Christi’s Blog

            A person’s attachment style develops based on the  interactions they had as an infant with their primary care giver.  To develop a secure attachment, the caregiver must be sensitive and responsive to the child’s needs and signals.  The classic symptoms of ADHD, such as inattention, hyperactivity, and impulsivity, run counter to the skills necessary for effective parenting (Murray, 2004). 

Inattentive

            High levels of inattention drastically reduce a parent’s ability to monitor a child’s behavior or help them with homework.  Murray (2008) studied sixty women and their children between the ages of 8 and 14, using a series of self-reports and laboratory measures designed to measure maternal monitoring of child behavior and consistency in parenting.  She found that mother’s with ADHD monitored their children less, had fewer routines and were less able to report their child’s activities over the last 24 hours.  A lack of parental monitoring is linked to higher rates of injury in toddlers, poor academic performance in school, and higher rates of risky behaviors in adolescents.  Murray also found that mothers with ADHD were significantly more inconsistent in both discipline and laxness.  Inattentive parents also struggle to provide structure in their child’s life.  When a parent is inattentive, they easily forget they put a child in time-out or fail to notice if a child does not follow instructions. 

Impulsive

            High levels of hyperactivity or impulsivity drastically reduce a parent’s ability to listen to a child talk about their day, maintain daily routines or enforce household rules.   Because parents with ADHD have fewer daily routines, they have fewer opportunities to gather information from their children (Murray, 2008).  Treating a child’s ADHD with medication is difficult if the parent administering the daily medication is unable to follow a daily routine.  A study by Arnold, O’Leary and Edwards (1997) investigated the impacts of ADHD on the parenting style of fathers.  They found that fathers with high ADHD symptoms were more like to have over-reactive discipline styles. 

Impact on the Behavior of a Child

            A child, who is genetically inclined to having ADHD and is interacting with a parent with untreated ADHD, may be especially at risk to develop ADHD - genetically and through the family environment.  A major part of handling a child with ADHD involves setting limits, realizing when a child misbehaves, and remaining calm in disciplining the child (Banks, 1999). 

            Minde, Eakin, Hechtman, Ocha, Bouffard, Greenfield, and Looper (2003) studied the psychosocial functioning of 23 spouses and 63 children of 33 families with an ADHD parent compared with a control group of 26 families.  They used diagnostic interviews, intellectual testing, and self-report measure to evaluate the adults and diagnostic interview, teacher report forms, intelligence and achievement testing, and social functioning inventory to evaluate the children.  The study found that non-ADHD children who had one healthy parent and one ADHD parent exhibit less problematic behaviors than children raised without a non-ADHD parent.  

            Banks studied eighty-two mothers of children between the ages of 3 and 6.  He evaluated participants with a demographic questionnaire and eight standardized measures.  The study found mothers with high ADHD symptoms were more likely to report lower parenting self-esteem and less effective disciplinary styles, compared with mothers with low ADHD symptoms. 

            Evans, Vallano, and Pelham (1994) provide a case study in which a mother sought help because she could not control her 6-year-old, ADHD son.  An evaluation revealed that the mother had ADHD.  As it turns out, the mother’s own ADHD symptoms interfered with her implementation of strategies she learned at parent training classes.  Following stimulant medication treatment for her symptoms, the mother reported an improvement in her parenting behaviors and in her son’s behavior (although he had not received medication).  She also reported feeling more successful and competent in her parenting when taking the medication.  

            A child with ADHD has very little impact on the psychological health of the parents; however, a parent with ADHD can significantly impact the psychological health of their children.  Due to the genetic link of ADHD, evaluating the parents of a child with ADHD may be essential in treating the child. 

            When a person with ADHD marries, their disorder affects many aspects relationship.  Attention Deficit Hyperactivity Disorder in adults has significant impact on one’s ability to establish close relationships - the closer the relationship, the more dramatic the impact.   

Attachment Problems

            Marital satisfaction can be predicted by one’s perception of their attachment to their spouse.  Several studies have revealed that the capacity to form intimate bonds with others is a principal feature of effective personality development and a key marker of mental health (Collins, 2004).  Attachment theory is the product of a desire to explain the attachment between infants and their primary care giver.  However, Bowlby found the basic functions of the attachment system continue to operate in adulthood (as cited in Collins).  The type of attachment formed depends upon the sensitivity and responsiveness to the person’s needs and signals.    The study done by Paul Ward (2008) found that only 33% adults with ADHD have secure type attachments with their spouse whereas, 70% of the non-ADHD adults have secure attachments.  Ward’s study confirms the findings of Donna McCoy research from 2003.  However, McCoy’s study also found that although the attachment style was stable for the first 18 months of the relationship, it could become more stable if the ADHD individual was married to a person who had a secure attachment style.  This result may show that a secure partner can provide the structure and support that the ADHD person needs to function successfully.

