick up unspoken information, such as how hassled everyone might appear, how well-lit an area is, how calm people seem as they interact with each other, and a host of other almost subliminal factors.

When all of this information has been collected, the following questions can be answered:

• What jobs are a "good fit" with my personal strengths, and what jobs are a poor fit?
• What fantasies or false beliefs did I have about the jobs I used to think would work well for me?
• For the jobs that are a good fit for me, what supportive strategies, accommodations or modifications are necessary to maximize my success? A

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The different ways ADHD presents in my family are just awesome.

My husband and I are about to go on vacation. The car will pick us up and take us to the airport at 3:00 p.m. It is now 12:30, and neither of us can sit still and relax. Everyone keeps telling us to just enjoy, sit, and chill out. Yeah, right.

I am catching up on my article writing. You see, I finally have a calm brain. Okay, a calmer brain. I’m not at work with a million things to do, so I can have some creative time, which I love! I need something to burn up all the pent-up energy due to the excitement of going away, so I’m writing.

My husband is currently vacuuming the basement. That’s my son’s job. After this morning, we have the cleanest house we have had in months. Too bad we are going away and can’t enjoy it.

We talked to our oldest child today, who is finally learning to drive at 25 years old. We were told that if you learn to drive in a parking lot, you can be charged with reckless driving. Yeah, we laughed at that, too. What you need to understand is that my child’s brain craves excitement. Everything becomes a drama, and we constantly challenge the narratives that we are told.

Our youngest child is struggling to finish high school. Unfortunately, this child does not live with us full-time, so we don’t have many options to help in this area. It is the last semester, but the interest in schoolwork is becoming difficult to maintain, particularly when there has been an offer of an apprenticeship in an area of intense interest. We will keep working to ensure that this one graduates successfully.

Our middle child fluctuates with remembering tasks and getting up on time for work. When things are going smoothly, this child is totally on the ball! Up on time, getting things done, anticipating what needs to be done. Then, suddenly, for no clear reason, everything becomes bumpy again. It is painful to watch the struggle and self-judgement when things aren’t running so smoothly. We keep working on self-forgiveness and self-esteem.

ADHD is not one size fits all. It is different for all of us. Having patience and understanding for everyone’s individual struggles is what keeps our family close and strong. A

​9 Ways ADHD May Strain Relationships

“The most destructive pattern in an ADHD relationship is when one partner becomes the responsible ‘parent’ figure and the other the irresponsible ‘child.'” 8 more unhealthy ADHD mistakes, and how to remedy them.

ADHD and Relationships

Relationships in which one or both partners have attention deficit disorder (ADHD or ADD) range from successful to disastrous. Partnerships affected — or should I say, distorted — by ADHD symptoms can bring “the worst of times.” Pain and anger abound. You can barely talk to each other about problems affecting the relationship. When you do, you rarely agree. You’re frustrated that you’ve gotten to this point, and you’re disappointed that you haven’t made things better.

Can ADHD Cause Divorce Or Other Relationship Issues?

ADHD can be a contributing factor in a wide range of marital problems. If your partner has ADD, you may feel ignored and lonely. Your partner can focus on things that interest them but not on you. They never seem to follow through on what they agree to do. They may seem to act like a child instead of an adult. You nag them, and you’ve started to dislike the person you’ve become. The two of you either fight or clam up. Worst of all, you are stressed about being saddled with household responsibilities while your partner gets to have all the fun.

If you have ADHD, you may feel your partner has become a nagging monster. The person you loved has become a control freak, trying to manage the details of your life. No matter how hard you try, you can’t meet your partner’s expectations. The easiest way to deal with them is to leave them alone.
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Either of these scenarios can ultimately result in the end of a relationship. If the above descriptions sound familiar, your relationship is suffering from what I call the ADHD effect. ADHD symptoms — and the responses both of you have to them — have damaged your partnership. The good news is that understanding the role that ADHD plays in your relationship can turn it around. When you learn to identify the challenges ADHD brings to relationships and the steps you can take to meet them, you can rebuild your lives. That’s exactly what my partner and I did.

Signs Undiagnosed ADHD Is Causing Relationship Problems

We didn’t know that my partner had ADHD. I had fallen in love with his brilliance, sharp wit, and his appetite for adventure. His intense focus on me was surprising and flattering. He was warm and attentive. When I got sick on our first date, he tucked me under a blanket on the sofa and made me hot tea. I was touched.

