ADHD, Empathy, & Dopamine: A Study, Book Excerpt, and Definition

ADHD empathy dopamine
What can a published study — and an excerpt from my first book —  explain about ADHD, empathy, and the neurotransmitter dopamine? That’s what this post is all about. (You’ll also find a link to my podcast of this topic.)

I started noticing a remarkable phenomenon 20 years ago. That is, stimulant medication, which targets dopamine, enhances empathy (or at least the ability to act on empathy) for many adults with ADHD. How is this possible?

In This Post:

I’ll tackle the topic from three angles:

1. Defining empathy (it’s not what most people think — at least it’s more complex).

2. Excerpting a passage on empathy and relationships from Is It You, Me, or Adult A.D.D.?

3. Sharing details from yet another study pointing to a connection between dopamine and cognitive empathy. (I’ll define cognitive empathy  in a minute.)

A sneak preview of the study:  Stimulant medication often enhances empathy in people with ADHD.

But wait. This happens not because the medication creates empathy. Rather, the medication enhances dopamine transmission. That, in turn, allows some people with  ADHD to focus on and access this “higher-order” brain function. In fact, it is one they have always possessed—but haven’t been able to reliably access.

You can also listen to the podcast version of this post:

Low Empathy and Narcissism: What’s the Connection?

It’s true that we can think of low empathy as fertile ground for narcissistic behavior. Trouble is, narcissism has been seen as a very poor prognosis—that it, it does not respond to treatment. That’s one reason I am sharing important research on that topic.

It is hard for me to over-state how commonly mental-health professionals see narcissism—or even Narcissistic Personality Disorder—where there is instead poorly managed ADHD.

[advertising; not endorsement] [advertising; not endorsement]

This point is critical: Low empathy sometimes increases with ADHD medication.

Until individuals and couples—and mental-health professionals—understand this, the risk is a far more permanent label: narcissist. My friend Taylor J. wrote of her concerns about her daughter here: ADHD and Empathy: Was I Raising A Narcissist?

Empathy sounds simple. But it’s really a complex phenomenon. In fact, some people with ADHD have trouble reining in their empathy. They might call themselves empaths, as I explain below.  Stimulant medication often helps them, too. It’s all about the self-regulation:  not over-doing, not under-doing, but finding the middle ground.

Hang in there. The concept should become more clear as you keep reading.  And be sure to read the comments for illuminating first-person insights.

ADHD, empathy, and dopamine


Empathy is Not Sympathy or Compassion

We often confuse empathy with other behaviors—sympathy, kindness, compassion, and the like. Empathy is not those behaviors or traits—though it might accompany them.

The most commonly accepted understanding of empathy is this: the quality that lets us “get in another person’s head.” When we empathize, we momentarily step outside of our own needs, thoughts, and desires.  We contemplate what another person might be feeling.

There is a difference, though, between empathic and “relating”.

For example, if you’ve been in a bad car accident, for example, you are probably better able to relate to the experiences of other people who survive crashes. You “know how it feels.” But what if you’ve never been in an auto accident? What is the mental process that allows you to imagine what it is like for someone else?

That is a very simple example, but it is meant to drive home the point: Empathy is what allows us to imagine what another person is feeling, even if we’ve never been in that situation ourselves.

Moreover, empathy can allow us to step back from our own emotions, in trying to understand the mindset of a person who is disagreeing or even opposing us.

The cognitive scientists have terms for various types of empathy. But the one we’re most familiar with is called cognitive empathy. It simply means: Imagining how the other person feels and what they might be thinking. It’s also called perspective-taking. Walking in another person’s moccasins.

To Recap:

  • Empathy is not compassion or kindness, not exactly. And it’s not sympathy.
  • Contrary to widespread misperception, having empathy for a person doesn’t necessarily mean forgiving that person or letting someone off the hook.
  • On the simplest level, empathy is simply being able to “understand where that person is coming from. “


empathy adhd dopamine


Book Excerpt: ADHD and Empathy Regulation

Being able to empathize is key to successful negotiations, including in personal relationships. It can also help us understand why humans do some of the horrible things they do—and, with any luck, helping them to act in more humane ways.

Impaired empathy often destroys relationships where ADHD symptoms go unrecognized or unaddressed.

But deficits in empathy cut both ways in ADHD-challenged relationships. Typically, both partners become more mutually empathic, once they both start learning about the causes and varied manifestations of ADHD.

Consider this excerpt from my book, Is It You, Me, or Adult A.D.D.?.  In it, I name “low empathy” as one of three common ADHD-related deficits that can derail relationships.

Poor Empathy: “All Take and No Give”

“My wife seems to have empathy for movie characters, stray animals, or the grocery store clerk,” Alex offers. “But when it comes to her husband and teenage daughter, she often acts downright self-centered.”

Actually, empathy involves two sets of skills, according to [psychologist Robert] Brooks:

  • The ability to take the perspective of another person
  • The ability to understand and identify emotions

Yet, for many people with ADHD, the world can seem so chaotic and their focus so erratic, they don’t even know what they feel, much less what someone else feels.

Even if an adult with ADHD possesses both sets of empathic skills listed above, the person’s impulsivity or rigidity might obscure seeing the world through another’s eyes.

“And if a person is lacking in empathy,” Brooks adds, “he or she is likely to misread a situation and misunderstand the intentions of others. They often expect others to adapt to them, but they aren’t as willing to change themselves.”

It could be that change seems impossible—and the resulting feeling of powerlessness frustrates them even more.

Stimulant Rx for ADHD Can Enhance Empathy

In general, we can’t assume that all humans are capable of “normal” levels of empathy. Empathy is largely a function of the brain, and we all have different capacities.

Treating ADHD with medication often enhances the ability to act empathically. Certain coexisting conditions, however, such as Asperger’s Syndrome, complicate the picture.

