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  • Carla Barrow, LMFT

Understanding the Role of ADHD With Couples



One of the things I love about couples therapy is that no two couples are alike. One unique difficulty facing some couples is their spouse’s neurodiversity, including the exhibition of ADHD (Attention Deficit Hyperactivity Disorder). It is estimated that the divorce rate among an ADHD couple is as much as twice that in the general population.


Elements of ADHD that can impact a couple include:

  • Hyperactivity and impulsiveness

  • Being unable to sit still, especially in calm or quiet surroundings

  • Being unable to concentrate on tasks

  • Excessive physical movement

  • Excessive talking

  • Being unable to wait their turn

  • Acting without thinking

  • Interrupting conversations

  • Sensitivity to rejection, criticism

  • Sensory overload that can lead one to shut down or explode

  • Executive functioning difficulty (flexible thinking, task completion, working memory, self-control)

Perpetual Difference in a Couple Could Be Brain Wiring


In Gottman couples therapy, we learn that approximately 69% of what couples argue about is due to “perpetual differences,” differences stemming from each client’s unique perspective of life based on family of origin, life experiences, culture, preferences and the like.


In the ADHD couple, one perpetual difference arises from how each person’s brain works. Some clients with ADHD are on medication and some are managing symptoms without it, with varying degrees of success and failure. Even the issue of medication can create rifts between the couple.


Although ADHD may be undiagnosed, more times than not in my practice, the neurodiverse spouse struggled prior to the marriage, perhaps in childhood at school, or as a teen with peers, or as an adult in the workplace.


The non-ADHD spouse may be generally aware of their earlier struggles, but sometimes not fully. They may not understand how deeply the difficulties of neurodiversity run and how much frustration, shame, failure and labeling their spouse has experienced, all of which can impact whether a spouse is prone to contest, “turn away” and defend themselves when their spouse logs a complaint.


What was once considered to be the creative, spontaneous side of the ADHD partner may now be considered to be impulsive, inconsiderate and downright intentional. Inattentiveness to the non-ADHD spouse and missed or miscommunication are key themes. While the ADHD spouse may exhibit wonderful traits of enthusiasm and perform well in crisis situations, any inability to provide stability in average daily activities, such as cleaning up, following through on tasks or coming home at a scheduled time can undermine the gifts they bring to the table.


How Conflict Looks inside the ADHD Couple


Indeed, these neurodiverse couples present unique challenges. The spouse without symptoms often complains that conflicts and challenges in married life (be it finances, substance use, parenting or household chores) are never resolved; in fact, one client described the syndrome as “stacking cards.” There is a sense that the communications around problem solving goes in one ear of the ADHD partner and out the other.


The non-ADHD partner, struggling with ways to pick up the loose pieces, may assume the role of parent and interpret actions of the ADHD partner as willfully refusing to cooperate. This, in turn, can lead to negative sentiments that increase the likelihood of conflict and discolor the couple’s prospects for harmony. One struggling wife saw her husband’s talkative, spontaneous nature as aggressive and rude, interpreting his actions as stealing the stage in social situations.


It’s easy to understand how any spouse could grow tired and agitated by the ADHD spouse’s suggestions that they did not mean to forget to pay the mortgage or mow the lawn; or that they did their best to stop and pick up the holiday order, but got caught up in another task and arrived just after the store had closed.


Disappointments and unfinished business may spur Gottman’s Four Horsemen of the Couple Apocalypse (criticism, defensiveness, contempt and stonewalling) to blaze trails through the relationship. This can be crippling to the couple, especially since the ADHD brain tends to perform best and be most motivated where reward is present, including praise and adulation, or what the Gottman Sound Relationship House model calls Fondness & Affection.





















Exploring Resources and Adjunctive Therapy for the Couple


Understanding the role of ADD or ADHD in the marriage is critical to reducing conflict and preserving connectedness in the couple, and thus dually important in the assessment stage of couples therapy. When I observe the possibility of neurodiversity issues, I explore it further with each spouse individually, and may recommend a medical or psychiatric consult to the affected client. I let the spouse know that there are counselors and coaches who specialize in ADHD and executive functioning, which may prove helpful as adjunctive individual therapy while the couple explores marital issues in couples therapy.


I find it helpful to give the couple resources that can help normalize the situation for each spouse and externalize what might otherwise sound like harsh labels or deficits. While there are a myriad of helpful books and online help, a few I recommend are ADDitude magazine, The Couple’s Guide to Thriving with ADHD by Melissa Orlov (who discusses her own ADHD couple challenges) and Nancie Kholenberger, LMFT and ADHD & Us: A Couple’s Guide to Loving and Living with Adult ADHD.


Here are a few tips to help prevent missed or misunderstood communications for couples with ADHD:


  1. A large whiteboard to notate chores, events, deadlines, family tasks, vacations, and the like. What I also like about a whiteboard is that it externalizes expectations that otherwise may become sources of conflict. No more “I thought you said X.” It can also serve as a physical cue that too much is being scheduled which could lead to sensory overload. Finally, the couple can leave warm love messages to each other or write inspiring quotes on the board, helping to remind each partner to keep an open perspective when times are challenging.

  2. A daily “check in” before leaving and upon returning from work. Given the ADHD spouse’s difficulty with working memory or distractedness, a short review of the day’s plan, followed with some affection (Gottman recommends a 6-second kiss) can positively reinforce what the couple wants to accomplish.

  3. Time-outs and cue words for taking a time out. Tempers can fly quickly, particularly if the ADHD spouse is sensitive to input and has difficulty regulating emotions. Cue words for a time out can be devised by the couple. One couple calls out the name of each spouse’s mother; another uses the word watermelon. Something such as “911” might also work. ADHD & Us recommends “Your brakes might be failing you,” since executive functions are not as strong in the ADHD partner and may lead to impulsive or destructive actions if the brakes aren’t applied.

  4. Executive function coaching for ADHD partners. Many such coaches suffer from ADHD themselves and provide helpful mentoring for the day-to-day functioning of the family.

  5. Finally, emotion regulation skill-building for the couple can also be helpful. I provide a 12-week course in Dialectical Behavioral Therapy skills training that focuses on mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness. Learning to validate and not invalidate (and how to recover from invalidation) are quintessential for an ADHD couple. For more information on the skills group, go to https://theintegraltherapist.com/skills-training.


Neurodiversity provides great benefits to the world and individuals with ADHD can be lovable, exciting, creatives who are often known to go out of their way to make people happy and who can come up with out-of-the-box solutions for life challenges. ADHD challenges need not doom a relationship, and can instead be managed with insight, education, and support such as counseling.


Research finds most couples wait years too long to address marital issues, so if you find neurodiverse issues are standing in the way of your marital happiness, don’t hesitate to reach out.


If you and your partner need more support with ADHD or additional challenges, I invite you to contact me for your complimentary phone consultation at 954-391-5305. I offer counseling at our beautiful office located in Plantation, Florida and across the state of Florida via online counseling. I look forward to speaking with you!