Not long after we got married, our relationship began to fall apart. I couldn’t understand how someone who had been so attentive could ignore my needs or be so “consistently inconsistent” in helping out around the house. He was equally confused and annoyed. How could the woman he had married, who had seemed so endearing and optimistic, change into a fire-breathing dragon who wouldn’t give him a break and wouldn’t leave him alone?

By our tenth anniversary, we had considered divorce. We were angry, frustrated, disconnected, and unhappy. I was beyond sad. We stayed glued together only by our desire to raise our children well and by a feeling, deep inside, that we ought to be able to do better. Around that time, our daughter, who was nine, was diagnosed as having a learning disability and ADHD. In time, my husband was also diagnosed with ADHD.

Learning to Treat and Cope With ADHD to Avoid Relationship Problems

Discovering that one or both partners have ADHD is just the beginning. Medication is an efficient way to jump-start treatment, but behavioural changes need to be made. What you do once you’ve started treatment is crucial to your relationship.

If an inability to follow through on tasks makes you unreliable in your partner’s eyes, use a smartphone reminder system or another organizational plan to get the task done. Coaching and cognitive behavioural therapy can also help.

Understand that such changes must be voluntary. No matter how much a non-ADHD partner may want to, they can’t force their partner to get organized or become more attentive. Both partners must change. Often, an ADHD partner sets up a system that works well for the other yet seems inefficient or strange to the non-ADHD partner. Their criticism or suggestions about how to do it better demoralize them. My husband and I learned this the hard way, mostly at his expense, as I kept trying to force him to do things differently. The harder I pushed, the more he resisted, and the worse our relationship became. Sound familiar?

Rediscovering romance and joy in your relationship again after years of hurt is a journey. Each partner works at reframing the challenges that ADHD introduces into their life. They work on systems and treatments for managing ADHD symptoms. And, one day, each finds that the good things about their partner are what they notice most.

The rewards are worth it. My husband and I moved from dysfunctional to happy. We thrive in our careers, and our relationship is stronger now than before. My husband’s ADHD symptoms are under control, and I understand and appreciate the effort that it takes. We recognize and accept — and laugh about — each other’s faults and rejoice in each other’s strengths.

You can do this, too. You can move past unhappiness and create something better if you recognize how ADHD affects your relationship and make adjustments in your attitude and behaviours.

9 Ways ADHD Affects Relationships

Many ADHD relationships are affected by similar patterns, especially when the disorder is under-managed. When you recognize these patterns, you can change them.

1. Hyperfocus Dating. The biggest shock to ADHD relationships comes with the transition from courtship to marriage. Typically, a person with ADHD hyperfocuses on their partner in the early stages of dating, making them feel like the center of their world. When the hyperfocus stops, the relationship changes dramatically. The non-ADHD partner takes it personally.

My husband stopped hyperfocusing on me the day we got home from our honeymoon. Suddenly, he was gone — back to work, back to his regular life. I was left behind. After six months of marriage, I wondered if I had married the right man. The non-ADHD partner should remember that inattentiveness is not intentional and find a way to forgive their partner. Feeling ignored is painful. Address the issue head-on by establishing ways to improve your connections and intimacy and allowing yourself to mourn the pain that hyperfocus shock has caused you both.

2. Walking On Eggshells. Tantrums, anger, and rude behaviour often accompany untreated ADHD symptoms. One man with ADHD described it to me as “having to anticipate my partner’s response to every single thing I do. I live my life trying to second-guess her because I want to please her, but most of the time, she’s just mad.” Changing behaviour in both partners is critical to turning around a relationship. Don’t assume that anger or frustration in either partner is part of ADHD. Chances are good that you can get these things under control.

3. Believing ADHD Doesn’t Matter. Some partners with ADHD don’t believe that ADHD is a factor in their relationship. They say, “I don’t need treatment! I like myself just the way I am. You’re the one who doesn’t like me and has problems with this relationship.” My husband was in denial. The good news for us was that, about a month or so after diagnosis, he decided he didn’t have much to lose by considering treatment. He discovered it made a world of difference.

So here’s my plea to all ADHD partners who are skeptical: If you don’t believe the disorder affects your relationship, assume that it does, and get an evaluation and effective treatment. It could save your relationship.