[Don’t worry! Elsewhere in the book, I address the empathy deficits in the partners of adults with ADHD. But remember, some of them have ADHD, too. Moreover, empathy distributes on a continuum among humans; there is no one-size-fits-all.]

Recent Study: Dopamine and Fair-Mindedness

The 2015 study from the University of California, Berkeley, published in Current Biology, isn’t the first to examine the effects of dopamine’s effects in the brain when it comes to empathy.

For example, 0ne 2014 study showed that gender plays a role in cognitive empathy. See The dopamine D4 receptor gene shows a gender-sensitive association with cognitive empathy: evidence from two independent samples. Interesting, eh?

This study bears particular relevance to ADHD because this D4 gene variant has been associated with (but is not exclusive to) ADHD.

What About Empaths?

It’s worth noting: Women carriers of a certain gene variant (the 7R-allele) scored higher in cognitive empathy than female non-carriers.

(I wonder if this might explain the folks who call themselves empaths.   As far as I know, the only empaths are the telepathic Betazoids, on Star Trek.  But I see the term bandied about a lot these days, applying to regular humans.  In my opinion, we only very cautiously assume that we know how another person is feeling. Sometimes this springs from over-confidence and grandiosity—and trouble picking up the signals in more direct ways.)

In men, however, those with the 7R variant scored lower than than men who did not have it.

The UC-Berkley researchers took a different approach in their 2015 paper: Dopamine Modulates Egalitarian Behavior in Humans.

Study Details: Follow the Money

Study participants, on two separate visits, received a pill containing either a placebo or a medication called tolcapone.

(Tolcapone prolongs the effects of dopamine, a neurotransmitter associated with reward and motivation in the brain. Stimulant medications such as Ritalin and Vyvanse also target dopamine; they slow the re-uptake of dopamine at the synapse, the gap between neurons. Tolcapone works a bit differently. This FDA-approved drug is used to treat people with Parkinson’s disease, a progressive neurological disorder affecting movement and muscle control, which are also affected by dopamine.)

This double-blind study of 35 participants, including 18 women.  Neither participants nor study staff members knew which pills contained the placebo or Tolcapone.

Dopamine Modulates Egalitarian Behavior in Humans.

Boost Dopamine — Increase Sensitivity to Inequality

Participants then played a game in which they divided the money among themselves and an anonymous recipient.

The result: Participants receiving Tolcapone divided the money with the strangers in a fairer, more egalitarian way, compared to participants who received the placebo.

According to the press release at the UC-Berkley website, “Altering brain chemistry makes us more sensitive to inequality”:

Andrew Kayser MD PhD
Andrew Kayser MD PhD, UCSF School of Medicine

By connecting to previous studies showing that economic inequity is evaluated in the prefrontal cortex, a core area of the brain that dopamine affects, this study brings researchers closer to pinpointing how pro-social behaviors such as fairness are initiated in the brain.

“We have taken an important step toward learning how our aversion to inequity is influenced by our brain chemistry,” said the study’s first author, Ignacio Sáez, a postdoctoral researcher at the Haas School of Business. “Studies in the past decade have shed light on the neural circuits that govern how we behave in social situations. What we show here is one brain ‘switch’ we can affect.”

The researchers also say that future research may lead to a better understanding of the interaction between altered dopamine-brain mechanisms and mental illnesses, such as schizophrenia or addiction, and potentially light the way to possible diagnostic tools or treatments for these disorders.

“Our hope is that medications targeting social function may someday be used to treat these disabling conditions,” said Andrew Kayser, a co-principal investigator on the study, an assistant professor of neurology at UC San Francisco and a researcher in the Helen Wills Neuroscience Institute at UC Berkeley.  See Kayser’s lab website: The Cognitive NeuroScience of Self-Regulation


This is a small study, one that remains to be replicated.

(I’m not sure what to make of the fact that it was jointly sponsored by the school of business and the neuroscience center, with funding from sources including the Defense Department.)

But the study adds to the increasing body of research around the role of dopamine and so-called “pro-social” behaviors such as fair-mindedness and empathy.

empathy dopamine medication

Two More Posts On Empathy

ADHD and Lacking Empathy: Was I Raising a Narcissist?


My parents are horribly mentally ill, and they refuse treatment. Instead, they blamed everyone else for their troubles—and drowned their sorrows in alcohol, drugs, and pity parties. Even when I was in the hospital—sick or with a new baby—my parents could only talk about themselves. I found their utter lack of empathy horrifying.

When married and starting a family of my own, I vowed to be different. Yet, in raising my first-born child, the oldest of four girls, I watched helplessly as every lesson about empathy I tried to impart seemed to bounce cleanly off her soul.

What do I mean by that? Well, for one thing, she would exploit others. She would set up games where everyone had to treat her like a queen visiting from another planet—or convince friends to “share” their favorite toys and clothes. Forever.

I even caught her in an elaborate kindergarten “protection racket” at one point: taking her sister’s money to keep monsters away. (She’d already made 6 dollars!)

Empathy and Mirror Neurons, Or, Monkey See, Monkey Yawn


My husband and I will be watching a TV show. Suddenly, there’s a surprise twist—a car bashes into a tree, a bullet lands, a fist flies into a face.  Instantaneously, I will react as if that action happened to me. Because, in a sense, that’s how it feels.

Reactions vary: I might yelp or my arm will jump. Whatever my reaction, it both annoys and amuses my husband.

I can suppress this empathic response if I am prepared for the action. But I can hardly anticipate a surprise, right?

Apparently, my mirror neurons are making themselves known.

More on ADHD Relationships

You’ll find many more posts on Adult ADHD here, from all angles, including relationships:

Breaking out of ADHD Relationship Dysfunction — After Not Breaking a Fall

Adult ADHD and the Automatic No — And Automatic Yes

Now, what about you

What has been your experience of empathy as it relates to ADHD?

