ADHD and Marriage
(This article is from my newsletter and is part of an ongoing series called The TEN PLAGUES ON MARRIAGE. If you would like to receive my newsletter, please fill out the form on the page called Newsletter Signup.)
Not much can hurt quite like the suffering in a painful relationship. Can we fix it or should we nix it? A person with the urge to leave the marriage faces the consequences of such a choice in a seemingly endless boxing match, during which time not only is one battered by this internal struggle, but is bruised by well-placed blows from the partner, as well as the guilt experienced by doing some well-placed bruising. Back and forth, again and again, clarity gives way to confusion, certainty to doubt, hope to hardness. If children are involved, multiply the intensity of the struggle by a factor of, oh, let's say a million!
Over the next several months I would like to address, from my clinical experience, many of the "plagues" that seem to threaten so many marriages. I am certain that I will not cover every force that can attack the bond of love and trust, but I hope to focus on many of the issues that seem to be most common, at least in my practice and in the practices of many of my colleagues with whom I am privileged to share.
A Brief Look at ADHD
The first such "plague" I would like to address is the impact of ADHD on a marriage. Since school has now begun, a lot of focus by parents and teachers will be placed upon children's academic performance and classroom behavior. It is in the school environment that some first notice that a child has difficulty paying attention or sitting still, or remembering or keeping the rules. Often, these children may be referred for psychological testing to rule out ADHD, which is actually a mix of several types of disorders. Many times when the issue is primarily one of attention, it may simply be referred to as ADD (Attention Deficit Disorder).
Daniel Amen, psychiatrist and researcher who utilizes SPECT (Single-Proton Emission Computerized Tomography)-imaging of the brain to determine how its various systems are functioning, outlines six different types of ADHD. What he has seen on these brain scans is that in most types of ADHD, blood flow is reduced to the prefrontal cortex, where decision-making, judgment, and processing consequences take place. ADHD is not a made-up diagnosis or a label placed on all children-behaving-badly: It is an actual organic disorder that can be seen on brain scans.
One conclusion regarding ADHD seems clear: Whether the child tends to daydream or becomes easily distracted, whether he or she cannot sit still or follow directions, or all of the above, what occurs in the classroom not only presents academic and cognitive challenges that impair learning, but--perhaps more importantly--social and emotional consequences that may significantly impact self-esteem and the capacity to relate well with others.
Social and Emotional Consequences of ADHD
As relational beings each of us requires from others in our world people who love us, accept us, believe in us, and yes, even cherish us. Whether we understand healthy human development through the eyes of modern psychological science or through the eyes of our faith and sense of morality, we know that loving a child well is essential for that child's sense of self in this world. It will set the stage for feeling competent in the world and for treating fellow human beings with dignity and respect: A healthy sense of self is vital to succeeding in work and love.
The problem is that children with any type of ADHD can be extremely difficult to love well. Each week I feel the exhaustion and exasperation of parents who have children with ADHD. Undiagnosed and untreated, these children do not remember what they have been told, and they can be constantly pinging from one source of interest to the next flashy distraction. Because the executive functioning center of the brain is not receiving enough blood flow, they CANNOT behave like others who have normal brain activity. It is, therefore, very frustrating for teachers and other authority figures, including parents, to interact effectively with these children. They can require constant monitoring or supervising. They frequently under-perform. They often daydream or forget or become distracted and find themselves breaking rules. Soon, these children conclude something quite significant: "I am not like these other kids."
Aha. This revelation may soon lead to other realizations like "Adults don't like me ... so I don't like them either," or "Look at these normal kids. Why can't I be like them?," or "What is wrong with me?" The stage is set for more chronic behavioral disorders (like Oppositional Defiant Disorder or Conduct Disorder), treating the world as they feel they have been treated--turning the frustration outward. The frustration can also turn inward, with vulnerability to depression and mood disorders, anxiety disorders, substance abuse and other self-destructive behaviors, when those with ADHD are left undiagnosed. Many with ADHD, especially those who are relatively bright, have some love in their lives, and show some competence somewhere in their lives, manage to meander through school into adulthood.
ADHD in Adulthood
Many years ago it was thought that individuals simply outgrew ADHD. We now know that is simply not true. Adults with undiagnosed and/or untreated ADHD may not have the unbridled energy of their 7-year-old selves, and they may have learned how to avoid being singled out as they once may have been, but make no mistake, the blood flow/brain functioning challenges do not simply vanish with age. Often times adults with untreated ADHD flounder in college, or may find jobs that require no degree. Many may bounce from job to job. Some find that they cannot work for bosses/supervisors/managers because often those in charge respond to them the way their teachers and parents did--with frustration, nagging, exasperation, yelling, shaming, comparing, etc. And while adults with ADHD may know how to have a good time and be fun to date (they are often spontaneous, exciting, and unpredictable), these qualities can wear thin on those with whom they are dating.
ADHD in Marriage
Sometimes two individuals with ADHD marry each other. Because they each know what it is to feel like the "outsider," they may--for the first time in their lives--feel understood and accepted. This kinship sensation may be quite powerful, so much so that since both might tend to be impulsive, they may at (possibly) an earlier age than others, marry or live together and begin having children. Again, because the judgment center of the brain is affected, they may have more children than their peers. This often puts these couples in what seems to be an insurmountable economic struggle simply to survive and provide for their children. And, since ADHD often runs in families, it is likely that at least one of their children will struggle with it as well. The result is a couple stressed to its limits financially, emotionally, and relationally.