4. Misinterpreting Symptoms. You and your partner probably misinterpret each other’s motives and actions because you think you understand each other. For example, a partner with undiagnosed ADHD may be distracted, paying little attention to those they love. This can be interpreted as “they don’t care” rather than “they’re distracted.” The response to the former is to feel hurt. The response to the latter is “to make time for each other.” Getting to know your differences in the context of ADHD can clear up misinterpretations.

5. Chore Wars. Having a partner with untreated ADHD often results in a non-ADHD partner taking on more housework. If workload imbalances aren’t addressed, the non-ADHD partner will feel resentment. Trying harder isn’t the answer. ADHD partners must try “differently” if they are going to succeed — and the non-ADHD partners must accept their partner’s unorthodox approaches. Leaving clean clothes in the dryer so they can be easily found the next morning may seem odd, but it may work for the ADHD partner. Both partners benefit when the non-ADHD partner admits that their way of doing things doesn’t work for their partner.

6. Impulsive Responses. ADHD symptoms alone aren’t destructive to a relationship; a partner’s response to the symptoms and the reaction that it evokes is. You can respond to a partner’s habit of impulsively blurting out things by feeling disrespected and fighting back. This will cause your ADHD partner to take up the fight. Or you can respond by changing your conversational patterns to make it easier for the ADHD partner to participate. Some ways to do this include speaking in shorter sentences and having your partner take notes to “hold” an idea for later. Couples who are aware of this pattern can choose productive responses.

7. Nag Now, Pay Later. If you have an ADHD partner, you probably nag your partner. The best reason not to do it is that it doesn’t work. Since the problem is the ADHD partner’s distractibility and untreated symptoms, not their motivation, nagging won’t help them get things done. It causes the ADHD partner to retreat, increasing feelings of loneliness and separation, and reinforces the shame that they feel after years of not meeting people’s expectations. Having a partner treat the ADHD symptoms and stopping when you find yourself nagging will break this pattern.

It Takes the Two of You

8. The Blame Game. The Blame Game sounds like the name of a TV show. “For 40 points: Who didn’t take out the garbage this week?” It’s not a game at all. The Blame Game is corrosive to a relationship. It is happening when the non-ADHD partner blames the ADHD partner’s unreliability for the relationship problems, and the ADHD partner blames the non-ADHD partner’s anger — “If they would just calm down, everything would be fine!” Accepting the validity of the other partner’s complaints quickly relieves some of the pressure. Differentiating your partner from their behaviour allows a couple to attack the problem, not the individual, head-on.

9. The Parent-Child Dynamic. The most destructive pattern in an ADHD relationship is when one partner becomes the responsible “parent” figure and the other the irresponsible “child.” This is caused by the inconsistency inherent in untreated ADHD. Since the ADHD partner can’t be relied upon, the non-ADHD partner takes over, resulting in anger and frustration in both partners. Parenting a partner is never good. You can change this pattern by using ADHD support strategies, such as reminder systems and treatment. These help the ADHD partner become more reliable and regain their status as “partner.” A

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Psychotherapy can be a helpful tool for those with neurodivergent conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and various learning disabilities.

Historically, neurodivergence was seen as an illness or disorder that needed to be fixed or changed. Thankfully, it is now understood and encouraged that neurodiversity is a strength that improves our society, emphasizing that seeking a neurodiversity-affirming therapist can be imperative.  When you receive your assessment report, many psychologists recommend psychotherapy to help with emotional regulation, behaviour management, and self-esteem/coping skills.

Neurodiversity-affirming care is a therapeutic approach that focuses on treatment plans and an environment that encourages one’s strengths. This means that your therapist will not see your neurodivergence as something that needs to be “fixed” or a weakness but rather as a strength that can be fostered. Our species needs neurotypical and neurodiverse brains in our environment to thrive, and it can be highly damaging to encourage individuals to act more neurotypically.

Neurodiversity-affirming therapists will ensure they honour the unique challenges, strengths, barriers, and necessities that neurodiverse individuals face daily. It is important not to hinder one’s strengths or teach one to hide who one is.

For instance, masking is a challenge that many neurodivergent individuals experience. Masking occurs when neurodivergent individuals act in a way that may be more “socially acceptable” by hiding specific impulses and behaviours. This can be harmful to individuals and ultimately lead to burnout. Some therapies in the past have involved methods to teach neurodivergent individuals to hide these behaviours. For instance, teaching individuals with ASD to mask self-soothing behaviours such as stimming (rocking, repeating words, hand flapping, etc.).