If you have ADHD, or if your loved one does, have you seen empathy impairments or enhanced abilities to empathize with medical treatment?

Or maybe you’ve seen something else entirely.

—Gina Pera

About The Author

145 thoughts on “ADHD, Empathy, & Dopamine: A Study, Book Excerpt, and Definition”

  1. Yvonne Conrad

    I stumbled upon this article while searching key words for ADHD and empathy; this is mind-blowing (in a good way), and I’ve read every reader’s comment and response by Gina.
    I must tell you that I cried alligator tears from seeing my lived experiences being described by total strangers and for the first time feeling ‘visible’, feeling ‘heard’, feeling validated and empowered.
    Thank you all for (re)telling my story through yours, and for unwittingly giving me the courage to persevere through a toxic three-year marriage to a man who was only diagnosed with ADHD at my insistence a year into our marriage at the age of 60 (by a $500 hour psychiatrist who doesn’t take insurance – and oh by the way, he kept ‘’forgetting”, despite gentle reminders to file the insurance claim after the visit; so (more) $$ down the drain) .
    We’ve spent thousands in co-pay with therapists not at all versant in ADHD – one even denying its existence in adults, which I believe has aided in my husband not “believing” he has it, and then layer in the stigma amongst many black Americans when it comes to issues related to mental health; triple-threat.
    Although it was recommended by our recent therapist that we each see a separate therapist who specializes in adult ADHD (VERY hard to find) , nothing has happened on his end, except delay, deflect, deny, disrespect, stonewall, unregulated emotions and the like.
    I feel sad, alone, hurt, isolated, disrespected, discounted, dismissed and depleted. Yet, despite all of that, I persevere; seeking information to better understand with empathy, ADHD’s impact on the neuro-diverse brain vs my neuro-typical one. I’ve attempted to share symptoms and their ensuing behaviors to help him understand but it’s unwanted.

    Gina, your perspective that “denial is complicated” and “not take his reflexive responses as his true perspective”, although difficult to handle, gives me some hope.
    I will definitely be poring over your recommended reading, to become even more informed.
    In the meantime, how do I (we) source for an adult ADHD therapist, and how do I get more information about your couples therapy sessions?

    Thank you SO much for blessing me today. It’s been a well-spent couple hours.

    1. Dear Yvonne,

      I love it when someone makes all this hard work …. worth it. 🙂

      I’m glad you found my blog, particularly this post.

      I hear you when you say:

      Gina, your perspective that “denial is complicated” and “not take his reflexive responses as his true perspective”, although difficult to handle, gives me some hope.

      It IS difficult to handle. And trust me, it’s difficult for me to say. Because sometime there’s…..blowback. In my face. 🙂

      Typically, this comes from people who just don’t know what I’m about, are unfamiliar with my work, and/or just cannot let go of what they know to be “right” (perhaps reinforced by therapists and the poorly informed elsewhere, including some ADHD conferences!) and prepare to learn something new.

      Living with ADHD — in oneself or a loved one — isn’t for lightweights! :-). It takes enormous intelligence and empathy to “get it” — and then to start working smarter, not harder.

      It’s so unpleasant when folks confuse my message with the pat messages found elsewhere — that it’s just a matter of “understanding” and “accommodating.”

      No, it’s not that simple. Unless you are trying to find your way to an early grave. That doesn’t serve the ADHD Partner, either.

      As the leading expert on ADHD and relationships worldwide, I know this topic better than the majority of therapists — often including those claiming ADHD expertise. I co-authored THE only professional guide to ADHD couple therapy. It’s based on the evidence of what works for Adult ADHD therapy and what works for couple therapy. Preeminent experts in both fields highly endorse our guide.

      I urge caution in seeking therapy. It truly can make things worse. That was true in 2008, when my first book came out (and featured a chapter saying as much). It’s even more true now, as there is more need chasing less supply.

      I created my online training to provide what Adult ADHD therapy, including couple therapy, should be providing. But seldom does. And to do it at warp-speed, cost-effectively.

      You can learn the details of Course 1 here:

      Here’s a Q&A blog post about it. Since then, I’ve released Course 2, all about physical strategies (optimizing medication and sleep, nutrition and exercise):

      Please contact me with any questions.

      take care!

  2. What I’ve read, on reputable websites is that people with ADHD tend to be MORE empathetic that neurotypical people. Where is the evidence that they are less so? Could you point me towards some peer reviewed articles or other sources please?

    1. Hi Cris,

      I appreciate the question. Yes, I understand why are you confused. The so-called “reputable” websites you mention are muddying the issue.

      Many pander to people with ADHD, telling them what they want to hear. These marketing lines have become so repeated online, they are accepted as dogma.

      They depict people with ADHD as clones — everyone alike. It’s ADHD vs the “Non-ADHD” wars. To which I say rubbish.

      The forces behind many of these sites seem to think that if they emphasize enough positives — a contrarian view of ADHD — well, something will happen. You’ll subscribe. You’ll buy their coaching, counseling, whatever.

      What makes you so sure, though, that they are “reputable” sites? Are you aware that a massive number of sites, including solopreneurs and commercial websites — even “non-profits” to a large degree — are funded largely by one ADHD pharma’s largesse (but not disclosed) — a pharma whose marketing message is “ADHD positives”? (They maintain it’s easier to sell their product that way, and they are quite profitable. But it does confuse people nonetheless.)

      I have a different approach: honesty and rigorous research. It’s an approach that emphasizes the enormous variability of this syndrome we call ADHD among the individuals who have it. No cookie cutters. It’s individual by individual.

