ADULT ADD/ADHDAttention problems in adults impact marriage and success in life and must be assessed early in individual and marriage counseling. ADD is associated with organizational difficulties, memory and listening problems, and the development of depression and anxiety
Problems in how we pay attention have a huge impact on how satisfying our relationships are. Problems in attention affect not only how well we do in school, but how well we do at work, how we listen to our spouse and children when they talk to us and how well we remember what we see and what we hear. Spouses complain that their partner "doesn't listen", "only thinks about himself", is "irresponsible", can't "be trusted", and "makes messes". Problems in attention may result from various underlying problems such as:
- anxiety or depression
- problems of sensory integration
Until recently, ADD was considered to be only a disorder of children. Many adults today have spent their developmental years, their education years, and their relationship-building years struggling with the effects of undiagnosed or unrecognized ADD.
Growing up with ADD usually means some disturbance in the family. The child and the parents argue about the child's success or failure in school and behaviour in the home. The child receives tremendous pressure from the adults to try harder, pay more attention, and do better. The child, at least for a period of time, attempts to do this. Some children learn to over-focus and exhaust themselves trying to do what the child at the next desk does with ease. If the child does succeed, s/he hears "Now we know you CAN do that, so we expect you to do that all the time!", but the child really knows very little about the way s/he does pay attention and learn, and so has no idea what s/he did in order to get that good grade and cannot repeat that performance reliably. Then at some point, the child gives up. S/he gives up on school and/or pleasing the parents. S/he may demonstrate disdain for school/parents by becoming a Goth, or a comedian, or an obedient shell of a person.
The parents often argue with each other regarding the proper course to take with the child. One parent often believes the child to be lazy, manipulative, or simply faking and in need of more structure and discipline while the other parent believes there is something wrong and the child needs more support. This parental conflict creates tremendous guilt in the child, who (despite appearances) does not want to be such a cause of unhappiness in his/her parents. Without a clear parental direction, the parents are not able to really provide the support AND limits the child really needs.
While all this is going on, the child is forming his/her self. The child notices that s/he is different from other children in the class but is often not allowed to discuss this with teachers or parents, as the teachers/parents become anxious. The issue of intelligence is especially prohibited in most conversations: when the child honestly reports his/her feeling of stupidity, the adult most often replies with "No you aren't stupid, you are as smart as anybody else. " This is the worst thing to say. It tells the child that s/he is so stupid s/he doesn't even know how stupid s/he is, that the adults are not really interested in hearing the truth about the child's inner life, and it drives the child underground into silence and cuts him/her off from future potentially helpful conversations. It tells the child that attention, school, learning, and feelings are not discussable. The child becomes more isolated from the adults. The deep beliefs about self that form from these experiences are that the child is defective in some way, lazy, crazy, or simply bad.
These deep beliefs determine the way the child lives the rest of his/her life. Some children continue wholly or partially given-up: they do not attempt much in their life. Some act out the bad belief by continuing as rebels who do not conform to normal standards and some become criminals. Most go on to relatively normal lives, but the now-adult is fighting against his/her self by believing that s/he cannot succeed no matter how hard she/he tries, or only if s/he tries without stopping. These adults may have few resources with which to deal with set-backs: while a non-add adult would figure out what went wrong and try again, the ADD adult may collapse in shame and not try again.
People with low-levels of ADD and/or inattentive type, which tends not to annoy adults as much as the hyperactive type and so tends not to be named, may grow up with less overt conflict in the home over prformance. They may be average students when their intelligence is significantly higher than that (the dreaded "you have such potential"). Often they do excell, particularly in either math/science or english/history. A danger point for these folks is college entrance. College presents a significant increase in demands for internal discipline. ADD adults who have relied on parents for organizational help and nudging to get homework done may not have developed the capacity to go on alone. College also presents an enormous increase in the demands on the language system, and ADD adults who have been just getting by or struggling to succeed in high school may not understand just what is harder and how to deal with it.
