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Section 19
Relationship Skills Deficits in Adults with ADD

Question 19 found at the bottom of this page
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Adolescents and adults who have ADHD often experience social skills deficits and have poorly developed communication skills. Accurately reading and interpreting social cues (body language, facial expression), a crucial component of developing good social skills, are often challenging to individuals who have ADHD. Their distractibility, impulsivity, sensitivity, overreactivity, self-focus, and poor self-regulation can interfere with learning these important skills. Children who have ADHD often miss the important details involved in mastering social skills through observing, copying, practicing, and receiving feedback. Adults may have learned some of these skills but have often missed important pieces and may not even know they are missing them. As children, many tend to be socially neglected, living on the periphery of the peer group (those who are primarily inattentive) or actively teased and rejected (those who are hyperactive). Females tend to be more negatively impacted by poor social interactions, as they typically have a greater need for peer affiliation
than do males (Nadeau). Many studies have documented social skills deficits in children who have ADHD (Frederick & Olmi; Landau & Moore), and several clinicians have even designed specific social skills training programs to teach them (Cohen), but there has been little research on adult social skills deficits in ADHD. Novotni focused on identifying and understanding the impact of social skills deficits on the relationships of such adults. She raises the important issue of attribution and misattribution. Many individuals who have ADHD have suffered from social isolation or rejection because their ADHD behaviors were misattributed to selfishness, lack of caring, thoughtlessness, laziness, stupidity, or craziness. For example, when an individual who has ADHD is late, others tend to attribute this to a lack of caring or selfishness, rather than understanding that time management is a chronic problem for many who have attention deficit disorder (ADD).

Low self-esteem is a contributing factor to the development of relationship deficits in individuals who have ADHD. Many have experienced a life replete with broken relationships. They have often felt disliked by parents, teachers, and peers. Many of their problematic behaviors, such as tantrums, arguments, and poor anger management, are indicators of relationship problems that continue into adulthood in the form of loud, angry arguments with family, friends, and even bosses. When growing up, children who have ADHD were frequently bombarded with countless criticisms of behaviors that bother adults, with little or no focus on what the child needs. Others typically do not understand how an individual who has ADHD experiences the world, and thus they often do not feel heard or understood. A parent’s understanding of the difficulty adolescents have in doing their chores, starting their homework, turning off the television or video game, going to bed, and getting out of bed in the morning may make it more likely that parents and their children will engage in problem solving, rather than blaming, criticizing, and arguing. Parents who have ADHD typically compound the problem through their own difficulties: tuning in to social cues, being distracted, and generally being busy, hurried, and disorganized. This cycle of frustration, blame, criticism, and lack of understanding forms the core experience of many individuals who have ADD in relationships with others, beginning in childhood and continuing though adulthood. Other environmental and family impacts can contribute to the relationship problems an individual has. One example is that some individuals who have ADHD must maintain an orderly and clutter-free home environment in order to function effectively. Without it, they experience significant anxiety about losing control—not seeing important bills and papers among the piles of clutter, forgetting critical events, or losing key items. A boisterous family’s typical noise and chaos can be overstimulating for many who have ADHD. Likewise, stressful home environments in which there are high levels of conflict, tension, or depression can exacerbate already challenged executive functioning and overload highly sensitized receptors. Another common family stressor is the tendency to take on too many activities, with resulting stressful overscheduling. These overcommitments can intensify ADHD difficulties with time management, lateness, and forgetfulness, as well as leave no down time to recuperate from life’s daily stresses. These issues illustrate the bilaterality of the relationship impact of individuals who have ADHD and those who share their environment.

ADHD Behaviors That Impact Relationships
The development of poor communication skills probably results from a combination of social skills deficits and other typical ADHD-related behaviors, which interfere with healthy communication in relationships. Many individuals who have ADHD feel understimulated and may attempt to self-stimulate by seeking conflict and provoking others. Some seem always to need to have the last word, to create arguments, and to be unable to refrain from arguing once they have begun. Their inattentiveness can result in divided attention while listening to significant others, hearing only parts of what is being communicated. The tendency to have difficulty holding onto thoughts, combined with impulsivity, may result in interruptions, speaking over others, and failing to communicate, believing they already have (“I thought I told you”). Other common challenges of ADHD are emotional sensitivity and overreactivity. Many have “hair-trigger” reactivity and may be prone to outbursts and moodiness. They are easily irritated, offended, and hurt because they instinctively respond to the smallest changes in the environment, both physical and emotional. This hypersensitivity, which Mate characterizes as having “emotional allergies,” leads these individuals to experience stimuli differently than other people do. Mate suggests that they serve as a good barometer for the stress levels in a family environment because of this highly tuned responsiveness. Their sensitivity is also affected by their emotional states. This hypersensitivity and subsequent hyperreactivity can be off-putting to spouses, family members, and others in the community. Others may respond by downplaying or negating what appear to be excessive reactions; by criticizing the individual as too thin-skinned, defensive, or sensitive; or by retreating from the intensity of the emotional response. This intense reactivity prevents people who have ADHD from being fully emotionally available to hear others, a trait that often leads to further exacerbation of the conflict or power struggle.

Impulsive behavior can also significantly impact relationships. There appears to be little mediation between the impulse to do something and the logical brain centers that allow us to slow down and think it through first. It is challenging for people who have ADD to learn to “put on the brakes” or “stop, look, and listen” before acting. The resulting impulsive behaviors can take many forms, such as crossing the street or changing lanes without looking, taking on too many activities, making plans or purchases without consulting spouse or family, and making poor decisions. Impulsive spending can be a huge problem in many families affected by ADD, potentially leading to bankruptcy and/or divorce. The combination of poor self-control, stimulation seeking, and self-medication can lead to compulsive or addictive behaviors as well.

Executive dysfunction creates yet another set of interpersonal behavior difficulties. Organizational and memory problems contribute to relationship conflicts, both within couples and between adolescents and parents. Disorganization and forgetfulness lead to piles of unfinished laundry, clutter, chronic lateness, lost keys, missed events, and unpaid bills. These behaviors decay trust over time; the individual who has ADHD cannot be depended on to “execute.” Disappointment sets in and often causes the spouse to feel unimportant. Halverstadt, writing about the impact of ADD on romantic relationships, emphasizes the importance of significance—“the quality of feeling valuable, important, and loved” (p. 106). He posits that most conflicts are about significance and the need to know that we are “significant enough to each other that our wants, needs, and desires are being heard.” It is more important to have our significance needs met through good communication than to be right or get our way.
-Robbins, CA; ADHD Couple And Family Relationships; Enhancing Communication And Understanding Through Imago Relationship Therapy; Journal of Clinical Psychology; May 2005; Vol. 61 Issue 5, p565

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Personal Reflection Exercise #5
The preceding section contained information about relationship skills deficits in adults with ADD.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 19
According to Robbins, what three ADD behaviors most significantly impact adult relationships? Record the letter of the correct answer the Answer Booklet.