      I actually do rely on the science — and, thus, avoid simplistic platitudes. I’ve offered a complex look at ADHD, empathy, and dopamine in that post—and since my first book’s publication, in 2008. Did you read the post? How about the comments? I could be wrong but I don’t think so.

      What have these other sites offered you in the way of the “peer reviewed articles or other sources” you are demanding from me?

      I based my writing on 25 years experience in this field and many solid sources, including what we know of the neurobiological issues associated with ADHD (e.g. impairments to higher-order brain functions such as empathy, conscience, reflection, etc.). ADHD symptoms themselves can make even the most emotionally empathic person extremely self-centered. Being “sensitive” is not the same as being empathic. Being emphatic is about perspective-taking — putting yourself in someone else’s shoes. It’s a rather complex brain function.

      There’s also clinical research and studies such as this one.

      It feels more like you’re calling me on the carpet for educating on a topic that few are willing to risk discussing publicly for fear of offending someone. Or, because they truly do not understand the complexity, much less know how to explain it. Or care.

      Here’s another post on empathy:

      I believe that people with ADHD and their loved ones deserve the most accurate and useful information I can present. I’ve never seen pandering help anyone. It only seems to prolong their suffering.

      Oh, and I’ve never accepted pharma industry support of any kind. It makes a difference.


  3. After my 7-year-old son was diagnosed with ADHD (ADD), his pediatrician told me, “Children like this grow up to abuse alcohol/drugs and go to prison.” That was 40 years ago, and so far, the prison thing hasn’t happened. I don’t think he’s even been arrested. I attribute this to his mother’s care and my absence. We separated when he was still an infant.

    My work excelled, but I burned every employment bridge I ever had. Interacting with others was strained and awkward. I tried to blend in, but my unacceptable behavior caused relationships to crumble and friendships to end. So many hurt. So many regrets.

    As a loner, I drank heavily for years.

    On December 13th, I became an octagenarian.

    My son’s pediatrician didn’t know I had done a couple of stretches in prison when I was in my early 20s, once in California and once in Nevada. He didn’t know anything about me, but my son’s prognosis could have been mine, and it would have all been correct.

    His ability to do this 40 years ago is stunning and reveals a great deal about ADHD.

    That’s what holds my interest now, educating our current legislature to show them the insidious nature of ADHD and its prevalence in our criminal justice system. A treatable neurodevelopmental disorder is running amuck, creating a revolving door of recidivism. It’s time we fix it.


    1. Hi Jim,

      Happy Birthday!

      Yes, I’ve long found it ….what’s the polite word for it….misguided to send so many people to prison who have diagnosable and treatable brain conditions.

      The prison-industrial complex has been making blood money from these unfortunate souls. It’s way past time for it to end.

      This book might give you some ideas…


  4. After being married for ten years I am just beginning to understand that my husband has ADHD, and just how many of our issues stem from it. His mom just told me that she always thought he had ADHD as a kid, after TEN years of confusion and not knowing if everyone’s marriage is so difficult, painful, and lacking in empathy.

    So I’ve been researching like crazy, learning so much and hoping to find anything that can help because I have been so hurt by these ADHD behaviors. He is very resistant to diagnosis and even more to medication. This idea of an inherent lack of empathy rings so true and leaves me feeling so alone.

    He is defensive at every turn. I have said, “It would be a comfort to me to know that you can understand why x could be upsetting to me.” His first response was that he didn’t do the thing I was referring to. His second response was to narrow his eyes and say, “you just want me to say that I did something wrong.”

    I then restated that I just wanted to know if he understood my point of view of the situation.

    I don’t think he is aware of anything but his own intense emotions, and I have sympathy for that, it has helped me understand so many intense situations we have been in. But can it excuse atrocious behavior? Is he less responsible for his actions than a typical person?

    I have read advice that blaming things on their ADHD and not on them is the way to a better relationship.

    Do I just have to laugh off bad behavior as “oh there goes his ADHD again!”

    I am worn out with managing his moods and irritability. I think he enjoys fighting, perhaps it gives a hit of dopamine or a rare moment of focus so he enjoys it? I am tired of the focus being on my understanding him and his adhd with no hope that he can understand and empathize with me.

    Thank you for this informative post. I want to read your book as well.

    1. Hi Rachel,

      I’m glad you found my blog. I do recommend that you read my first book—and consider taking my course.

      Trying to manage a spouse’s moods is a one-way ticket to depression and exhaustion.

      “Blaming things on their ADHD and not them is the way to a better relationship”? In a sense, yes. That’s why my book’s title is “Is it You, me, or Adult ADHD?” :-). But the “ooops, blame it on ADHD” thing applies only when someone is on board with diagnosis and strategies — not in the full throes of significant impairment.

      Confronting a spouse with poorly managed ADHD about each transgression or mistake is also a surefire way to trigger long-established defenses.

      Finding your way out of this depends on getting a solid education. (My advice: Ignore most of what you see online; it doesn’t come from people with true expertise in ADHD, only self-promotion.) It also likely depends on evidence-based treatment.

      Don’t expect him to just say, “Oh, great idea!” 🙂

      First, you need to get very grounded in what ADHD is — and is not. You need validation of your perceptions. And, you need to let a lot of this settle in your mind before even approaching him about an evaluation, much less treatment. That’s my time-honored advice.

      Moreover, the sorry fact is that we cannot depend on the average mental healthcare provider to help us. Including many claiming ADHD expertise. Expecting that truly can make things worse. Hard to believe but true!

