Your spouse litters the home with half-finished projects and loses a cell phone or set of keys at least twice a week. Your sibling talks before thinking, and nearly missed your graduation. Your grown child still relies on your birthday reminders and just left another job. Your parent exhibits all of these symptoms and refuses to acknowledge that something is wrong.
If this sounds familiar, you understand how daunting and draining it sometimes feels to support and advocate for a loved one with adult attention deficit disorder (ADHD or ADD).
You also understand that your loved one is capable of tremendous things — with a little support and positive reinforcement. The trick is learning how to provide that without overstepping boundaries or passing judgment. When my patients’ loved ones appear to be struggling, I recommend the following 6 steps:
- Learn the true symptoms of ADHD
- Understand the potential impairments of ADHD
- Acknowledge the impact ADHD has on you
- Assess your loved one’s readiness to change
- Know the best treatments for ADHD
- Decide what role you will play
Step 1: Learn the True Symptoms of ADHD
Until you understand what is really going on in the ADHD brain, your efforts to help can be half-baked, ineffective, or even harmful. To begin, ADHD is not just a deficit of attention. It is a pervasive, serious cognitive and psychological impairment.
The well-known signs of ADHD – inattention, hyperactivity, and impulsivity – fail to reflect the one complex and crippling symptom shared by the vast majority of people with ADD: deficient executive functioning.
There are seven executive functions that impact self-awareness, self-monitoring, inhibition, memory, planning/sense of time, emotional control and self-motivation. When they don’t work properly, they can make people with ADHD appear insensitive, unprepared, disorganized, or overly emotional.
Executive dysfunctions may look like intentional slights, but these are largely biological problems that originate in the brain.
Understanding that your loved one’s mistakes are not a sign of disrespect or selfishness, but a brain chemistry imbalance makes it easier to extend to them the same compassion you show to people with mental health problems or developmental disabilities.
Step 2: Understand the Potential Impairments of ADHD
People with untreated ADHD may experience a number of long-term challenges, including the following:
Impairments Associated with Untreated ADHD in Children/Teens
- Comorbid psychiatric disorders (ODD, CD, ASD, anxiety, etc.)
- Peer relationship problems (50-70%)
- LDs, low academic achievement, school maladjustment
- Greater family conflict/stress
- Developmental delays (motor, speech, adaptive skills, etc.)
- Internet use dependency/addiction (5-25%)
- Antisocial behavior (25-40%)
- Risky sexual behavior (irregular contraceptive use, STDs, etc.)
- Impaired driving performance
Impairments Associated with Untreated ADHD in Adults
- Marital dissatisfaction/divorce
- Occupational maladjustment, frequent changes
- Antisocial behavior, arrests, jail time
- Continuing peer relationship problems
- Greater family of origin conflict/stress
- Financial problems, poor credit
- Impaired parenting behavior
- Greater loneliness in old age
- Increased risk for anxiety disorders
- Intimate partner violence
- Intimate relationship problems
- Limited educational attainment
Understanding these elevated risks can help you realize the gravity of the condition your loved one grapples with, and be more sensitive to potential future problems.
Step 3: Acknowledge the Impact ADHD Has on You
Loving someone with ADHD can be a lot of fun. Many people with ADHD are remarkably creative, very caring, and have a great sense of humor. They may also demand a great deal of time and attention from loved ones.
The parents or spouse of a person with ADHD may put their own physical and mental health on the back burner as they work to keep him or task, remind her of that appointment, or pick up after both of you.
When a person with ADHD doesn’t meet his responsibilities, it can make loved ones feel worn out, tired. When the irresponsible behavior is extreme, it can weigh heavily on those around her.
It’s OK — even essential — to acknowledge the anger, frustration, impatience, hostility, guilt, and discouragement you may experience. Those feelings don’t make you a bad person and they don’t mean you will abandon your loved one.
What they do mean is that you need to take time for yourself. Ask for help. Seek support from professionals. And remember that ADHD is a rollercoaster. For each dip, there is a hope for extraordinary success – like that experienced by Michael Phelps, Simone Biles, Justin Timberlake, and Adam Levine. Many people are able to lead productive, effective, happy, and successful lives with ADHD. Practice self-care, and don’t give up on your loved one.
Step 4: Assess Your Loved One’s Readiness to Change
You can’t help someone who isn’t ready to accept help, or doesn’t believe she has ADHD. Before trying to intervene, acknowledge your loved one’s “readiness to change,” and adjust accordingly.
For example, the things you might do to support a loved one who says to you, “I think I have ADHD. I’d like to make an appointment. Can you help me do that?” are very different than the things you might do for a person who does not accept that he might have ADHD.
1. Pre-Contemplation Stage
Your loved one denies she has ADHD, or fails to admit she has a problem.
In this stage, make ADHD information readily available – bookmark ADDitudeMag.com, CHADD, or ADD.org. Look for a window of opportunity — perhaps when something goes wrong, and your loved one is wondering what has happened.
Say, “You know, this isn’t the first time you’ve had this problem. I know it’s frustrating to you because you’ve come to me a few times. Do you think it might be ADHD creating a problem? I think we need more information. Let’s start with these resources you might find useful.”
2. Contemplation Stage
Your loved one is thinking – and even accepting – that ADHD might be a problem.
In this stage, provide a list of local experts or ADHD clinics where they can learn more and pursue an evaluation.
3. Preparation State
Your loved one is getting ready to engage in the diagnostic and treatment process.
Help him start right and follow through. Offer to drive him to the clinic, or call with reminders of her appointment. Take any steps you can to get the diagnosis underway.
4. Action Stage
Your loved one is getting help. She has a list of treatments and is working on self-change.
Help her get the prescription filled. Make an appointment with the recommended cognitive behavioral therapist. Call the ADHD coach, and set up a session.
60% of adults with ADHD are not compliant with their treatment within six months of getting a prescription. Help them overcome difficulties with executive functions and working memory that may stand in the way.
5. Maintenance Stage
Your loved one is improving and doing fine — maybe so fine that he doesn’t think he needs treatment anymore.
Your role is to check in periodically, and offer help if he needs it. Be ready to encourage him to stick with the treatment process.
Step 5: Know the Best Treatments for ADHD
ADHD is a medical condition, not unlike diabetes, that you need to fully understand before you can treat it effectively. Your loved one may benefit from sessions with a counselor or medical professional designed to teach her about the condition and its chronic symptoms in order to drive home the importance of treatment.
An effective treatment plan comprises two parts: medication and behavioral therapy to target executive function deficits. Even with that, your loved one may need additional, complementary therapies including:
- ADHD coaching
- Regular exercise
- Mindfulness training
- Treatment for a comorbid condition
The first medication might not work. Your loved one may need to introduce additional therapies or medications to address remaining symptoms, or symptoms of another, related condition. Stand with her while she finds the right combination.
Step 6: Decide What Role You Will Play
You can adopt one of four main roles for your loved one with ADHD:
- Acceptor and listener: The trusted person your loved one can always go to in times of trouble who will listen without judgement or walking away.
- Support team member: The person who actively helps with matters related to ADHD – you don’t just “get it,” you help “fix it.”
- Advocate: The person who helps explain ADHD to people outside of the immediate family, and who asks them to make accommodations for her.
- Benefactor: This is not a role everyone can play. It is a person who can offer financial help when a person with ADHD needs it to pay for a constructive or effective intervention. For instance, life coaching or books at college.