Having under-managed ADHD in your relationship means angry interactions are likely. But once you understand ADHD better, you can find the love you thought you had lost.
ADHD brings very consistent patterns to romantic relationships, particularly when it goes undiagnosed or under-managed. One of the most common, and most destructive, is what I call “parent/child dynamics.” In this pattern, the ADHD partner makes promises but has trouble following through on those promises for reasons that include: distraction; difficulty planning; trouble completing; trouble remembering to do the thing, and more.
The ADHD partner is “consistently inconsistent,” which means the other partner cannot rely on him or her. Because the non-ADHD (or more organized other ADHD) partner never knows what will or won’t happen, s/he takes on more and more responsibility to compensate. Many adopt an ‘if I don’t do it, it won’t get done’ attitude. Unfortunately, the burden of taking on so much eventually leads to resentment and anger in the non-ADHD partner, particularly after children are added to the family. In response to the non-ADHD partner’s anger, the ADHD partner then also gets angry. It becomes a negatively reinforcing, downward spiral of interactions.
Other common relationship issues include: chore wars; having the non-ADHD partner who feels unloved because it’s so hard to get the ADHD partner’s attention; misinterpretingADHD symptoms in a negative way; lying and cover ups of ADHD symptomatic behaviors; and difficulties with their sex life. The good news is that once partners better understand ADHD and learn how to deal with it, they can find the love they thought they had lost.
Melissa Orlov is the founder of ADHDmarriage.com, and author of two award-winning books on the impact of ADHD in relationships, including The ADHD Effect on Marriage (rev. 2020). She is considered one of the foremost authorities on the topic of how ADHD impacts adult relationships.
ADHD goes along with other diagnoses over the life span. In childhood, oppositional defiant disorder or conduct disorder are e.g. frequently occurring with ADHD. In adulthood, mood and anxiety disorders, but also substance use disorders are found most often.
ADHD usually starts early in life, typically between ages six and 12. Besides the core symptoms of hyperactivity, impulsivity, inattention and also emotional instability, many affected people suffer from other mental disorders that are found more frequently than expected by chance – so called comorbid disorders. The pattern of comorbid disorders however changes considerably over the life span. In childhood, oppositional defiant disorder (ODD) or conduct disorder (CD) are the most frequent comorbid disorders. However, ADHD can also occur together with autism spectrum disorders and learning disorders.
When people get older, ADHD may persist into adulthood and around two thirds of people continue to experience impairing symptoms. ODD and CD may develop further into antisocial personality disorder, and substance use disorders (for both legal substances like alcohol and illicit drugs such as cannabis or cocaine) may become a problematic comorbidity with respective overall health consequences. Most frequently however, adults with ADHD suffer from anxiety or mood disorders; up to 50% of people suffering from adult ADHD also experience at least once in their life an episode of major depression. Furthermore, overall mortality rate is increased due to higher risks of suicide and unintentional injuries.
Prof. Andreas Reif, MD is head of the Department of Psychiatry, Psychosomatic Medicine and Psychotherapy of the University Hospital Frankfurt, Germany. His clinical and research interests comprise ADHD and mood disorder, with focus on mechanisms to enable new treatments. He coordinates the large EU consortium CoCA on comorbid conditions of ADHD.
Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, Cormand B, Faraone SV, Ginsberg Y, Haavik J, Kuntsi J, Larsson H, Lesch KP, Ramos-Quiroga JA, Réthelyi JM, Ribases M, Reif A. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol. 2018 Oct;28(10):1059-1088. doi: 10.1016/j.euroneuro.2018.08.001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379245/
ADHD and sleep problems are intimately intertwined in 80% of children and adults with ADHD during lifetime. The sleep loss results in increased severity of ADHD symptoms, (winter) depression, obesity, and chronic diseases in the long term.
Is ADHD a sleep disorder?
ADHD and sleep problems are intimately intertwined in the majority of children as well as adults. The sleep problems usually also start in early childhood. Most people have difficulty falling asleep on time, in children described as ‘bedtime resistance’ and adults are called ‘evening types’ or ‘night owls’. This circadian rhythm disorder, or Delayed Sleep Phase Syndrome is associated with a delayed onset of the sleep hormone melatonin, as was objectively measured in saliva (van Veen 2010). ADHD itself is associated with a dysregulation of the neurotransmitter dopamine, which is typically produced during daytime. So disturbances in the rhythm of day and night seem implicated in ADHD. Which leads to the question: could ADHD (also) be a sleep disorder??(Bijlenga 2019). We are testing this hypothesis in our research. If this is true, treatment of the delayed rhythm may improve ADHD symptoms, leading to a new perspective in the treatment of ADHD.