      If we want to turn around our marriages and families, we need to get educated, validated, and start spear-heading the changes. It’s not fair. It’s exhausting. But it’s just reality, unfortunately.

      take care

  5. Hi fellow readers 🙂 I was diagnosed with ADHD when I was about 7 years old I’m 20 now, and I’ve been on stimulant medication since I got diagnosed. Both my parents worked in the medical field and so I grew up with extremely caring parents and of course that means I learned the importance of having compassion for others. With ADHD comes sensitivity and I have always been a sensitive person, both physically and mentally, I can handle myself a lot more now but when I was little everything upset me, and of course my parents got upset with me sometimes but they always reacted to my feelings with an understanding of why I feel that way and they were able to put themselves in my mindset.
    As an adult as I’ve grown up with always being on meds and my extremely empathetic parents, I’ve developed a kind of superpower of empathy, that I’m very proud of, I help my friends through difficult situations and I’m able to be there for them when they need someone one. I know I don’t have an actual super power but it’s a trait that I have that I can say was developed through a combination of my parents upbringing and my medication and I think it’s one of my favorite traits in me 🙂

    1. Hi Olivia,

      Thanks for your sharing your story here.

      I bet that your empathy is one of your friends and loved ones’ favorite traits in you, too. 🙂


  6. Findingvthe terminology to explain the inherent abusiveness of ADHD behavior is difficult without a PhD… and perhaps even with one…. I finally concluded after 3yrs of toxic rollercoaster following a few weeks of lovely hyperfocus, where we fell in love, that the issue for my 50yr old unmanaged ADHD partner (diagnosed age 21 in college, but unaddressed—and long forgotten—after Adderrall got him through graduation), is that he cannot recognize others EXIST, perhaps cannot recognize the separateness of anything outside himself and his need from that other. person/thing.
    G-Rated example. After a horrible episode of lashing out and name-calling, we agree with trepidation to meet at a small restaurant, a safe place, as he always wants to look good, heroic even, in public, in front of family, etc. The restaurant unfortunately was very loud, Led Zeppelin blassting, only table offerred was large, near the open kitchen. We would have to yell to hear each other. I can’t eat, talk, or connect in that environment (expression of self, NOT criticism of him, after all, I chose the restaurant). I say, “Isn’t it loud in here, you’re way over there, let’s ask for that booth or get outta here.”
    Him, “No, you’re fine.” And that’s final, the man has spoken and he orders.
    Translation: ALL unwelcome communication (from me) is perceived as potential criticism/conflict. So in HIS mind, I was worried HE thought too loud etc. so he corrected me and shit me down.
    I exist too. I need to express MY needs and my experience.
    All I ask after an ADHD attack on me or a forgotten date, or failure to check the car work was done before paying the service, etc is that I be heard. He can then decide, later, if the cost to him to make a different choice NEXT TIME (and PROMPT himself to realize there IS a choice) is really a greater cost than the cost/pain experience avoided for me?

    This calculus never happens. It’s near reptilian striking out instead, lashing out, immediately, at near ANY movement or sound that he PERCEIVES could become criticism of his behavior. Any such sound on my part is cut off by a shutdown retort as above (so I suffered an hour of cacophony and a $120 dinner tab), or by an insta-tantrum which creates an impenetrable “wall of sound” after say the first 3 words of a sentence. Interruption is always chosen over listening. Always.. The interruption is usually an evasion, lame excuse, defense, etc.

    Like, after letting my dog out, unleashed, into a busy 4-lane street in San Francisco at rush hour because he “had no choice, [you] said let’s meet out front and he (the dog) wouldn’t let me put the leash on.!!! How was I supposed to know a UPS truck was there!!!”” This after terrifying outcome of my dog circling UPS truck in center lane of traffic (wanting a treat), an angry UPS driver, much honking, luckily my dog survived. I say What? There cpuld have been a bus? I don’t care if Santa Claus is singing outside the front door, he cannot go outside offleash! ADHD takes over, “I wish he WAS hit by a bus, you too you B/5(H!!.” All followed by fist pounding, and packing up and bailing (typical sequence of events). He cannot see there were other choices. Dog needs a leash to be safe but dog won’t let me put it on,. Stop, ask self, what can I do here? Go get Emily to ask her to leash him? Wait for Emily to come in? He absolutely cannot see there are choices.

    He’ll be an hour late to pick me up from the airport with no heads up. His excuse, “I COULDN’T call you (like, to let you know to grab an Uber to meet up later), MY KIDS were in the car, they FREAK out if I text and drive.” So, I felt abandoned at the airport on a holiday, a trip that was, again, designed to try to reconnect after prior unrepentant episodes of rageful name-calling over a failure of unmanaged ADHD. Like, hello, (1) pull over and text you’re an hour late then re-enter the roadway, (2) hand the 13-yr old the phone to do it, showing them how to be responsible when traffic—or poor planning—causes you to be late, (3) call and leave a voicemail using hands-free calling., again modeling respectful behavior for children.
    His children don’t trust him so he’s on eggshells on the (very rare) occasions his ex allows them to see him. Consequences of ADhD behavior in their marriage? No doubt.
    I could give 1000 examples of rude behavior, and after three years NONE of it has been apologized for except, after much battling, the cheating and lying about an existing friend-with-benefits when we first met, who he never gave up….

