Why create a special model to help couples challenged by Adult ADHD—in one or both partners? Four questions and answers go a long way toward explaining that.
In case you missed it, my new book (with psychologist Arthur L. Robin) is Adult ADHD-Focused Couple Therapy: Clinical Interventions.
As part of the book’s debut, the publisher sponsored a contest on Twitter. Routledge Press invited the public to ask questions of Dr. Arthur Robin and me, with the answers to appear on the publisher’s page for the book.
I’ve re-printed the first four below, with more to follow in a future post.
1. What made you decide to write this book?
First, the situation is dire for ADHD-challenged couples worldwide. Thanks to burgeoning adult ADHD awareness, couples are seeking clinical expertise and guidance—yet rarely finding it.
Second, evidence-based interventions exist for adult ADHD. But there were no such interventions for ADHD-affected couples. We wrote this book to fill this void, by blending two critical components:
- Evidence-based interventions for adult ADHD
- Evidence-based couples’ interventions with sound behavioral principles.
(The term evidence-based means that these are interventions that have been studied and published in clinical journals as being effective. These are not simply personal opinions.)
To summarize, we wrote this book so that all therapists can
- Understand how unrecognized or poorly managed ADHD may be standing in the way of positive clinical outcomes, and
- Implement state-of-the-art therapies designed to enrich their practice and clients’ lives.
2. What is one thing you hope readers take away from this book?
Adult ADHD is in no way a fringe sub-specialty. Conservatively, the worldwide prevalence rate for ADHD is about 5 percent. That means, in the U.S. alone, adults who have ADHD number in the tens of millions. Yet only 1 in 10 is diagnosed.
In fact, they are much more likely to be diagnosed with conditions secondary to ADHD—depression, anxiety, substance-abuse, and even attachment disorders. Treatment that misses these adults’ core issue of ADHD, however, is not likely to have a positive outcome.
Couple therapy represents an excellent opportunity to screen for ADHD and, in so doing, increase positive outcomes. In fact, there is good reason to believe that undiagnosed ADHD is over-represented among couples seeking counseling.
Furthermore, an estimated 10 to 15 percent of the population suffers at least moderate ADHD-related impairment. That is, 23-35 million adults in the U.S. alone, not counting the impact on all their loved ones. Similar prevalence rates have been found worldwide.
Expanding the helpful reach even further: The interventions in Adult ADHD-Focused Couple Therapy ™ stand to help even greater numbers of people. That includes individuals who struggle with similar behaviors yet do not fully qualify for the ADHD diagnosis. After all, the associated traits of ADHD—procrastination, distractibility, emotional dysregulation, impulsivity, and the like—fall on a continuum in the human population.
3. Is there another point you’d like to highlight about this topic?
There is hope for couples on the brink of disaster due to the poorly managed impact of adult ADHD on their relationships.
That hope, however, depends on understanding one critical point: ADHD has its basis in neurobiology. Brain-based challenges underlie many of the issues that bring these couples to therapy—problems around money, sex and intimacy, chore-sharing, co-parenting, communication, and the like.
Too often, though, neurobiology is often ignored or poorly understood, and these couples’ challenges are too often viewed as typical “couples troubles.” This core knowledge of ADHD’s neurobiological underpinnings—and the targeted strategies in this book—can make all the difference in outcome.
Couple therapy has moved well beyond interventions for intimate relationship distress. Increasingly, evidence-based extensions of couple therapy have been developed for treating emotional, behavioral, or physical health problems in one or both partners.
ADHD presents a critical destabilizing influence on couple relationships that has, heretofore, been largely understudied and under-treated. This book offers a treasure trove of evidence-based interventions for helping partners to cope with this personal and relational challenge.
4. What is a common misconception about this topic that you would like to clear up?
Misconceptions about ADHD flood the Internet and popular media—and even quarters of the mental-health profession. We address several common myths in the book, including that the ADHD diagnosis pathologizes “normal human behavior.”
Taken by themselves, ADHD symptoms are indeed “normal human behaviors.” But it is both the number and intensity of these behaviors—combined with actual impairment in life—that makes the diagnosis.
Far from being a “new invention,” ADHD cuts across many of the problems that have historically brought legions of people to therapy, especially couple therapy. Yet, because their Adult ADHD was missed or its interventions poorly understood, these clients have rarely received—despite their therapists’ best intentions and efforts—the clinical guidance needed to make lasting changes.
Since the 1990s’ so-called Decade of the Brain, revolutionary brain-imaging methods have exponentially increased our understanding of this most complex human organ and, thus, conditions such as ADHD. To date, according to PubMed, more than 15,000 papers with ADHD or ADD as a major focus have been published since 1970.
The literature makes clear: ADHD is real, it is more common than most people realize, and its treatments can be highly effective. Equally well documented: ADHD neurobehaviors, when left unaddressed, can limit the options, the self-fulfillment, and even the physical health of the people who have it and adversely affect everyone in their spheres of influence.