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Wednesday, June 1, 2016

Can Adults with ADHD Really Change?


“I am who I am” and “I can’t change” are more about fear than reality, and don’t reflect the science around ADHD.

Recently, a non-ADHD partner wrote me in despair, saying “my ADHD partner says he’s got a mental illness and he can’t change…how can we possibly improve our relationship?”  Her despair in the face of her partner’s unwillingness to try ‘ADHD –friendly’ tactics for improving his side of their relationship was palpable.  ‘Take it or leave it’ is a disastrous approach to a relationship when either of you is miserable and struggling.

I suspect that this ADHD partner’s comments reflect his past struggles in managing ADHD symptoms such as distraction, poor memory, and poor time management.   They also likely reflect that he has not actually optimized his treatment of his ADHD symptoms.  Repeated failures at doing things have led him to believe that he is a person who is not capable of doing things.  Research actually suggests that it is more likely than not that he CAN change how he interacts with the world – quite significantly – if only he is willing to optimize his ADHD treatment to do so.

Russell Barkley, one of the most experienced researchers in the world of ADHD, wrote in his book, Taking Charge of Adult ADHD, “Studies show that ADHD medications can normalize the behavior of 50-65% of those with ADHD and substantially improve the behavior of another 20-30%...”*  As much as I hate the word ‘normalize,’ it does suggest the extent to which good ADHD treatment can help.  When people think about ‘mental illness’ they don’t think about 70-80% of the population with an issue being able to address it that well.

And, to be clear, the research also demonstrates that medication alone is NOT the best treatment.  But more on that in a moment.

In the case of the man above, lack of confidence, fear and too little knowledge are the real enemies, not his ADHD.  This is common in adults with ADHD.  They have a lifetime of people telling them they are underperforming (“if you would only try harder, you could do so well!”…”why on earth did you do it that way?!”) and years of repeated mistakes and failures which they had trouble explaining or responding to.  Over the years they have learned that the amount of effort they expend often does not correlate with a positive outcome.  Too often, ADHD symptomatic behaviors such as distraction and poor memory, got in their way.  It’s no wonder adults with ADHD often lack confidence in their ability to change their world.

Combining a Broad Range of ADHD Treatments Leads to Life Changes

Optimizing your treatment of ADHD means using multiple strategies simultaneously.  I explain treatment to my clients as having three legs:

Leg 1 – physiological treatments that change the chemistry of the brain, where ADHD originates.  Exercise, medications and mindfulness training all fit into this leg.

Leg 2 – behavioral and habit changes that help ADHD adults be more reliable.  Calendars, lists, alarms and a very wide array of ‘external structures’ and systems comprise Leg 2 treatments

Leg 3 – interactive changes that allow neutral and positive interactions around ADHD issues – setting up chore meetings with a partner, and using verbal cues to stay engaged in a conversation are just two examples.

ADHD adults should choose as many of the various ‘treatments’ as they can, to see which work to address their specific target symptoms.  Typically, more is better – particularly if the adult with ADHD has a good sense of the most important (target) symptoms they wish to measure their progress against.  These symptoms are the ones that, if addressed, would result in the greatest improvement in their life.

I do not wish to imply that it is easy to change habits in a way that will improve the life and relationship of an ADHD adult.  It takes time and effort to: find the right medication and dosage; set up a good exercise and sleep routine; learn to effectively and consistently use a reminder system; and create better communication with your partner around many topics...just to name a few treatment options.  There are "ADHD savvy" ways to do these things (i.e. 'trying differently', not just trying harder the way non-ADHD people do things.)  But the results of that effort can amazing.

Can adults with ADHD change?  The research says resoundingly ‘YES!’ and my experience reinforces this.  If your partner says “I can’t change” be empathetic – there are many reasons why he or she would say this.  Gently help your partner learn the facts, create a safe place to try (and fail – which is part of trying new things).  Consider getting the help of an expert who understands adult ADHD.  Bottom line?  Don’t let fear, and past negative experiences, dictate your future!

*Barkley, R.A., Benton, C.M. (2010) Taking Charge of Adult ADHD, p. 12



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