    On our first date, he casually me mentioned he “doesn’t do conflict well” after telling me he was divorced four years prior. Looking back, what I didn’t realize, is ANY sound from me, any action or event that isn’t easy or fun or simple = conflict. I cannot overstate enough that ADHD definition of conflict.
    Any unwanted intrusion to doing what he wants how he wants and when he wants is met with extrene anger—the defensive/offense armory comes out in a split second creating chaos and a wall of sound to prevent any words getting through from me. If I don’t immediately shut down my existence (needs, opinion, knowledge, ideas), he’ll block, deflect, avoid, bail, literally Uber to the closest airport and fly away.
    As if my explaining why I like something is criticism, why I would prefer something else is criticism. And most certainly after feeling emotionally abandoned, insulted, crushed, if I dare to explain why I feel that way when X happens, it is, by definition, criticism that must be prevented from airing at all cost. If it means burn-down-the-house rage, throwing things, police visit, etc.
    All I wanted was the opportunity to say three sentences, to provide insight into how his actions affect others, for him to ponder. Not to CHANGE him but to encourage learning about the ADHD default reaction, to encourage ADDING skills to try other choices… He will never let me finish a sentence…
    After 18 months of these confounding, hurtful, abusive experiences I racked my brain what this could be. My friends were yelling Narcissist, Get Out. His wife replaced him after 21yrs marriage with young kids, after carrying on a relationship INSIDE their home for a year until she was engaged, and he had NO idea, totally oblivious their marriage was over. Relying on my old theory that a man will always reveal on a first date what will kill the relationship, I relived the entire conversation, and I remembered, he did say when talking about his 6-year college experience, his mom dragged him to a therapist where he got an ADD Rx for Adderall.

    HaiGE red flag but I had no idea of Adult ADHD. I thought nothing of it—like most Americans, I associate the diagnosis with wiggly kids in school. In the 1980’s. When two working parents and latchkey kids had become the norm. But I was desperate. After 18 months of abuse, I googled “Adult ADD relationships.”
    OMG, it was us. It took months of the lamest excuses to finally get him to a therapist. I found the guy! He had a great blog that helped me. The therapist wanted him to bring me in and my ADHD partner wouldn’t. Initially he lied, saying the guy was no longer available or raged that it was none of my business, if I occasionally asked, Are you getting something from the sessions? Or, do you feel differently on the meds—I hear it takes awhile to fine-tune them? He had bailed. He had popped a few Adderaall then back to rude/rage/defensive/evasive abuse whenever I try to exist—be a different person than him with different desires, needs, sources of joy— in his presence (or on the phone). As if the opportunity to share in another’s joy, or help avoid another’s concerns, is not a great way to expand your own experience in life. Imagine never having the joy of seeing your dog get excited over a bone….

    Remarkably, he briefly joined a zoom ADHD support group where I believe they tried to pump each other up and he was told (I believe) “Never apologize for who you are.”

    He becane remarkably arrogant after that. My needs (or the first 3-4 words of a short paragraph needed to express them) were referred to as self-centered and arrogant. He’d fly off the handle at a PERCEIVED slight (like I like to add pepper to my eggs) and when I said it hurts that I can’t share myself (or half those words got out) he’d start defending himself screaming about how do I think he’s lived this long if he doesn’t know how to cook… and I beg for the yelling to stop. I’m still suffering six Friday nights in a row of him forgetting our date or not being available by phone when a flight is late and I need to adapt our plan, on top of every nane-calling not apologized for, neber talked about, and he’s screaming that he doesn’t need me to tell him about the anchor of my most-watched business news channel, screaming I must think he’s stupid if Indon’t think he can watch TV by himself, and the defenses are coming so hard and fast I eventually beg for the Wall of Sound to STOP. “See, this is the thing, it’s YOU who won’t listen!” To a bunch of lame defenses and excuses to an attack I never made? To a sentence I wasn’t permitted to finish?
    Exhausting. Gaslighting.

    After 3 years of abuse with absolutely defiant refusal to apologize, cheating on me, lying to me, avoiding any innocent question, raging at me for asking “How far out are you?” on a night he promised (but now obvioysly forgot) to drive to my home after work, and I’m cheerfully just preparing dinner on a Friday night,… Not mad. Not even atvthis point taking the risk of asking for an ETA estimate. Just hoping for a quiet evening and some miracle breakthrough—like a real conversation between two people, it never happens and I’m done.
    I think it’s a grave injustice to society to reinforce with ADHDer’s that they have no accountability for the effects of their behavior.
    After he threw a pie at me on Thanksgiving because I wanted to express a thpught about the stock market, he raged at me for 20-30 minutes, and when I said Jesus, you just abused me for 40 minutes at 90 decibels,” his response, “Get put of my house and go to get therapy yourself if you don’t feel good, and it was only TEN minutes.”
    Bam. His excuse—he says the toxic abuse didn’t last EXACTLY as long as I perceived it did.

    I’m done. It seems to me the ADHD brain works overtime to manufacture ANY excuse/reason, no matter how inane, to block out other’s existence, to avoid accountability, to avoid feedback, to avoid maturing, to avoid resoecting others and sharing a friendship, to avoid connection as a human being. No willingness to be himself yet ALSO where possible accommodate others where simple, easy, better choices abound. To create a win-win. Because the second win, yours, really doesn’t exist for him. He can not grasp that concept. There seems no trigger for “Uh oh, somethong is not what Inexpected; What are my choices RIGHT NOW?”
    Doesn’t happen. Just opens the door anyway, or starts screaming or keeps driving or lets dog out or enjoys sex offered by another woman, etc. whatever is in front of him AT THAT MOMENT.
    Sorry state of being for a 50yo intelligent man who can be funny, takes amazing photos, cooks a great breakfast, and will do ANY favor you ask, except acknowledge your existence by LISTENING to your experience or feelings and considering them in his choices. It seems clear this is because outside of his beliefs about himself—like being a hero for cleaning your gutters—you truly do not exist as a separate, easily delighted being…
    I hope you can find a way to show ADHD adults that’s a lonely, unfulfilling way to live.

    1. Hi Emily,

      I appreciate your experience — and taking the time to detail it.

      You wrote: I hope you can find a way to show ADHD adults that’s a lonely, unfulfilling way to live.”

      For 20 years, I’ve worked to show adults with ADHD and their partners that there is typically a better way.

      But I’m not sure I’m the arbiter of what’s a fulfilling life. 🙂

      It sounds like the death knell came with the Adult ADHD group that, seemingly, traded in narcissistic supply.

