MHM Magazine

8 | MENTAL HEALTH MATTERS | 2023 | Issue 4 MHM substances and alcohol once they are young adults. This exacerbates the incidence of interpersonal violence. Aggression in general, both externally and self-directed, is a common feature in adults with ADHD. In fact, adult males with childhood ADHD and exposure to domestic violence as children are more likely to perpetrate interpersonal violence. SYMPTOMS AFFECTING THE PARTNER The common symptoms of ADHD have an effect within relationships by impacting partners of those diagnosed with ADHD. These take place within the following ways: • Inattention: those with ADHD can lose focus in conversation, which may leave their partner feeling devalued. They may also commit to issues and later forget, which may result in frustration and resentment from their partners. • Forgetfulness: it’s difficult for those with ADHD to sustain focus and they may easily forget discussed information. This may, in turn, lead to their partner feeling they are incapable, unreliable, and untrustworthy. • Impulsivity: those with ADHD may frequently interrupt others during conversations or blurt out what they’re thinking without considering another person’s feelings. These symptoms may result in a partner’s feelings being hurt. • Disorganisation: ADHD makes it difficult to organise, prioritise, and complete household tasks, which lends itself to a disordered environment. Another thing that is more difficult for those with ADHD is holding a job. This has a great effect on household finances and places additional pressure on their partner, which itself lends to feelings of frustration and resentment. • Explosive temper: due to emotional dysregulation and poor stress/frustration tolerance, people with ADHD have a tendency towards anger outbursts and aggression. This naturally could lead to their partner feeling hurt, fearful, and even abused. RELATIONAL DYNAMICS Those with ADHD who are in relationships may find themselves in interesting relational dynamics than those of a typical partnership. Commonly, the relational dynamics may present as: • Parent/child dynamics: one partner may feel that they have a child instead of a partner, as those with ADHD struggle to complete tasks that they perceive as boring or that require their full attention, which leads to their partner taking on most of the responsibilities and feeling resentful. • The constant critic: partners of those with ADHD may feel like they are forced to nag, remind, and constantly tell their partner how and when to do things properly. In turn, the person with ADHD may feel as though they are being evaluated, monitored, and corrected, which results in low esteem and demoralisation. • The hyper-focus courtship: because those with ADHD often present with a hyper-focus, their partner may feel like they are special and loved, making their courtship an amazing experience. When this hyper-focus stage ends, however (which often happens quite abruptly), their partner is left feeling alone, confused, and betrayed. MANAGEMENT For all the personal and relational implications mentioned above, it’s easy to see why effective management of adult ADHD is a necessity. Management that is both combination and holistic has been found to be most effective. A starting point would be to exclude any possible organic causes. Following this, medications such as stimulant (methylphenidate or dexamphetamine being the first line), non-stimulants like atomoxetine (for those who struggle with stimulants), antidepressants like bupropion, and other medications targeting the co- occurring disorders are indicated. Psychotherapy as an adjunct is also indicated. Types of suggested therapies for those with ADHD and their families or partners include: • Cognitive behavioural therapy (CBT) focusing on challenging thinking and managing behaviour • Dialectical behavioural therapy (DBT) focusing largely on emotional regulation, distress tolerance, and interpersonal effectiveness • Family and couples therapy which focuses on familial relationships, communication, and problem- solving skills within relationships • ADHD coaching which assists with improving time management, goal-setting, and organisational skills Occupational therapy is also an essential key in ADHD management, with occupational therapists providing the tools to assist those with ADHD to organise their environments, enhance their social interactions and awareness, optimise time management, monitor and regulate sensory stimulation, and develop stress-management techniques. For those with ADHD and those in relationships with them, many options are available. It’s up to us to set the tone for treatment and prevent further fall-out resulting from the illness. References available on request.