            Several studies find that adults with ADHD experience significantly lower levels of marital satisfaction than control groups without ADHD (Banks, 1999; Ward, 2008).   Murphy and Barkley report that adults with ADHD not only reported lower levels of marital satisfaction; they also had higher rates of divorce and more re-marriages than controls (as cited in Murray, 2003).   

Intimacy Problems

            ADHD plays a big role in the ability of people with the disorder to enjoy sexual encounters.  Sexual intimacy is a key element of marriage relationships.    Hallowell and Ratey (2006) report that every ADHD adult they interviewed experienced sexual problems related to the disorder.  For most people, the first phase of sex causes the mind and body to relax.  For a person with ADHD “relaxing of the mind” allows their thoughts to roam from one topic to another.  The inattention that characterizes ADHD can communicate a lack of interest to the partner and hinder sexual performance.  The most common sexual problem related to a person with ADHD is the inability to linger (Hallowell & Ratey).  Another characteristic of ADHD that causes a lack of sexual intercourse is poor time management.  Many times an individual with ADHD will have every intention of having sexual intercourse with their partner, however throughout the day so many things crowd into their mind that by the time finish everything they are too exhausted to perform sexually (Hallowell & Ratey).  This causes their spouse to feel that they are not a priority in the ADHD person’s life.  While the person with ADHD considers their spouse an essential component of their life, they just do not have enough control of their thoughts to communicate this well.

Partnership Problems

            Since marriage is a partnership between two people who agree to share their lives, most people expect their partner to be interested in the things they do and help with household responsibilities.  The shifting attentions of a person with ADHD can cause confusion for their partner.  For example, someone who loves hiking during the dating phase of the relationship may have no interest in it by the first wedding anniversary.  The shifting interests combined with impulsivity makes it difficult for a person with ADHD to stay in the same job for a prolonged amount of time, so they do not bring as much income into a partnership.  Compound the lack of income with the impulsive spending habits that characterize the disorder and it becomes obvious these relationships suffer from financial stress.  Paul Ward (2008) finds that the person with ADHD and their spouse report more negative perceptions of their relationship than the control group. He also reports ADHD in families is associated with increased stress, fewer resources, and limited coping methods for the family.   

            Halverstadt (1998) found that forgetfulness is one ADHD trait attributed to undermining romantic relationships.  The problem is not that people with ADHD are unromantic.  Often, romantic relationships form because people with ADHD can hyper focus on the needs of their significant others.  Problems come when their attention focuses on something else and their partners feel deserted. The truth is, a person with ADHD rarely forgets things. In reality, they just remember them at the wrong time.  They often become completely absorbed planning great romantic surprise for birthdays, anniversaries, or other important dates, months in advance and cause their partner to feel neglected because the ADHD person does not share their thoughts during this time.  However, by the time the date arrives, the ADHD person’s attention shifts and they forget to carry out their plans. 

           The symptoms of inattention and impulsivity that characterize Attention Deficit Hyperactivity Disorder make forming and maintaining relationship extremely difficult.  To have a basic conversation with a new acquaintance, one must pay attention to the conversation and respond appropriately.  If a person with ADHD overcomes this hurdle, the new relationship must be maintained.  Too many missed events and unreturned phone calls will end a relationship.  A history of misunderstandings and failed relationships can cause individuals with ADHD to develop social anxiety disorders.  Relationship researchers find that when a person’s social relationships are frequently marked by confusion, misunderstandings, and failure, the person develops a low self-esteem (Banks,1999). 

Problems in Social Situations for People with ADHD

            The unregulated attention that characterizes ADHD makes it nearly impossible to stay tuned-in during conversations.  Adults with ADHD report difficulty noticing social cues - whose turn it is to talk or what subjects are inappropriate (White, 2008).  Persons with ADHD are easily distracted by the background activity of people in the room, or by random thoughts that come to mind.  Solden (2005) believes people with ADHD often move away from relationships in the initial stages of forming friendships because they have difficulty making small talk.  People with ADHD tend to talk too fast and jump from topic to topic in a way that is difficult for others to understand.  Halverstadt (1998) explains that when a comment triggers a thought for ADHD persons, they are compelled to say it immediately even if it is unrelated to the conversation, because they know they will forget it quickly.   It is not uncommon for a person with ADHD to interrupt, blurt out, or change topics in the middle of a conversation. 