      While a certain amount of self-acceptance is wise, promoting denial because there’s nothing else on offer seems…..deceptive and lazy.

      If you haven’t read my Adderall post — or my first book — you might want go do so now. They will probably explain a lot.

      take care,

    2. Wow, the person you are describing sounds to me like they are, in addition to having ADHD, also suffering from some form of narcissism. Or rather they are causing you to suffer from their narcissistic behavior. I know that is not a term to use lightly, but as someone who has suffered through narcissistic abuse, I believe that really might explain what you have experienced. If you haven’t already read about it, I would suggest it. It might help you. I hope things are better for you now then they were when you posted.

    3. Hi Bo,

      ADHD is associated with higher risk of narcissism.

      As I wrote about in this post, empathy is often impaired with ADHD. Poor/Low empathy is the foundation of narcissism — a poorly defined term that covers a lot of territory.

      This all presents a gray area that’s difficult for many people to navigate. Narcissistic behaviors will improve in some people with ADHD once they start treatment. Some will simply become more adept with their narcissism. All kinds of possibilities.


    4. I am ADHD. I have had 10 narcissists and my last one was a LTR with a covert narcissist was particularly abusive so I know the difference. She sounded a lot like your partner, same tactics. What you’ve described are not solely (or even largely) adhd issues. I’m basically an expert on narcasistic abuse. You need to get out of there. You’re in a toxic narcasistic abusive relationship and he will never value or hear you, it will *never* change. As long as you keep trying to make him see, you’ll continue to have hope and you’ll keep allowing him to abuse you. Go to reddit r/npd and hear what the narcissists there have to say. Learn as much as you can through YouTube/books/support groups etc. get therapy to address codependency and heal or you will continue to attract the same type of partners But by all means, gtfo.

    5. Thats not ADHD at all. Plenty of men like him doing all that who aren’t ADHD. None of what you described there covers anyone I know with the condition. What it does cover: narcissistic abusers and people with a lack of character / morality and toxic people. This isn’t the place to blame your relationship choices and vent. That’s what therapy is for. No disorder should be used as a way of justifying or condoning abuse. People with ADHD don’t need to read this monologue of a dysfunctional relationship which you persevered with. That’s for you to go explore why you spent 3 years with an abusive and toxic man. Its nothing to do with ADHD.

    6. Hi Mollie —

      I’m curious. How do you know what ADHD is and isn’t? How many people do you know who have ADHD? How much do you know about the genetics, about impairments to higher-order brain functions….such as the research examines in this post?

      Nowhere did Emily claim “all people with ADHD do this”.

      It is quite common online to talk about “the ADHD brain” as if it’s a monolithic “tribe” of people. It’s not. In the U.S. alone, it’s 10-30 million individuals with variable manifestations of this highly variable syndrome. With all the rest of personality, background, education, etc. to consider.

      No one is condoning abuse. Including the kind that happens online when strangers feel a need to invalidate a vulnerable person.

      No one made you read her comment. It wasn’t there for you. It’s there for her — and others who might relate.

      “This isn’t the place to blame relationship choices and vent,” you wrote. Actually it is.

      This has nothing to do with you. If you have an opinion, you can share it without discounting or blaming other commenters for their situations.

      I leave your comment here only to show the subtle forms of bullying that come from some people who might have ADHD but who know little about it beyond their personal experience, yet still find it necessary to invalidate the experiences of others.

      I have a no bullying policy here.


  7. Josephine Scherer

    Hi Gina
    I have really identified with what has been recorded from other people’s experience of what it is like to live with people with ADHD
    I had a partner of 17 years with ADHD
    who I separated with when my son was 4 years old
    My son also has ADHD
    I have only concluded this in the last 2 years
    I am now 71 years old and still looking out for my son and waiting for a diagnosis
    I am exhausted with all the drama and disruption ADHD has caused me for the last ,50 years and 39 years for my son and 79 years for my ex partner
    Who I have just informed and he did not know about ADHD although he asked me why I had not told him before ?
    I believe he recognises the devastation it has had on relationships
    It is such a relief to have so many people have the same and similar descriptions and experiences of living with relatives with ADHD
    I really thought I was on my own
    So many people outside of these relationships do not understand because people with ADHD can come over as attractive confident charming the joker happy ect
    I am going to get your books
    It may be a little late in the day for my my ex partner and myself except hopefully I have and will get to understand my son a little better through from all the information on your sight and in your books
    I hope that my son can get same relief and also my grandson who I also believe may have ADHD
    If I am successful in getting my son the medication for ADHD he has been on a waiting list here in the UK for the last 2 years
    Will it work?
    I am at my wit’s end as I continue to try to help my son and hopefully my grandson
    I myself have dyslexia so I am sorry if this is all a little hard to decipher and understand
    Thank you ,thank you for helping me to realise I am not on my own and not going mad
    At least their are other people who understand
    I just hope I can now help them and myself Best wishes
    Josephine scherer

    1. Dear Josephine,

      I’m so grateful that my work has helped expand your understanding of ADHD — and, I hope, make a real difference for you and your family.

      I find your words absolutely clear, nothing to “decipher.”

      Granted, 71 is a bit…advanced….to be learning about ADHD. But a man who just completed my first course is 72, and just started medication treatment after finally being diagnosed. He is having a strong positive response to the medication.

      Everyone presents a different case, however. This man is particularly healthy and fit. No complicating physical conditions.

      For some people, living for many decades with undiagnosed ADHD means they suffer from chronic sleep debt, “self-medicating” habits (food, substances, etc.), destroyed relationships, under-employment, and more.

      It really just depends.

      I do encourage you to read my books and consider taking my course. Or for your ex-husband to take it. Videos are more relatable than books for some folks with undiagnosed/untreated ADHD.

