The data suggests that about two-thirds of all children diagnosed with Attention Deficit Disorder (ADD) become adults with ADD. That means that a few million men and women are married to someone with ADD. Often it isn't even recognized until either a child is diagnosed and the parent sees the same patterns of behavior in him/herself or an astute couples therapist recognizes the presence of the disorder as a core issue in their problem.
The symptoms are common. Forgetfulness, disorder, impulsivity, lateness, job problems, and, for many, an agitation that replaces the hyperactivity that may have been part of the childhood disorder. But there are also the non-observable symptoms, those remnants of a childhood gone awry: The lack of confidence from being a chronic underachiever, the shame of being constantly yelled at or punished for messing up, the sense of always letting others down. All of these issues have the potential to be significant barriers to a successful, intimate relationship.
By the time a couple seeks help, there is usually a serious accumulation of hurt and disappointment. Messed up money management, incidents where children's needs weren't taken care of, and career struggles are all common complaints. But perhaps the deepest hurt of all is that the non-ADD spouse has come to interpret the failures of the ADD spouse as a sign of not caring. The inability to change problem behaviors is seen as a lack of desire to change. If you really loved me you would stop screwing up. That's the destructive mantra. The couple often is sitting there with one spouse virtually out the door and the other pleading to keep the marriage intact.
Properly diagnosing ADD as a central component of the problem is not a magical elixir. Old hurts are not easily forgotten. Old behaviors don't necessarily change. But certainly an education of what ADD means in the life of an adult is an important starting point. Both spouses need to read books such as Sari Solden's "Women with Attention Deficit Disorder", Kathy Nadeau's "A Comprehensive Guide to Attention Deficit Disorder in Adults" and her equally helpful "ADD in the Workplace." Then there is the aptly titled "You Mean I'm Not Lazy, Stupid, or Crazy!" by Kelly and Ramundo. In addition, becoming members of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) is very helpful. Their website, www.chadd.org, is a valuable resource, as are their publications, conferences, and local support groups.
ADD impacts marriages in a variety of ways. First, gender roles, though changed over the years, still retain important differences in marriage and family process. Therefore the impact of the disorder will be different for each. Second, there is a wide range of intensity of symptoms, from virtually routine problems with concentration, attention, and impulse control to extreme difficulties in these areas. Clearly where one falls on this continuum has a significant impact on potential problems in the relationship.
A central aspect of the couples work often focuses on altering unrealistic expectations for change and the concepts of responsibility, trust, and respect. It is not just the idea that the spouse with ADD is seen as irresponsible and /or uncaring in his frequent screw-ups of money or time management, forgetting to take care of an important child-related task or failing to remember something important to his spouse. Wives carry the female's tendency to feel responsible for "fixing" others, resulting in her own sense of failure as well. In addition, women especially focus on the relationship aspects of life and are more inclined to see their husbands' problems as a statement about the marriage than a chronic "disorder" residing within the husband.
Men usually see achievement as the core of their sense of worth, so their inability to be a good provider or to manage delegated family/home responsibilities feeds into their old "narrative" of being an incompetent loser. These husbands often try to defend against the pain of owning that feeling by covering it up with criticism and anger towards others. Sometimes, however, their response is very opposite: A passive withdrawal into the proverbial male "cave" to avoid more failures.
ADD in wives is especially challenging in marriage and family roles. Women, regardless of career roles, are the "stationmasters" at the center of the complex process of managing family life. When they are burdened with the symptoms of ADD, the effects ripple through the household which ends up operating in various degrees of chaos. This is usually exacerbated by the fact the heritability of ADD usually means at least one child with the same diagnosis who needs more structure at home than other children. The mother and child with the same set of problems often are constantly clashing, two trains that are forever going off their tracks, frequently as a result of running into each other!
Often, adults with ADD marry someone who is particularly well-organized. Potentially that could be helpful, but only when there is an early understanding of the nature of ADD and roles and expectations are properly established before too much damage is done. Otherwise, messiness becomes a source of constant significant criticism and lateness frequently sets off exploding frustrations.
Unpaid bills are seen as a serious failing that an organized adult cannot fathom. In fact, there are many issues which the organized spouse cannot understand or accept. "How could you ignore that pile of bills on your desk?" "What do you mean you forgot to pick up Jennifer at 4?" "I hate walking into this kitchen when I get home from work. How can you leave such a mess?" These, and many more plaintiff cries are common and become trigger points for painful, often explosive, confrontations.
Of course, once the ADD is properly diagnosed, steps can be taken to reduce symptoms. Medication will sometimes make a remarkable difference, but it doesn't always work or it may only partially help. Furthermore sometimes it generates unpleasant side effects that eliminate its use. But, even when meds are very helpful, other strategies are needed. Time and task management are key ones. List making is virtually essential but it's not always easy to find a way to make lists work. Modern technology is helping with those personal organizers that can even remind you when you need to check to see what you were supposed to do. But one also has to avoid misplacing the PDA or find/look at the list for it to be helpful.
One of the most common issues is poor time estimation. Adults with ADD typically underestimate the amount of time it will take to do something by about 50%. Part of the reason is inherent to the disorder. The adult with ADD is easily distracted by something of greater appeal in the midst of whatever task she is doing. Both spouses need to understand this and make accommodations for it.
This makes for a nice lead into one of the most important, central challenges for these couples: accommodation. It requires the earlier recommendation of acquiring a full understanding of the disorder. Then see what changes can be achieved through medication and other strategies. Once the dust settles from these first steps, the couple must have the flexibility to revisit how they manage their lives and learn to make changes in roles and responsibilities that will create a more functionally successful relationship. In turn, that can potentially allow for a more loving relationship. But this can be a formidable challenge.
It may mean that the father with ADD should become the primary caretaker and the mother, the primary earner. It may mean the spouse with ADD may have to be given a weekly allowance and no credit cards because of an irreversible history of impulsive spending. It may mean that a father cannot be expected to help his children with their homework or a mother may need to turn the kitchen over to her husband, who in turn must be willing to accept that role. It may alter decisions about what career options are really doable and where a family should live.
Thus, in many ways, while making the diagnosis is critical for the potential to resolve the marital crisis, that diagnosis is really the easiest step the couple faces. Establishing a mutually empathetic and truly cooperative partnership is the much more challenging task, especially with a history of hurt and disappointment getting in the way. But the reward for such an effort can be important enough to make it worthwhile. To develop a marriage that works and be able to keep a family intact is, as the old commercial says, priceless.
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