Neurodiverse-affirming therapists ensure they approach therapy from a culturally sensitive perspective, keeping current on ongoing training and remaining aware of their biases. In addition, they support individuals with an individualized approach that honours their unique challenges and strengths. There is no denying that neurodiverse individuals face unique challenges every day, and therapy can be a helpful tool to help manage them.

Within neurodiverse-affirming therapy, the goal is to ensure that everyone has access to care. This includes flexible online booking, sending out several automated appointment reminders, ensuring clear expectations, providing visual information when needed, and fostering a sensory-inclusive space.

As we know, various disorders can coexist with ADHD, including anxiety, depression, mood disorders, substance use disorders, and sleep disorders. Therapy can be helpful in effectively exploring the origin of these conditions while helping individuals develop coping skills and tools to deal with these daily concerns. Therapy can also be a helpful tool for individuals who are living with loved ones who are neurodivergent, such as a partner, child, sibling, or parent.

If you’re looking for a therapist, you can visit https://www.psychologytoday.com/ca and filter for the specific needs you’re looking for, or feel free to reach out, and we can help provide some recommendations in the area! A

Recently, my husband and I were out at a concert at a local venue we adore. It’s a 100-year-old downtown theatre that they have updated and renovated into a beautiful concert and theatre space. As a recovering thespian, I have worked in numerous theatres, all of them having their own beauty and scars. My favourite was a renovated theatre in Calgary. Another 100+ year old space where they had kept amazing parts of the original and incorporated them into the new site. I have a significant soft spot for old theatres. It has been almost 15 years since I worked in theatre, and I miss it. I love what I do now, but I still miss my old life.

On the stage screens, during the intermission, the theatre announced that they will be closing in December 2024. We were devastated. For a moment.

Then my entrepreneurial, ADHD brain kicked into high gear. What if we bought the theatre? My husband and I discussed this, jokingly, until the band started up again. Then, I spent the first few songs running the numbers and working through how I could actually make it work. It stopped being a joke and I wanted to figure out how to make it a reality. I missed out on some good tunes, but I became unreasonably excited about the prospect of running a theatre. It was a dream of mine for so long!

The idea ran around in the back of my mind for the remainder of the weekend. It took a backseat on Monday when I finally got back to work and greeted my staff and started working with my clients.

Eventually, after seeing a few of my clients, I realized there is no way that I am walking away from this work.

My job is to work myself out of a job. My clients aren’t supposed to work with me forever. I help them to learn to manage their ADHD on their own and how to establish a strong toolkit of skills that will enable them to achieve their goals on their terms.

It is bittersweet when a client “graduates” from working with me. I am so excited to see them move on, but I will miss them. We have established a wonderful working relationship, and I will miss hearing about their life, their struggles and their successes. It is a joy to hear from clients who touch base after having graduated from our sessions.

I also remembered that my work has an added, unexpected, and unplanned benefit for me and my clients.

I wear an Oura ring. Among other things, it monitors my stress level during the day. When I first received it, I noticed that at many points during the day, I was in a restorative state. Even if I was in a stressed state, suddenly, I would move to a restorative place. This just happened to coincide with my coaching sessions. I realized that when I am coaching my clients, they often arrive in an elevated state. They may be excited or stressed, or they may need to have a “brain dump” before they can begin effective work. The information from the Oura clearly shows that I naturally move to a restorative state so that I can be fully present for my clients. My calm, open, and fully present state offers them the space to decompress, find their centre, and create effective change.

My work with my clients helps them heal while helping me heal! This is truly rewarding work on all levels.

I loved theatre. The majority of young people who start out in theatre end up moving on to other work due to the stress, alongside poor remuneration. There is a reason they call them “starving artists.” I could be a starving artist again. I could give owning and running my own theatre a try. There are literally TONS of things that I could be doing to make a living. I’m neurodiverse. I am interested in a MILLION professions.

I would grieve the loss of client interaction. I would miss the satisfaction of watching my client’s blossom. I would miss my staff and watching their joy as they work with their clients.

Sometimes, it takes us a long time to find out where we belong. A friend who spoke at my wedding compared my life journey to a labyrinth. It sometimes looked as if I was walking backward and pretty much everyone doubted me, but I have been moving forward this whole time. Perhaps this is why I can hold restorative space for my clients. I viscerally understand that we can trust their intuition on personal journey. A