Adults with mild ADHD may flourish at the office, but flounder in personal relationships like friendships and marriage.
For the adult with mild attention deficit disorder (ADHD or ADD), high energy levels and the ability to hyperfocus can lead to a flourishing career while the real trouble surfaces at home in an ADHD marriage.
Harvard’s John Ratey, M.D.coined the term “Shadow Syndrome” to describe a psychological disorder in so mild a form that diagnosis can elude even a trained therapist. Just as a cloud can cast a pall across an otherwise sunny day, a mild case of attention deficit disorder casts its cloud over our day-to-day lives. In the following excerpt from his book, John Ratey offer some examples of domestic mini-dramas, caused by mild ADD, that can “trap” our attention and cause major discord.
To understand the mild case of ADHD, it helps to look at ADHD in its full-blown form, where precipitous actions tumble forth as quickly as do impulsive words. The adult with attention deficit disorder may quickly jump in and out of jobs, relationships, projects, and commitments, swerving from one to another. The classic story of untreated full-blown ADD is the intelligent person who cannot get her life together, and who becomes increasingly demoralized, anxious, and depressed as the years wear on.
But the person with mild ADHD is not simply the less chaotic sibling of his severely afflicted twin. In fact, the adult with mild ADD may be a brilliant success on the job. High energy, enthusiasm, and the ability to hyperfocus can take a person to great heights in some professions. The mildly hyperactive adult can survey herself and see what she needs to work on. Thus, she might deliberately cultivate an obsession with her datebook, checking and rechecking it throughout the day. The mild ADDer may be the top salesman who can never finish his paperwork on time, or the financial executive who cannot file his own taxes. With a good assistant, these limitations won’t cripple your career.
But the two ends of the attentional spectrum — hyperfocus on the present moment and the constant search for the next high-energy task – that can be assets on the job may not work to the same advantage in the mild ADDer’s personal life. With mild ADD, as with many shadow syndromes, the real trouble registers in the social realm.
ADD and Love
A person who has a problem with paying attention is not going to be any more “attentive” to relationships than he was to school as a child. So, when the disorder goes undiagnosed, the ADD adult’s lack of attentiveness looks like poor judgment or a lack of intimacy and consideration. The mild ADDer is probably not going to be a social klutz, but he may have problems in the subtler realm of deciding whom to approach and whom to avoid. A mild ADDer may repeatedly choose the wrong person to love, in part because he does not absorb all the social cues other people may see from the start.
Or the person’s need for stimulation may actually cause her to seek out trouble when choosing a mate. A mildly hyperactive adult may choose mates who are “bad” for her because they hold her interest in a way that the “nice guys” don’t. Some individuals know this about themselves; they know they are not looking for a calm and steady presence, as this leaves them feeling starved for stimulation.
One of Dr. Ratey’s patients came for help when she found herself consistently provoking fights with the one good man she had finally been able to love. The last straw had been a recent romantic evening. Despite wine, good food, and candlelight, she could not relax, could not unwind, and was horrified to find herself subtly sabotaging the mood until the evening was ruined. The diagnosis of ADD came as a revelation, although she was certainly no stranger to its symptoms. She had not made the connection between being hyper and her previous pattern of falling in love with men who were not good for her.
What she learned was that, she was, in short, self-medicating with the drug of a bad relationship. Life changed radically once she received a diagnosis and began treatment. For the first time, she could sit still; she could not only tolerate a calm day in the presence of a benevolent love, she could enjoy it. The difference was so startling that she took to calling the medication she had been prescribed her “love potion.”
ADD at Home
Even a very mild case of ADD can take a serious toll on an individual’s capacity to function in a domestic setting. A hyperactive person is likely to find a low-stim life of naps and diapers, grocery lists and cleaning, extremely difficult.
Managing a household requires tremendous organizational skills. Toys, bills, remote controls — for the ADD brain, the sheer amount of stuff to keep track of in an entire house is overwhelming. When the mildly ADD adult finds himself chronically searching for the application forms to summer camp, the bottle of cough syrup, or the keys to the car, he can easily skid into a state of perpetual aggravation.
The distractions inherent in parenthood are difficult for the person who is even mildly ADD. Looked at from the perspective of ADD, children are full-time distraction machines: Their needs are never predictable, and one of their main functions in life is to interrupt their parents. The ADD mother may find herself continually unable to remember what she was doing, where she was going, what she was thinking.