      Moreover, many people are really enjoying the opportunity to meet and speak with others, during the course option that come with 6 Zoom Q&A sessions. With me and other course participants.

      Solving Your Adult ADHD Puzzle — for Couples and Individuals.
      COVID has definitely amplified ADHD-related challenges for MANY people — even as it’s made evaluation/treatment harder to come by. In the UK, it was hard before COVID.

      It will really behoove you to be educated about how medication should be approached (see my first book), to prepare for your son’s appointment. We just cannot count on the average prescriber or even some self-proclaimed “ADHD specialists” to know what’s what. And yes, teamwork is the best approach.

      How will some professionals feel about a young man’s mother being involved? The truth is, they should be asking for third-party feedback — a spouse, family member, close friend. But they often don’t. If your son asked if you could be included, it would be easier. Just a thought.

      take care,

    2. Josephine if your adult son is still waiting after 2 years for NHS treatment, it’s a common problem, especially during the COVID pandemic.

      My advice is to search online and find a private clinic specialising in ADHD diagnosis and treatment which could offer an assessment for your son, the fees vary somewhat so you may need to contact several.

      It is crucial that you first ask any doctor or clinic involved in diagnosis to confirm if also licensed to prescribe ADHD medicines, if not, look elsewhere.

      Your son could be assessed within days and following a treatment plan soon after, with follow up appointments to assess if the medicine is suited to his needs, or if alternatives may be preferable.

      After some months you could then ask an NHS GP to consider prescribing medicines on the NHS following the prescription regimen confirmed by the private consultant (not all GPs will do this so your son may have to find an alternative NHS GP).

      I have never had a need to previously consider private treatment for myself or my family but in the case of my son with ADHD in the first year of university study it was an absolute necessity. He is now able to continue at university and is so very grateful for the diagnosis (at last) and medication which are helping him to pursue his goals and bring some considerable degree of stability in his life.

      Diagnosis and ADHD medicine are just the beginning, after initial treatment your son would likely still benefit from further consultation with NHS specialists when available to him at some point in the future.

    3. I have ADHD myself and I’m 67 years old, meditations do help a lot with my attention span and aides with completing my over thinking brain. I also have undiagnosed dyslexia, I think your statement is very understandable, also both your son and grandchild will do a lot better once meditations become available. Good luck from Minneapolis Minnesota.

  8. I have spent hours reading this site today.

    My husband and I are in couples therapy (EFT) but it just is not making any difference at all. He has untreated ADD, he’s 44.

    I am practicing and he just is not. Just like our last therapy, which then reinforces he cycles we go through. Our therapist said he is ADD informed, but I realise from reading today that our entire cycle is centred around ADD and we are treating it all as attachment based cycles. I have realised so much today!

    Why he blurts out such awful things at really vulnerable moments for me. I lost my job and he said ‘I wouldn’t have moved in with you if I’d have known you might lose your job’. I was paying most of our rent at the time due to his debt.

    I have wanted to understand the WHY of him doing these weird things when he’s such a good kind person. I think I found my answer today.

    He can’t fathom cause and effect so he repeats the same mistakes, forgets promises and breaks his word then defends that as he’s smart as hell so can justify anything, he always has music playing in his head and I’ll say something and he will reply with a line from a song, work drains him totally so he flatlines in front of the TV for the rest of the night, doesn’t come to bed with me as he stays up until 2am, loads of empathy for TV characters but cannot attune emotionally to me, has an automatic no, has OCD, bait and switch hyper focus for the start of our relationship, he can’t plan, can’t finish tasks, 0 to mega frustration and anger in 2 seconds and just gets stuck repeating himself over and over in a way that used to alarm me as it was like a stuck robot and I would get frightened by the lack of human connection.

    He is a beautiful human being with wonderful traits and heart. But this is serious and couples therapy has made me put so much emphasis on me not reacting to him, understanding he is protecting, doing all the work…..but that isn’t going to work I realise now.

    I’m going to get exhausted and it won’t be healthy. We are equal partners and I don’t want him to work ‘harder’ as he’s clearly working his ass off coping in all these ways he has learned to.

    I will read the books and see if there is any better way to suggest assessment/help. I have done before but he said he doesn’t need anything as he likes how he is. I respect that – but it is hard to explain that his ADD impacts me as he has no awareness of it, and has such sensitivity to perceived criticism.

    His daughter now realises she has it too so I hope he can model for her what it’s like to work with our innate processing differences from empowerment not shame. Easier said than done. But I want to see if I can support him to get there. Thank you SO SO SO much for this incredible resource. The time and expertise in here is mind blowing. I appreciate you. N x

    1. Dear Nadia,

      No matter how many times I read “Wrong Therapy” stories, they still make me cringe.

      It’s nothing less than a public health DISASTER.

      Then, even if by some miracle, couples happen upon a truly ADHD-savvy couple therapist, they must then identify a prescriber who won’t throw Adderall at the ADHD partner.

      These problems in the mental-health system are deeply entrenched and insidious. When mental health workers rely on Psychology Today PR pieces by self-promoters, the various “health” sites that milk ADHD “keywords” to boost their traffic, when one pharma has way too much influence over what we see online….it’s not going to end well for individuals struggling with these issues.

      I encourage you to learn all you can. Read my first book. The more you become educated, the less of a block your husband’s apparent “denial” can be.

      Denial is complicated. I would not take his reflexive responses as his true perspective. He might want help but doesn’t know how to get it, is afraid of medication, afraid of being diagnosed “crazy” and so much more. It’s why I devoted three chapters to denial in the book.

      Soon, I will launch my online training. I am well and truly exhausted but this will be a game-changer for individuals and couples. If you’re subscribed to my blog, you’ll receive notification.

      Solving Your Adult Puzzle — Including in Relationships

      Best of luck to you two. You are on your way!


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