CHARACTERISTICS OF ADULT ADD:
1. Problems of Organization and Memory. Loses objects, spends a lot of time looking for objects; is rushed, late, unprepared. Messy, cannot file, becomes agitated if someone moves the piles of paper that accumulate. Forgets appoints, birthdays, or assignments. May have developed a rigid compensation for these problems by becoming rigid and compulsively organized.
2. Problems of Mood: Irritable, difficulty controlling temper, especially around issues of failure/success, time and organization. Low frustration tolerance. Will quit or explode when facing minor obstacles or tasks with several stages. Experiences depression and anxiety, especailly around issues of competence and performance. May be spacey or minimize failures with humor.
3. Problems of Time Management: Difficulty knowing realistically how long projects will take. Takes on too many projects. Becomes focused on a relatively unimportant part of the task. does not complete tasks. May over-focus on the task in a marathon of work at the last minute.
4. Problems of Impulsivity: blurts out and interrupts. Says inappropriate things. Does not consider his impact on the listener. Poor ability to notice and interpret social cues. Makes impulsive decisions without considering consequences.
5. Problems of Achievement: May underachieve in school or do quite well, particularly in one or two subjects, not across the board. Is a Lone Ranger, does not work well in groups and often does not get promoted in organizations. Often is successful starting his own company, or several companies, but has difficulty with day-to-day operations, particularly with paperwork and filing. Unreliable--may be extremely talented or knowledgable in particular areas but cannot perform consistently.
6. Problems in Relationships: Spouses/boses/friends/children are often let down by the ADD adult. They experience this as the ADD adult not caring about them, not valuing the relationship, or not being committed to the relationship. They feel hurt, angry, and disappointed and begin to trust less.
TREATMENT OF ADULTS WITH ADD:
There is no clear protocol for diagnosis or treatment and professionals have different ideas about what treatment should be. In the next decade, brain scan techniques should make this field much clearer than it is today. Some evaluations are helpful and many aren't. A good assessment should provide information about specific deficits or undeveloped areas that have a possible remediation or treatment. Assessments that measure how the ADD adult uses language offer information about what the adult can and cannot do, kinds of situations that are more problematic or less problematic, and how life can be structured to support language.
Gestalt psychotherapy is particularly effective for treatment of Adult ADD in that Gestalt focuses on the development of awareness. Gestalt treatment asks the ADD Adult to notice his/her inner world and report it, as well as to notice their outer world and report their noticing. In doing this, the ADD Adult develops more ability to notice and shape their attention. Also, feelings have a powerful effect on attention. People who cannot notice and tolerate sensations and feeling states will deflect their attention away from these areas. Gestalt therapy helps ADD Adults notice the feelings and make conscious decisions regarding deflecting or not.
Gestalt helps ADD Adults discover and explore their own attentional processes. Most have never done this, instead having attempted to follow the directions of other people on how to pay attention, organize, and remember. They do not know, for instance, that most people have a flowing attention that brings other elements into their current focus, and that we are engaged constantly in sorting and rejecting competing elements for attention. Allowing this to happen is frightening for the ADD Adult, who may have spent his/her life over-focusing, fearful that any movement away from the current focus will send him/her reeling into the outer space of inattention. However, they usually find that they can develop this ability and begin to gently bring their attention back to where they want it.
Gestalt helps ADD Adults discover, explore, and resolve shame, hurt, and anger regarding how the world has dealt with them and their ADD. The deep beliefs of being defective, stupid, and bad are explored, experienced, grieved, and the person is able to let them go and develop more accurate beliefs about the self.
Gestalt helps ADD Adults deal more effectively with spouses, family, and work. They become able to open up their secret inner world of ADD and ADD compensation and include others as supportive collaborators instead of treating them as threatening opponents. The ADD Adult works on finding the line between what s/he CAN'T do and what s/he WON'T do, both at work and at home.
GOOD BOOKS TO READ:
Amen, Daniel G.
Healing ADD: The Six Types of ADD. 2001: GP Putnam sons.
Kelly, Kate and Peggy Ramundo.
You Mean I"m Not Lazy, Crazy, or Stupid?. 1993: Fireside.
Nancy Shleich LISW-S
2388 East Main Street
Bexley, Ohio 43209
614-235-0728
schleich.1@osu.edu