Emotions, Relationships,

& ADHD

Kate Carr-FanningVice Chairperson, HADD

Ph.D. Candidate, Psychology in Education, Trinity College Dublin

September 20111

Contents• What is Adult ADHD?

– Executive function deficits.

• Emotion & ADHD.– Neurobiological & psychological explanations.

• Relationships & ADHD.– Why relationships are difficult for pwADHD.

• Professional treatment.

• Coping strategies.– Self-awareness.– Managing stress.– Communication.

2

Potential Issues

Possible Solutions

What is Adult ADHD ???

3

What is Adult ADHD ???

4

Childhood Adolescence Adulthood

INATTENTION

HYPERACTIVITY

(Mick et al., 2005)

IMPULSIVITY

• Symptoms manifest

differently across the life span.

• Changes to DSM-V

& ICD-11.

• Maturation vs. environmental demands.

What are Executive Functions ???

Brown EF

Barkley EF

•Activation•Effort•Emotions•Memory •Action

•Self –Regulation•Working Memory•Internal Monologue•Reconstruction

“... deficits in self-regulation, impairment in the ability to organize behaviour towards present & future goals & difficulty

adapting socially & behaviourally to the environment ...“ (Barkley, 1994).

“The symphony of the brain” (Brown, 2006)

Emotions & ADHD

6

Emotions & ADHD• “Affective Liability”:

– Emotional volatility is not diagnostic core symptom but frequently seen (esp. in adults).

– Co-morbidity (co-occurrence of mood disorders).

• Commonly Reported Examples:– Frustration / irritability.– Sensitivity. – Impatient.– Anxiety and depression.– Motivation and perseverance.– Changeable.

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(Barkley, 2001, 2003, 2006; Lewis, 2010; Wender, 1987, 1995)

Neurobiology of Emotional Disregulation

Two Sides to the Story:

• Barkley’s (1997) response inhibition.

• Brown’s (2006) modulating emotions and managing frustration.

Brown EF Barkley EF

•Activation•Effort•Emotions•Memory •Action

•Self -Regulation•Working Memory•Internal Monologue•Reconstruction

Psychology behind Emotional Disregulation

• History of negative experiences.– Perceptual sequencing difficulties & anxiety.– Repeated failures.

• Living in a state of tension.

• Underdeveloped skills &/or coping mechanisms.

• Unrealistic self appraisal &/or goals.

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Relationships & ADHD

Relationships• Relationships are difficult for pwADHD:

– Higher divorce rate, quickly falling in and out of love / intense relationships, frequent arguments with friends and family quickly get out of hand, etc.

• Biggest problems for spouse / partner of pwADHD1. Sharing responsibilities.2. Doesn't listen & never remembers.3. Social skills.4. Getting into trouble.5. Disorganized, messy, & collecting things.

Relationships• The relationship we have with ourselves:

– Confusion and anxiety.– Self-blame and loathing.– Inadequacy.– Processing emotional information.

Professional Treatment

Professional Treatments• Psychiatric and psychological treatment for emotional

disregulation:

1. Medication.

2. Psychological therapies: – Cognitive Behavioural Therapy (anxiety).– Talk therapy &/or couples / family therapy.

3. Getting help getting your physical world in order (e.g., OT, life coach) can have a big impact on how you feel.

Practical Coping Strategies

1. Self-Awareness2. Managing

Stress3. Communication

Self-Awareness• Self-awareness is the key!!!

– Who am I, what do I want & value,?– What are my strengths & weaknesses?– How does my ADHD affect me?– How does my ADHD affect others?

Why is Self-Awareness SO Vital ???

SELF SOCIAL

RE

CO

GN

ITIO

NR

EG

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Self Awareness Social Awareness

Relationship Management

Self Management

Developing Self-Awareness• Strengths, capabilities, and talents:

– Start from a strengths based model - we often get stuck on what’s wrong with the person, & ignore what’s right with them.

– Positive aspects of ADHD.– Consider realistic applications and options.

• Acceptance: – Mindfulness vs. externalizing or blocking of emotions /

difficulties.– Don’t get stuck in the tyranny of the “should”.

• Develop and implement strategies.

• Evaluate effectiveness of strategies & adapt:– Trial and error where error is your friend.

www.authentichappiness.sas.upenn.edu/Default.aspx

Managing Stress• Finding the Balance:

– Extreme ‘all-or-nothing’ living & emotional imbalance;

• e.g., over-working, over-drinking, over-sleeping, etc.– Time management;

• Hyper-focusing on one area of life & letting all the other aspects on life.

– Holistic.

• Organization Skills:– ADHD brain is an exciting, disorganized, & unpredictable

place - so make your physical environment as predictable & calm as possible

– e.g., de-clutter your space & your life, make plans & lists, have a routine, don’t over commit yourself, etc.

Managing Stress• Counteracting Impulsivity:

– Impulsivity (immediate reaction) to emotional stimulus = problem!

– Stress is when there are too many demands placed on us relative to our actual capacities and resources.

– Since people with ADHD lack certain capacities certain parts of life are going to be much more stressful for them than for others.

– So be aware of what this means for you (know your weaknesses) and plan ahead!

Communication• Develop Understanding:

– Not always easy for someone with ADHD to communicate their thoughts and feels.

– But educating each other is so important in relationships:• If you don't know why you'll make up your own story and it

will not be pretty.

• What is “Fair”?– “You don’t care”

• Faking flaky is more trouble than it’s worth!– “You’re wrong”

• Often there is no right or wrong - it’s all about perception.

Communication• Some Helpful Communication Tips:

– Sitting on the couch whining about ‘our relationship’ might not be the most productive things - try the walk and talk approach.

– “I feel” statements.– Give lots of examples (make it real and tangible).– Active listening.

• No drifting off, interrupting, or offering solutions.– Positive communication aids - figure out structures for

remembering without nagging.– Set clear limits and expectations.

• Reasonable & realistic – don’t set up more failures.– Collaborate on finding solutions.

Thank You For Your Attention

Contact:

carrfank@tcd.ie