Besides the delayed sleep rhythm, there are several other sleep disorders associated with ADHD: Restless Legs (restlessness before falling asleep)/Periodic Limp Movement Disorder (restlessness during sleep), Insomnia (arousal, worrying in bed) and Sleep Apnea (sleep breathing disorder) (Vogel 2017;Wynchank 2016,2017). Some people with ADHD even have several sleep disorders. If disturbed sleep is not treated, the treatment of ADHD will be suboptimal due to sleep loss, that induces memory & attention problems and irritability.
Treatment of sleep and ADHD
Every sleep disorder has its own specified treatment:
Delayed sleep is treated by ‘Chronotherapy’ consisting of
sleep hygiene measures (no screens at night, or wearing orange goggles to protect the eyes from the blue light, no caffeine at night, shower before bedtime, and many more)
Melatonin in the evening, and
Light therapy in the early morning (7-8 am). This combination is an effective way to reset the late sleep rhythm in a few weeks. Only sleep hygiene is usually insufficient.
Insomnia is effectively treated by a special Cognitive Behavior therapy for Insomnia (CGT-I).
Restless legs by supplementing ferritin levels if too low, and medication.
Sleep apnea by diet (often in obese people), prevention of supine position, devices in the mouth to advance the jaw or tongue, and CPAP (Continuous Positive Airway Pressure).
Knowledge about sleep disorders is increasing, but treatment is not always available in psychiatry or at the GP. When ADHD is treated with medication and coaching or CBT, and the sleep disorder according to the guidelines, the rhythm of night and day, memory, attention and mood improve, as well as control over appetite and weight. In the long term, this may prevent the development of chronic diseases.
Prof. Dr. J.J. Sandra Kooij is a psychiatrist and researcher specialized in ADHD and sleep in adults. She is affiliated with Amsterdam University Medical Center/VUmc and PsyQ, psycho-medical programs in the Hague, the Netherlands.
A clarifying easy read is the book Why We Sleep by Matthew Walker.
Adults with ADHD have unhealthy eating habits, leading to overweight/obesity, with the odds ratio increasing with age. They are also suffering more from eating disorders.
Individuals with ADHD have a higher body mass index (BMI) and a higher prevalence of obesity, with the odds ratio increasing with age. Indeed, the pooled prevalence increase by about 70% in adults and 40% in children. Additionally, individuals with ADHD suffer more from eating disorders (OR=3.82*), especially binge eating (OR=4.13).
Several mechanisms have been suggested to account for this association including shared genetic transmission, dysregulation of dopamine, mood lability, psychiatric comorbidities, and low participation in physical activity, impulsivity, inattention, and poor eating habits. It was found that both children and adults with ADHD consume less healthy foods (such as vegetables, fruits, and dairy products) and more unhealthy foods (fatty, sweet and processed foods, such as snacks, candies, “fast food” and “junk food.”)
Egbert AH, Wilfley DE, Eddy KT, Boutelle KN, Zucker N, Peterson CB, Celio Doyle A, Le Grange D, Goldschmidt AB. Attention-Deficit/Hyperactivity Disorder Symptoms Are Associated with Overeating with and without Loss of Control in Youth with Overweight/Obesity. Child Obes. 2018 Jan;14(1):50-57. doi: 10.1089/chi.2017.0114. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5743031/
The biggest concerns for adolescents and young adults with ADHD during COVID-19 are social isolation, motivation problems, and difficulties engaging in online work or schooling. These risk factors create a perfect storm for the onset of depression, school dropout, or work underperformance.
Emerging studies from the COVID-19 pandemic show that ADHD symptom severity appears to be increasing during this global event. Several factors may be to blame. First, students with ADHD must adjust to low-structure, online learning platforms. These school environments demand more self-discipline than regular school, which can make concentration and motivation very challenging. For older high school and college students with ADHD, disengaging from virtual school may pave a slippery path towards formal dropout. Warning signs include a build-up of missing work, avoiding virtual class meetings, and slipping grades.
Second, social isolation is a known consequence of COVID-19 and is a risk factor for depression and suicide. During COVID-19, social isolation may be particularly severe for people with ADHD, who often have few close friends or may have trouble getting motivated to set-up social activities. On top of this concern, increased ADHD symptoms can be triggered by high stress situations. COVID-19 brings stressors that include safety concerns, economic hardship, and increased family conflict during confinement. In addition to worsening ADHD symptoms, ongoing stress exposure can also create risks for depression. To prevent these concerns, individuals with ADHD and their family members can:
ensure that proper academic supports are in place at school,
prioritize social interaction (even if it means getting creative) during COVID-19,
practice stress reduction behaviors such as outdoor and physical activity, spending positive time with loved ones, and practicing favorite hobbie, and
reach out to mental health providers early on if you notice signs of emerging school disengagement or depression.
Both mental health therapy and medication can support children, adolescents, and adults with ADHD through these challenging times.
Margaret H. Sibley, Ph.D. is Associate Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine and a Licensed Clinical Psychologist at Seattle Children’s Hospital. Her research is focused on ADHD in adolescence and young adulthood.
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