            Maintaining relationships with friends and family can be difficult for a person with ADHD.  Each new relationship adds to the stress and increases feelings of being overwhelmed.  Solden (2005) characterizes the relationships of people with ADHD as a series of missed events or occasions, forgotten thank-you notes, invitations that are not reciprocated and phone calls that are not returned.  Many people with ADHD express a dislike of communicating through e-mail or the telephone because the social cues are even harder to interpret when you can not see the other person involved in the conversation (Solden).  As a result, relationships are not maintained and then the ADHD person fears rejection if they attempt to re-establish contact.  

            The amount of time and energy a person with ADHD must invest in organizing and getting their lives together so they can appear normal makes it difficult for them to keep up with the ordinary social and recreational events that people without ADHD do regularly (Solden, 2005).  It is not uncommon for a person with ADHD to have stacks and piles of things all over their house.  When a person with ADHD goes through a stack of papers, they find year old cards for friends and family members already addressed and stamped but never mailed.  Although these people felt forgotten by their ADHD friend or relation, a person with ADHD rarely completely forgets something, they are just unable to complete the steps required to meet expectations.

Anxiety Problems cause by Symptoms of ADHD

            After years of being misunderstood and criticized in social situations, many people with ADHD choose to avoid social gatherings all together. Large social gatherings require a person to pick up on and respond to social cues quickly, while blocking out the surrounding stimuli and focusing on the group they are with.  None of these tasks are easy for a person with ADHD.  Ward (2008) reports many ADHD individuals isolate themselves because of perceived relational failures, and mood or anxiety disorders. These disorders further exacerbate their social situations.  Young and Gudjonsson (2006) analyze the differences between individuals with ADHD and a control group in relation to antisocial behaviors, poor socialization and general adjustment.  On all three measures the ADHD group had the most dysfunctional scores. 

            Melinda White (2008) find that many ADHD adults report “feeling like a fraud” and living with a fear that someone is going to discover they are not “normal”.  Anxiety, for persons with ADHD, is not limited to social situations.  Because they fear criticism from others, the impulsive nature of the disorder makes it difficult for people to set limits in all areas of their lives.  The pressure people with ADHD feel to appear “normal” leads them to take on more responsibilities than they can manage.  Consequently, they leave trails of unfinished tasks.  Work, church, PTA and a countless number of other situations create enormous amounts of anxiety for people with ADHD as they attempt to live up to perceived expectations.          

 From Childhood to Adult Hood

            For years, people believed ADHD was a childhood disorder that was outgrown during puberty. In reality, the changes puberty brings only alter the expression of ADHD. Anderson and Teicher report that before and during puberty boys have an overproduction of dopamine receptors, explaining their hyperactivity and motor dysfunction (as cited in Taylor and Keltner, 2002). By adulthood receptor density in boys reduces 55%, explaining the remitting hyperactivity in ADHD symptoms. Girls, on the other hand, seem protected from the hyperactive component of ADHD untilpuberty, when they experience an increase in dopamine receptors. Therefore, it is not uncommon for the hyperactivity of ADHD in girls to hide until puberty (Taylor&Keltner,2002). In girls hyperactivity typically manifests verbally, causing them to become “hyper-talkative” rather than “hyper-active.” Yet this hyper-talkative behavior is not consistent. Taylor and Keltner point out that the production of estrogen which begins during puberty causes an increase in the production of dopamine. Since, in girls, the “hyper” behaviors are the result of an imbalance between the amount of dopamine and dopamine receptors, this decreases the severity of the symptoms –at least most of the time. 

            Many girls are never diagnosed with the disorder because their symptoms do not become obvious until the time when most people believed the disorder was out grown.  Because so many girls with ADHD enter adulthood without being diagnosed, they are at risk for a variety of other problems. Girls with ADHD realize that something is wrong with them, but society pressures them to appear normal. Consequently, many girls with ADHD internalize their feelings of inadequacy. Guilt and shame from failed attempts to control the symptoms of their ADHD are common feelings among women with this disorder.

Medical Aspects of Attention Deficit Hyperactivity Disorder

            ADHD is a genetically-linked medical condition caused by changes in the structure and functioning of the brain. Biederman (2008) reports a 76% heritability coefficient for ADHD (the heritability coefficient for breast cancer is only 35%).   Unfortunately, most researchers report that ADHD is probably the most under diagnosed condition in psychology today(Brassett & Butler, 2007; Hallowell & Ratey, 2006; Solden, 2005; White,2008; Young & Gudjonsson, 2006). Scudder found the boy:girl ratio of ADHD diagnosis is as high as 5:1. None of the genetic research on ADHD reveals any reason for a gender difference, and the adult male-to-female ratio of ADHD is 1:1 (as cited in Taylor&Keltner,2002).

