Navigating Relationships and AD/HD

When someone enters therapy for ADHD, they often have a range of concerns that they are hoping to address. Whether that be improving their performance at work or at school, reducing impulsivity, managing finances more effectively, organizing their physical space, or managing the side effects of medications. Any of these issues can be important to address in treatment. These areas mostly focus on the individual and their personal goals. Aside from these issues, ADHD symptoms can also affect important relationships in a person’s life and can contribute to conflict that exacerbates their executive functioning difficulties.

When thinking about healthy relationships, whether that be parent-child, romantic partnerships, or friendships, many of these relationships are built on mutual trust. Knowing that the people we care about will have our back, respond to our requests, follow through on shared objectives, and remember important events contributes to the sense of partnership we feel with them. These can all be areas that are negatively affected by ADHD, as a person’s ability to organize and follow through on intentions can contribute to a sense of inequity in these relationships.

Patients in treatment often report that important people in their lives believe the patient “doesn’t seem to care,” “is distracted all of the time,” or “is lazy.” Over time, others close to them may take on more responsibility for following through on tasks and trust the person with ADHD less. Especially in romantic partnerships and friendships, this can lead to resentment and frustration on the other side from a perpetual sense that things seem unequal. People with ADHD may commonly feel angry with frequent criticism, guilty about the inequity in the relationship, or hopeless that they will be able to meaningfully change their behavior.

Using ADHD therapy to address relationships

Through talk therapy, individuals with ADHD will have the tools to organize and follow through on intentions more consistently. This can have an indirect benefit on a person’s relationships. If they are remembering events, following through on their intentions, and contributing to shared goals more consistently and effectively, their relationships may begin to feel more equitable, and thus conflict can be reduced.

Still, improved executive functioning alone may not be enough to address some of the problems in a person’s relationships. Once a person is in treatment, one approach that can be helpful is inviting partners or other family members in for an educational session. This differs from family therapy in that it is usually brief (1-2 sessions with the therapist, the patient, and their family members) and the goal is to better understand the person with ADHD. This can correct inaccurate understandings family members may have about ADHD and identify ways to support the person with ADHD. Additionally, family members may be able to offer information about the person with ADHD that could be useful in treatment.

For some, separate couples or family therapy could be recommended. Aside from ADHD, there may be other factors at play that are having a negative effect on the health of the relationship overall, which ADHD treatment and education alone may not be able to effectively address. When this occurs, a separate couples or family therapist is often suggested, so the ADHD therapist is not placed in the dual role of being both the therapist to the person with ADHD as well as the couple.

Steps to take

Entering talk therapy for ADHD does provide patients with a set of tools that tend to address some of the points of conflict in their relationships. Though aside from learning more effective organizational skills, there are some other steps couples and families could take to help everyone get on the same page:

• Coordinating Systems: Two of the tools I typically recommend to better organize responsibilities are calendar and to-do list systems. Couples and families can streamline this recommendation by using shared systems. Typically, this means using cloud-based calendars and to-do lists that can be viewed and modified by 2 or more people. Maintaining separate systems increases the possibility of miscommunication, mismanagement, and conflict.
• Planning Check-Ins: Another strategy I commonly recommend to my patients is to set aside a time daily to review their calendar and to-do list systems. While it may not be necessary to do this daily for families or couples, having a regular time to touch base on shared goals can be useful. Setting aside time 1x/week to review calendars and update one another on progress towards goals can help to improve communication on these topics. This offers an alternative to only discussing shared goals when things aren’t going well.
• Education: While the person with ADHD in the relationship works on improving their organizational skills, other family members can increase their knowledge and understanding of ADHD. Learning more about the condition may help adjust expectations, leading to better communication and more empathy. A book I have recommended for family members is When An Adult You Love Has ADHD by Russell Barkley.These are a few recommendations to address the ways ADHD can affect not only the person with the condition, but those close to them as well. ADHD skills training can be a useful first step in addressing some of the problems that affect these relationships.