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How to manage your marriage when your spouse has ADHD

By Jessica Yadegaran
Sunday, January 2, 2011; A03

WALNUT CREEK, CALIF. - The constant bickering was only the beginning of Fong's and John's marital problems. John was angry, explosively so. She'd ask him to do something, and then later, her husband of 32 years would deny that she ever did. They both knew he wasn't paying attention.

Sometimes, it went the other way. When the 50-something couple decided to paint the walls of their Cupertino, Calif., home, Fong saw it as a team project. They'd need to pick a day, agree on colors and purchase paint, she thought. But, when she came home from work the next day, the walls were wet with paint.

"He'd done it on his own because he needed something to focus on that day," says Fong, who works in biotech. She felt ignored and unloved.

Meanwhile, inside John, a war was brewing. He grew bored easily and had trouble finishing projects, yet he suffered from anxiety and racing thoughts.

"I would think of 100 things at a time," says John, who holds a government job. "I couldn't sit still. And I had a lot of fear, mostly of failure."

Four years ago, John was had adult attention deficit hyperactivity disorder diagnosed. ADHD is a syndrome that experts believe affects nearly 5 percent of adults. Because they weren't squirmy or chatty as kids, an estimated 90 percent of those adults are never diagnosed and try to cope as various degrees of distractibility, disorganization, impulsivity and lack of emotional control cause problems in all areas of their relationships.

The breakdown occurs because the non-ADHD spouse feels frustrated, unheard and unloved, based on her spouse's behavior, explains Russell Barkley, an ADHD researcher, author and professor of psychiatry at the Medical University of South Carolina.

"The ADHD spouse is not following through on promises and often isn't able to understand the needs of others," Barkley says. "It's a torrent of one-way conversations for the non-ADHD spouse. It feels like they're raising a kid."

On the ADHD spouse's watch, bills may not get paid, credit can be destroyed and a bad driving record often means the person isn't fit to schlep the kids to school and soccer practice, he explains.

All of this creates an unequal division of labor, says ADHD specialist and author Ned Hallowell, a Boston psychiatrist who in 30 years has treated 10,000 adults with ADHD.

But the ADHD spouse is not doing any of this on purpose.

"Their brain is like a toddler on a picnic," Hallowell says. "It goes where curiosity and enchantment lead it with no regard to authority or danger."

Hallowell is referring to the brain chemistry of an ADHD sufferer. Not only is the condition highly heritable - the same as height, according to some researchers - but a person with ADHD either underproduces or does not process dopamine in the attention and reward centers of the brain in the same way as someone without ADHD, Barkley explains.

"People with ADHD have reductions in this area, so things get boring for them pretty fast," he says. "Dopamine not only increases reward value but also the powers of inhibition."

Lack of inhibition

That lack of inhibition is what used to frustrate and embarrass Janet about James, her boyfriend of three years.

"He'd walk into a party or event and just say something inappropriate to someone or interrupt them when they were talking," says Janet, who, like many in this article, requested to omit her last name to protect her privacy.

Janet, a Menlo Park, Calif., teacher, had fallen in love with James for his sharp intellect and love of the outdoors, she says. Within six months of their relationship, she began noticing his issues with inhibition as well as his absent-mindedness and tendency to lose things or talk excessively.

Janet, 55, recognized the symptoms of ADHD. Her ex-husband had untreated ADHD, and she believes that it contributed to their divorce. So, she asked James to get evaluated for the condition. James, now 49, was diagnosed within the year.

"What being diagnosed enabled me to do was recognize the behaviors and accept that they are things I need to change," says James, who works in high tech. "To me, love is about being vulnerable and feeling safe, and the ADHD has almost become something that bonds us now. I feel safe enough with Janet and respect her enough that I'm willing to ask for support and take her direction."

These elements are key, because at its core, adult ADHD is about a lack of executive skills, says Gina Pera, a San Mateo support group coordinator with CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) and author of "Is It You, Me, or ADD?: Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder."

About 80 percent of adults benefit from stimulant medications that help to alleviate the symptoms of ADHD. But therapy and behavioral modifications are just as important, and experts say many couples see dramatic improvements in their relationships by educating themselves on the condition and making appropriate changes.

"First, depersonalize the emotions around the symptoms and the problems you're having in your marriage," Pera says. "The more you read about the neurobiology of ADHD the more it makes sense. It becomes real."

Next, analyze. "Pick the two biggest areas that you fight about - chores and picking up the kids - and figure out what you can do immediately to alleviate the issues instead of nagging or bickering," Pera says. For instance, if the ADHD spouse is an absent-minded driver, she stays home and does the laundry.

Lastly, because ADHD sufferers don't hold a lot of "stuff" in their brains at one time, they must learn to rely on external reminders. Sticky notes and checklists work for some, but most adults with ADHD benefit from professional organizers or life coaches familiar with the condition.

"They can help you put the right system in place," Pera says.

'Something shiny syndrome'

Heather and Rick used coaches. The couple has been together for three years, and they both have ADHD.

Heather, a massage therapist the San Francisco area, was diagnosed 12 years ago, at the age of 28. Rick, a Walnut Creek, Calif., real estate entrepreneur, got diagnosed after both of his children from his first marriage were diagnosed in school, which is often the way it goes with adults and ADHD.

Before he got help, Rick struggled with money management. "I'd make $100,000 in a month and reinvest it, and yet the [utility bill] wouldn't get paid," he says. "I didn't understand what I was doing."

Heather's biggest challenge is still time management. But Rick, who is now 58 and runs a CHADD support group in Walnut Creek, understands. They communicate. He calls her if she's out with friends and loses track of time. He also celebrates what she calls her "something shiny syndrome," how she becomes distracted by new or interesting things and tends to hyperfocus on them.

"He honors every little quirk and interest that I have," she says. "And if I'm talking and he does the, 'Uh-huh uh-huh I'm listening' thing, I get it, because I've probably done that to him."

Rick and Heather don't try to change each other. That's not what relationships are about, Heather says. Rather, they provide encouragement to work on their individual issues.

Even for the frustrated, non-ADHD spouse, that effort to improve and rebuild a relationship can mean everything. Just ask Fong and John, the Cupertino couple who have been married for three decades. Through medication and therapy, John's condition is much improved, and so is their relationship.

"As long as someone's trying, that's everything," Fong says, of John. "He has this extreme condition, but he is also one of the most loving, generous and kind people I've ever known. That's why I stick with it."

- Contra Costa Times

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