Why Therapists Need to Understand the Role of Adult ADHD in Marital Dysfunction
Couples succeed when therapists consider adult ADHD
Posted October 4, 2011
ADHD impacts about 5-7% of adults, making it one of the most common mental health issues adults face. More importantly, research suggests 58% of relationships in which one or both partners has ADHD are clinically dysfunctional*, about double the rate for the non-ADHD population. This means that virtually every therapist who works with couples encounters ADHD issues in their practice. However, since less than half of adults with ADHD are currently diagnosed, patient and therapist are often unaware that ADHD is playing a significant role in marital dysfunction.
What should therapists look for? ADHD symptoms encourage predictable patterns of behavior in adult relationships - parent/child dynamics, chore wars, chronic blame, chronic anger and chronic shame to name a few. ADHD is also often co-morbid with other mental health issues, such as depression (53% of adults with ADHD will be diagnosed with depression at some point in their lives), anxiety (24 - 43% depending upon which research study you rely upon), ODD (24-35%), CD (17-25%) and alcohol abuse (21-53%). This means that therapists who don't understand what to look for might miss the underlying ADHD issues and focus on the co-morbid disorder. This significantly sub-optimizes treatment, as ADHD symptoms such as distractibility, impulsivity, and difficulty organizing must be addressed in order for a patient with ADHD to be successful in making permanent improvements in their lives and their marriage.
ADHD adults are often encouraged by well-meaning therapists to "try harder" to overcome their issues. Patients are encouraged to think harder about which words they choose, asked to engage with a parent-figure partner whom they secretly fear disrespects them, or told that "it's only fair" to carry more of the household burden. This sort of advice is ineffective when ADHD symptoms are not being treated. The issue isn't that a partner doesn't wish to participate in household tasks, but that he or she doesn't have the internal planning structures to successfully do so. It's brain wiring, not willpower. So "trying harder" isn't the issue. "Trying differently" is. Adults with ADHD need to optimize treatment for ADHD using a multi-modal approach shown by research to be effective in managing ADHD symptoms. It is only then that they are able to pay attention better, control their impulsive behavior, organize themselves so they can initiate and complete tasks, and become the full partner they wish to be.
The burden does not rest on the ADHD partner alone. Therapists need to understand the very real role that the non-ADHD partner plays in the couple's dynamics. Chronic anger and frustration in the face of unmanaged ADHD symptoms that significantly impact a non-ADHD spouse's life encourage the adoption of poor coping strategies by both. Retreat from engaging with each other, verbal abuse and nagging, defensiveness, and controlling behavior are just a few.
The good news is that once therapists and their patients correctly identify ADHD - and a non-ADHD spouse's reaction to ADHD symptoms - as very significant factors in marital dysfunction they can dramatically improve the relationship. Know the 12 patterns that ADHD symptoms encourage - and then interrupt them. Get appropriate treatment for both partners. Teach them "ADHD friendly" ways to interact with each other that reinforce respect for their differences. Identify ways for ADHD clients to create the external structures they need to compensate for their lack of internal structures to improve their reliability at home. Help both partners grieve about the fact that they didn't identify the ADHD sooner. This is the work of therapists when they knowledgably treat couples impacted by ADHD. And it works. In my experience, even the most exhausted and distressed couples find new hope that often leads to significant success when the root issue of their marital dysfunction is finally addressed.
Research references, see ADHD in Adults: What the Science Says by Russell A. Barkley, Kevin R. Murphy, and Mariellen Fischer, The Guildford Press, 2008. Pp 384-393 and pp. 205-206, 223, 241