ADHD is a neurobiological disorder that is hereditary and lifelong. Approximately 5% of the adult population are said to have it. While many believe it is over-diagnosed in children, it may be under-diagnosed in adults. This is because up until the late 1980s and early 1990s ADHD was believed to end in adolescence. In my clinical experience there are far too many adults with ADHD that have missed the benefit of early diagnosis. Diagnosing the disorder somewhere between the ages of 5 and 6 allows one, over time, to: recognize symptoms both positive and negative, get used to taking medication, develop coping skills, and better understand how ADHD affects those around them. The latter is perhaps the biggest contributor to a higher than average divorce rate in the ADHD population.
The diagnostic process for ADHD is far better than ever, with most children discovered to have the disorder around third grade as the school-work-load increases and a greater level of attention and organizational skills are required to function successfully. The DSM-V acknowledges three major types of ADHD: 1. Combined presentation; 2. Predominantly inattentive presentation; and 3. Predominantly hyperactive/impulsive presentation. The manual also includes: 4. Other specified attention deficit/hyperactivity disorder; and 5. Unspecified attention-deficit/hyperactivity disorder.
Some of the symptoms of ADHD are as follows:
1. Hyperactivity (e.g., fidgety or the constant need to be doing something stimulating)
2. Impulsivity (e.g., verbal such as blurting out inappropriately) or (e.g., behavioral such as driving through red lights or changing jobs indiscriminately)
3. Distractibility (e.g., difficulty paying attention; getting sidetracked)
4. Emotional lability (e.g., mood shifts which may merit a need to distinguish it from bipolar disorder)
5. Oppositional (e.g., drama creates stimulation)
6. Hypersensitivity (e.g., emotional and/or physical)
7. Forgetfulness (e.g., losing things or chronic lateness)
8. Organizational problems (e.g., messiness)
9. Maturational lag (e.g., behind peers of the same age group)
10. Hyperfocusing (e.g., Ironically, there may be a tendency to lock in on something to the exclusion of the surrounding environment, like a video game or television show)
It is not unusual for ADHD to be accompanied by anxiety, depression, and learning disabilities. Having trouble keeping up with peers can be daunting for someone with ADHD. Also, the constant frustration of trying to maintain some sense of order is a huge task for many. Clients with ADHD have told me that they have to “work extra hard just to function.”
I’ve found that two of the most common sexual problems associated with ADHD are of the orgasm phase: Delayed Ejaculation and Female Orgasmic Disorder. It stands to reason that if one has difficulty concentrating during sexual activity, it will be that much harder to achieve an appropriate level of stimulation to reach orgasm. Clients with ADHD have told me that they have several things going through their minds simultaneously and therefore, find it hard to focus on the task at hand. One male client said: “I have 25 things going through my mind at any given time. When I’m having sex I’m okay for a minute or two and then I start thinking about paying bills or cutting the lawn.”
Boredom, a common issue for those who seek high levels stimulation can also lead to orgasm dysfunction. Typically a relationship in which at least one partner is ADHD (particularly the hyperactive/impulsive type) starts off with great excitement, intensity and passion. Those with ADHD can also be a lot of fun. But I’ve seen boredom set in the ADHD partner very quickly and in turn, a lack of attraction quickly develops even for the sexiest partner. A decrease in romance and affection tends to follow.
Many people with ADHD fail to see the impact they have on their mates and as a consequence, a parent/child dynamic often emerges. The non-ADHD partner plays the critical, frustrated parent, and the ADHD partner, the rebellious child. Breaking the parent/child dynamic (p-c) is crucial to repairing the ADHD relationship and improving the couple’s sexual life. Oftentimes the parental partner will blame the ADHD partner for all the couple’s issues. This must be stopped or the circular p-c dynamic will continue. Many parental figures have been overly responsible in their families of origin. Helping them recognize this may spur them to take responsibility for their own contribution to p-c dynamic. The ADHD partner must learn to stand up for him/herself in an adult-like fashion rather than rebel like an adolescent. While not all scholars agree, I tend to view medication as a necessity for the ADHD partner. Taking it signifies the recognition of ADHD, and makes it less likely that the ADHD partner will seek other forms of stimulation such as illicit drugs or even arguments.
Variety is important in any couple’s sex life, but especially in an ADHD relationship. For some couple’s changing positions or even venues (e.g., sex on the couch instead of always in the bed) may help. Anything that can safely increase stimulation and the ability to focus is usually welcomed (e.g., erotic films and/or fantasy). In some cases I’ve recommended the missionary position because it’s more difficult for ADHD partners to lose sight of their mates, and allow their minds to wander. Many who suffer from orgasm problems “shut down” just as they are about to climax. As partners get close to climax, I recommend that they simulate orgasm (e.g., moan and gyrate hips) in order to push themselves over the threshold. In some cases a vibrator can be used and eventually integrated with intercourse. And last, many partners of ADHD people have reported to me that lovemaking is too mechanical; that their ADHD mates try to “get right to the sex and get it over with.” Sensate Focus Exercises (e.g., mutually caressing exercises) that reduce anxiety and increase intimacy may help the sexual activity to flow.