            New studies using brain imaging techniques show differences in the morphology of the brains of those with ADHD (Brassett & Butler, 2007). Using new high-resolution, three-dimensional brain maps, Sowell and Peterson studied the brains of 27 children with ADHD and 47 children without the disorder (Rosack, 2004). They observed significant differences in brain structure in the frontal cortices of both sides of the brain, reduced brain size in areas of the dorsal prefrontal cortices and the anterior temporal areas, and increases in the volume of gray mater in the posterior temporal and inferior parietal cortices of the brains of children with ADHD compared to a control group.  These regions were previously identified as the areas of the brain controlling attention and impulse control. Sowell and Peterson correlated the anatomical variations of the brain with the symptoms of ADHD and found that there is a link in reduction of gray matter and increased inattentiveness, whereas larger frontal lobes were linked with higher levels of hyperactivity. “ADHD,” Sowell and Peterson concluded in the study, “is almost certainly a disorder of heterogeneous etiologies that have correspondingly heterogeneous neuro-anatomical underpinnings.  “These findings are very important to helping people understand the relevancy of the disorder because many people try to tell people with the disorder they are just lazy or unfocused. These brain scans prove there is a problem that a person with ADHD can not change by choice or desire.

            Finding an individual with ADHD and a comorbidity is more likely than finding a person with ADHD alone. ADHD contributes to substance abuse, depression, impulsivity, isolation, unemployment, low educational attainment, unintended pregnancy, and relationship disruption in adulthood (Ward, 2008).  Solden (2005) reports that each year that goes by without a diagnosis can lead to more severe secondary emotional problems, relationship difficulties, and feeling of under-achievement.

Characteristics

            Most people associate ADHD with poor academic performance in school, however, the attention, focus, and planning needed for good academic performance are also required in many other areas of life. Biederman (2008) finds that respondents with ADHD report significantly poorer functioning on virtually every single measure he examined: quality of childhood experiences, educational impairment in high school, relationships with peers, teachers, and parents during high school, relationships in adult life, prevalence of addiction, antisocial or destructive behaviors.

            Individuals with ADHD must find away to stimulate the prefrontal cortex in order to activate it (Stein,2008). Activating the prefrontal cortex allows people with ADHD to focus their attention, thus they feel better about themselves and more in control. Considering the number of people that go through life with the ADHD and never seek medical attention, it is not uncommon to find them self medicating with alcohol, narcotics, risky behavior, or a variety of other things to stimulate the prefrontal cortex of the brain. Women with ADHD experience a higher rate of eating disorders than thos who don not have ADHD. Solden (2005) suggests these women use the stimulation from starvation as a form of self medication.  Since the sympathetic nervous system in the prefrontal cortex regulates the fight or flight response (Heffner, 2001), and ADHD affects the prefrontal cortex, it can be inferred that the disorder can affect an individual’s ability to handle stressful situations. Using SPECT brain imaging, Halverstadt (1998) identifies two primary ways people with ADHD respond to conflict. First, the person can become overwhelmed by stress if the prefrontal cortex is overloaded by data and stops functioning. Second, the person can become overly stimulated and seek to prolong this stimulation as a method of self medication. Both of these options make it difficult for someone with ADHD to overcome stressful situations. When the prefrontal cortex stops functioning, the person can no longer process informational or emotional stimulus. Often, a person with ADHD simply walks out of a room in the middle of a conversation, argument, exam, or other stressful situation to seek a quiet, dark place to sit until they are able to process information again. Without a functioning prefrontal cortex, people can not identify what they feel, emotionally or physically, or explain their behavior. On the other hand, when a person uses stress to self medicate, they seek stressful situations and prolong them, even though it may damage relationships.    

            Murphy and Barkley report that adults with ADHD have higher rates of impulsively quitting or being fired from their jobs. They also hold more jobs in their lifetime than those in control groups (as cited in Murray, 2004). Adults with ADHD typically have more jobs than adults without ADHD and rarely make it to higher pay scales. Even when an individual with ADHD achieves an advanced degree, their income is significantly less. According to Biederman (2008), the average household income among the ADHD group was slightly more than half that in the non-ADHD group ($52,000 vs. $91,000 respectively).

            Impulsive decision coupled with a need for high risk stimulation can impact the quality of life for people who have ADHD. Stein (2008) reports individuals with ADHD lose their virginity, on average, a year earlier than a control group. He also says 38% of the ADHD women report having an unplanned pregnancy, compared to only 4% of the control group. People with ADHD experience more traffic accidents and receive more tickets than those without ADHD. This is true from beginning of driving throughout adulthood, unless the ADHD individual is on effective medication. When a person with ADHD is properly medicated, statistics show no difference between them and the control group.