Relationships and Adult ADHD

Even though the interpersonal effects of ADHD are getting more attention, it is still an underappreciated problem area for adults with ADHD. It is also ironic that social functioning has been late to the game in terms of recognized ADHD-related impairments compared to work and school problems, as the suite of self-regulation skills that are compromised in adults with ADHD likely arose from the demands of the increased interdependence of early human groups who were able to survive and gradually thrive by working together.

Self-Regulation and Sociality

The skills involved in sociality beyond kin allowed humans to learn from one another (including watching how others solved problems), working together for mutually beneficial goals, acceleration of communication and shared language, tit-for-tat reciprocal altruism, and a general approach that one is better off “working and playing well with others” than going it alone.¹ The social contexts and the environmental demands faced by our human ancestors favored and honed self-control skills—also known as executive functions—which spurred shared knowledge and cultural evolution.

The executive functions can be parsed into categories of organization and problem solving, time management, attention, flexibility and shifting between tasks, initiation, self-monitoring, impulse control, motivation, and emotional regulation. Emotion management includes the social emotions of empathy, shame, and guilt. Apart from its wider benefits, this suite of skills is relevant to relationships insofar as it helps you to:

• Identify your needs in relation to others’ needs
• Recognize the need for compromise and cooperation in certain situations
• Track and follow through on promises made to others to ensure you are contributing your fair share to a project or relationship
• Keep an eye on commitments owed to you by others to catch those who might be freeloaders

Unfortunately, these are some of the very issues that are difficult for many adults with ADHD.

Sociality and Adult ADHD

On the one hand, a good personality and interpersonal skills are “superpowers” for some folks with ADHD that allow them to build vibrant, stable social networks. Such conviviality may compensate for various social faux pas and slip-ups. In some cases, these skills help adults with ADHD to cope via adaptive partnerships in the form of “buddy systems,” such as recruiting exercise or study buddies, or “body doubles” in which friends trade off keeping each other on task—“You help me organize my closet and I’ll help you catch up on your yard work.” Such likability may build social capital with others inasmuch as any glitches from scatteredness and inconsistency in a relationship (“Where are you? I’ve been waiting for 30 minutes?!”) are buffered by the uplifting high-spiritedness and positive energy of the friend with ADHD.

Unfortunately, executive function deficits and their effects on social skill use create problems for many adults with ADHD. They are difficulties with repeated forgetfulness and lateness for tasks and promises, poor organization and execution on plans and commitments, emotional overreactions (or non-reactions when one is called for), inappropriate, impulsive comments, and a perception that one is not listening that over time erode relationships.

Thus, it is no surprise that two of the social emotions—shame and guilt—are commonly reported by adults with ADHD. These are adaptive but dose-dependent emotions—in reasonable doses, they provide feedback and information to help one tend to relationship matters, such as staying in touch or making amends for gaffes; in larger doses, though, they can be toxic and add a heavy emotional layer to managing ADHD and relationships, magnifying already fraught situations.

Humans also have the capacity for empathy and positive feelings associated with helping others, reciprocal altruism, and working together with others. Our human factory settings, however, come with a negativity bias² and a proneness to experience the bad to a greater magnitude than we do the good, especially in tracking relationships, which contributes to the negative self-views held by many adults with ADHD that are magnified by relationship problems, not to mention corresponding anger, shame, and/or guilt reactions. It is no surprise that such emotions make a contribution to the avoidant coping characteristic of adult ADHD³ that also creates relationship problems.

Vectors of Social Health

A way to think about the effects of ADHD on one’s “social health” is the different vectors of sociality.⁴ The vertical dimension is one’s reputation or status with others in a broader social community, such as school or work. In this domain, it is one’s conscientiousness (a personality factor consistently low in adults with ADHD), dependability, organization, sense of duty to others, and being a low maintenance, reliable contributor on a team. There are various buffers at play, such as if someone has a unique skill set, their difficult personality traits will be tolerated.

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On the horizontal dimension is a sense of belonging to groups. On this vector, it is a sense of closeness and degrees of closeness, concentric “circles of trust,” the innermost circles being family, romantic partners, and friendships and radiating outwards to various levels of acquaintanceship and familiarity. There is often less conditional pressure in the inner circles of this domain, as inhabitants have either earned or been granted truly unconditional positive regard and acceptance, although there is at least some expectation of reciprocity and pulling one’s share in relationships and even these bonds can be strained.

The unfortunate issue with adult ADHD and social health is that it is the implementation difficulties that define ADHD that create the problems and not a lack of desire, intention, or caring about the people in one’s life. Nonetheless, the automatic reactions by those in the social networks of adults with ADHD often assume a lack of caring, selfishness, or other less-than-desirable traits. Lab-based studies of tit-for-tat sharing interactions indicate that negative emotions and corresponding effects on interactions are triggered when one is viewed as “not playing fair,” including activation of brain regions associated with negative emotions.⁴

Strategies for Managing Your Social Accounts

So, what can be done about this? The interpersonal domain of managing ADHD in the social/interpersonal world involves managing one’s social capital and “accounts” with others. Our relationships can be considered akin to a shared financial account with others in our lives. We each make deposits to and withdrawals from these accounts in good faith. Extending the economic analogy, we also have to monitor accounts for overdrafts and keeping to an agreed-upon budget.

In a broad sense, psychosocial treatment approaches for adult ADHD mind the relationship domain by fostering the implementation of the coping strategies that are needed to improve adult role functioning. That is, most targets for treatment involve coping better at work or school, improved follow-through on household and parenting duties, and other matters that have ripple effects on others. In fact, the reason for pursuing treatment for ADHD in the first case may stem from issues in a marriage or other committed relationship, social isolation, or problems with bosses or co-workers.

For the most part, it is not necessarily a lack of knowledge about social behaviors, but poor timing, impulsivity, or other difficulties with the timely implementation. Pharmacotherapy can be helpful in improving these interfering symptoms. In addition to promoting role-fulfillment, psychosocial treatments can help identify high-yield situations and prospectively develop coping regimens with externalized reminders to promote their use at the “point of performance.” Even recognizing and dealing with distractions in the environment can help one play to their strengths (“Let me sit on the other side of the table because I’ll be distracted by the television over the bar”).

Keeping up with friends on the horizontal dimension of the social world can be managed proactively as any other “task” for follow-through. Setting up times to respond to or send texts or emails helps keep in touch. Having set “check-in” times with a spouse or romantic partner—face-to-face, in-person sit-downs with phones put away—to coordinate any plans, attend to any relationship matters, and perhaps as a springboard to an activity together is a good habit. Arranging for positive time and activities with children, too, is another target of planning and organizational skills. Humans also have the capacity for empathy and positive feelings associated with helping others, reciprocal altruism, and working together with others. Hence, setting a daily “act of kindness” directed at a loved one can go on a daily to-do list. There are some other resources for social skills⁵ and relationship treatments modified for adults with ADHD.⁶

Sigmund Freud famously said that the two main components of a fulfilled life are “to love and to work.” Adult ADHD has effects on both of these, but there are effective ways to improve these domains, especially your social health.