Often, however, a partner with ADHD meets someone who seems to be his opposite--responsible, compliant with society's rules and laws, tuned in to details and deadlines. This is the story of opposites attracting: The ADHD partner discovers he (or she) can, in fact, be loved by one of the 'normals' in society. This provides a healing sense of mastery for one with ADHD: 'Finally, I am loved by one of them! Maybe I, too, can be normal now.' And for the non-ADHD partner, life with someone with ADHD can feel adventurous, lively, and freeing, especially for someone who has spent her (or his) entire life coloring inside the lines. They each see the other as complementary, completing a missing part of the self.
The honeymoon may soon come to an end, however, as differences begin to wear on each other. The spouse without ADHD begins to feel the burden to manage so many of life's constant demands. Perhaps she watches her spouse lose job after job or clash with one boss after another, and soon she concludes that the financial stability for their household rests squarely on her shoulders (I am using her for convenience; ADHD can afflict both sexes). Perhaps she watches her spouse dabble with drugs and/or alcohol to numb life's disappointments. Secretly she begins to wonder what she saw in him, resenting him for his 'irresponsibility.'
On the other hand, the spouse with ADHD once again feels like the 'screw-up' who cannot do life like the 'normals.' All around him he sees others working, making a living, finding relative contentment, but, just like in school days, he is not one of them. Something is wrong; it is either me...or them! He becomes fed up with his wife's constant complaints, and finds her disappointment with him withering to his soul.
If this couple finds their way into couple's therapy, it will usually be at this time that the non-ADHD spouse is filled with disappointment, resentment, and even contempt, and the ADHD spouse is often in a defensive posture, demanding to be accepted as he is: "You think you're so perfect!" is a frequent retort to his spouse. Beneath this time-honed defensive strategy, designed to protect him from the pain of relational failure, is considerable shame and self-loathing.
When One Spouse Has ADHD
Couples' therapy, in which one partner experiences ADHD, can actually be an incredibly rewarding time. If love at all remains, then hope remains. This is not to say that treatment is easy, but, with time, a couple may be able to see the ADHD as a challenge and address it as a team. Both husband and wife may begin to depersonalize their pain: Instead of becoming irritated with the spouse who has ADHD, the irritation is with the ADHD itself; instead of feeling defective and helpless, the spouse struggling with ADHD now sees the disorder as the problem, NOT HIMSELF! Yes, life would be preferable without ADHD, but many millions (upon millions) of people, in America alone, deal with this--and help is available. You truly can say, I no longer have to experience life as I have until now: the best is yet to come for me
Please do not misunderstand: after years of being in this ADHD/non-ADHD type of relationship, patterns of being can be very difficult to change. Likely, the non-ADHD spouse has felt that she has had to clean up everybody's messes; that she has had to be the responsible one while others got to play. Perhaps she had an emotionally needy parent (or two) or problematic siblings. To dare to let go of being the responsible one requires extraordinary daring! 'If I no longer have to wear the mantle of being the responsible one, then what 'way of being' is left for me? That is the only way I know 'how to be' in the world.' It requires the co-creation of a new, freer self, which takes practice and time.
Meanwhile, the one with ADHD has become accustomed to feeling unable and hopeless, like a rebel or an alien. They have seen themselves proudly as those who "march to the beat of a different drum." What happens when they realize they can both retain their individuality and yet still feel like welcomed and contributing members of the human race? This also takes quite a while to imagine, to practice, and to enjoy!
When Both Spouses Have ADHD
When spouses share this diagnosis, it can actually deepen their bond: "We knew it! We knew we were different!" Initially, they come to treatment because, frankly, their lives are a mess across the board; with money, work, parenting, they feel in over their heads. They may both use alcohol and/or drugs to help them numb themselves from the world's demands. Without diagnosing and treating the ADHD, however, they are likely to replace old problems with new ones. It is imperative for this couple that both accept the diagnosis and engage the strategies for treatment. If not, one will sabotage the other in order to keep their dynamic between them from changing because it can be frightening to imagine what the relationship may become: 'Maybe I will lose my spouse once he or she changes.'
Today, so many adults find their way into therapy never having been diagnosed with ADHD, struggling with significant attention and distractibility problems, lack of follow through, and/or impulsivity. Psychological testing and clinical interactions with a therapist familiar with ADHD help to rule in or out this diagnosis. Often, with an ADHD diagnosis, a referral is made to a physician who may prescribe and monitor medications to improve brain function. Alternative ways of treating ADHD may be used alone or in conjunction with medication, including omega-3 oil and other supplements, neurofeedback (a computer-based program that rewards the brain for working in healthier ways), and adherence to a planning method, whether computer-based or paper-based, in which one sees what is to be done and is required to check it off when completed.
Frankly, while all of the above methods (and more are on the way) are very helpful, ACCEPTING the diagnosis may well be the most important step a person with ADHD may take. For some, admitting this to themselves feels very shaming; it confirms in their minds that they are, indeed, defective. For others, problems trusting authority figures (like psychologists or physicians) trip up their treatment. Still others feel as if acknowledging this reality about themselves would be a defeat in which the chorus of voices accusing them over the years of being "slackers" (or worse) would be validated: 'If I admit this, then they win, and I will never give them the satisfaction!' If the spouse happens to be one of those voices, then what? All that is left is a loveless power struggle--no fun!
ADHD certainly plagues many marriages; it can be the monster in the closet. But, like most monsters, once the light is turned on, it is seen for what it is. And this monster can be defeated; this plague cured.