An adult with even mild ADD is likely to feel a grating “pull to the stimulus” of objects each time she sets foot in a messy room. It’s hard for her to walk through the house without feeling bombarded by things that need to be done. One woman describes this phenomenon:
I’ll walk in the kitchen, see the dirty dishes, and think, “Oh, I have to do those dishes.” But then, on my way to get more dish detergent from a cupboard, I’ll see the laundry basket and think, “Oh, I have to do the laundry.” But then I’ll start sorting laundry and… . I feel bad all the time because I’m not getting any of it done.
This woman may want to plan a family trip, but the plane reservations never get made. Or she may want to return to work, but can’t find the time to work on her resume. Having to see the dust or the mess is a signal that she is not seeing the larger picture that is her life. She cannot move beyond the present.
Add the ADD adult’s problem with forgetfulness and you quickly uncover a group of thoroughly exasperated spouses. Dave, diagnosed in his 40s, is well aware of this problem. However, as a mild ADDer, he has found ways to compensate:
My wife will ask me to get some eggs, a loaf of bread, and a gallon of milk from the store. There’s a good chance I’ve already forgotten one item by the time I’m out the door, and, by the time I reach the store, I’ve probably forgotten all three. I’ve learned to survive on notes.
Although Dave has a great deal of difficulty remembering all that he is supposed to do, the mildness of his attention deficit does allow him to “remember to remember.” His memory works well enough to keep him coming back to the memory aids without which he would be lost.
Patient Profile: One Woman’s Story
Debby, a 50-year-old former therapist, perfectly captures the fine-at-work/miserable-at-home dichotomy mildly ADD adults may confront.
One reason for her success in her career as a therapist was her extraordinary ability to focus upon other people’s problems. Unfortunately, “They got better, and I got worse,” she says. She was riveted by the problems her patients brought to her, and she had no choice but to live them. As she says: “We who have ADD find other people very contagious.” Debby was ricocheting from one patient’s life crisis to another.
Meanwhile, Debby desperately wanted to develop a second career as a writer, but she simply could not make the time to sit down to write. Finally, she stopped seeing patients in order to devote herself full-time to her writing. As a mild ADDer, Debby was self-aware enough to know that, unless she removed the demanding stimulus of her patients’ dramas, she would not be able to shift the focus of her “attentional apparatus” to her own writing.
Soon after, however, she met and married a man who was himself suffering from a full-blown version of ADD. Although energetic and an enormous amount of fun, he was also unable to see any project through to its end. He always had schemes up his sleeve, but none of his big dreams came to pass. Debby’s savings supported them both through six tumultuous years of marriage.
Debby slid into a state of depression. Looking back, after her divorce, Debby says today, “I literally did nothing during my entire marriage.” Needless to say, nothing came of her writing, either.
Debby’s Surprising Diagnosis
It was Dr. Ratey who first suggested a diagnosis of attention deficit disorder. Debby’s previous doctor had attempted to treat her for depression, but neither therapy nor antidepressants worked. Instead of a troubled childhood or her relationship with her mother, Dr. Ratey looked instead at Debby’s lifelong inability to complete projects. Instead of setting reasonable goals and meeting them, she would jump into a writing project with both feet, only to abandon it as soon as her initial enthusiasm faded. Dr. Ratey also found that, while Debby was physically calm, she was mentally frenetic. Her brain was churning, continuously searching for a focus. Mentally, she could not sit still for a moment.
Debby took a second look at herself through the lens of her brain’s thought processes. She saw how her attention deficit had thwarted her ambition to become a writer, and that she had grown depressed over her difficulty in sustaining focus.
In the years following her diagnosis, since launching a successful writing career, Debby gave a great deal of thought to the changes in her life:
Now, I have a sense of the context. If a bleak feeling is coming upon me, I don’t say, “I’m a terrible person.” I just say, “It’s a gray day,” and know that I need more stimulation in order to cheer up.
Adults with full-blown cases of ADD are risk-takers; they are attracted to any situation that shocks the brain, whether it be race-car driving or corporate deal-making or shouting matches with loved ones. Mildly ADD people may self-medicate with milder dramas – the daily micromanagement of a family’s needs and troubles or the choosing of difficult people as lovers.
Needless to say, distractibility, restlessness, and impulsivity can wreak havoc in any relationship. But with a genuine understanding of the disorder driving these behaviors, both partners can take a step back — outside the present moment — and decide how to work around it.
Excerpted from Shadow Syndromes, by John J. Ratey, M.D., and Catherine Johnson, Ph.D. (Bantam Books). Reprinted with permission.
John Ratey, M.D., is a member of the ADDitude ADHD Medical Review Panel.