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Four revelations about how ADHD affects relationships and what you can do about it

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On Tuesday's St. Louis on the Air, host Don Marsh discussed how ADHD affects relationships.

Typical symptoms associated with Attention Deficit Hyperactivity Disorder behavior include forgetfulness, distractedness, hyper-focus, disorganization and emotional difficulties. Tackling these issues by oneself is difficult enough, but bringing another person into the equation in a relationship can be even harder.

Psychologist Wes Crenshaw has spent his career studying and treating ADHD. On Tuesday’s St. Louis on the Air, he and author and marriage consultant Melissa Orlov discussed with host Don Marsh how ADHD affects relationships and marriage.

“I do not have ADHD, my husband has ADHD,” Orlov said. “What you see is some incredibly predictable patterns that show up because ADHD is there. The most common couple is one who did not know that ADHD was there when they got together. All these things, like distractability, a partner who does not complete tasks when they said they are going to, not feeling very loved…a lot of those things point to ADHD being there and being undiagnosed or mismanaged.”

Orlov said that adult ADHD has been a recent realization and that’s part of why couples don’t realize when they get together that one partner or another has such difficulties. It has been estimated that five percent of the population has diagnosable ADHD.

In fact, Crenshaw added, those who lean toward the ADHD spectrum and those who lean toward the anxiety spectrum are often attracted to each other because they are complementary. This sets up power dynamics in the relationship that need to be retrained.

“Everybody tends to either lean to the anxious side or the ADHD side,” Crenshaw said. “People leaning to the anxious side are careful people, fastidious. People leaning to ADHD side are the carefree and fun folks at the party. What you will see is that the anxious people tend to gravitate to ADHD people and careful people tend to gravitate to the fun people. Hijinks ensue.”

Here are four things we learned about how ADHD affects relationships and what can be done about it:

1. Changing dopamine levels throughout a relationship may mean ADHD symptoms don’t show up until later in a relationship.

“The biology of infatuation during a courtship is that your brain gets loaded up with a whole lot of extra dopamine,” Orlov said. “The ADHD partner whose normal ADHD brain does not have enough dopamine is actually covered up. My husband was exceptionally attentive. But after about two years, that dopamine level returned down to normal. What that couple is then faced with is a new person in the relationship that wasn’t there before. That person is back at a low dopamine state which is inattentive.”

Couples don’t realize these dopamine levels and ADHD are at play.

“It is a confusing time for the couples this does happen to,” Orlov said. “First, you’re confused and then you’re angry. Because it is an ADHD symptom, it doesn’t go away.”

In fact, divorce rates go up over time because ADHD goes undiagnosed and that’s what is leading to issues in the relationship, Orlov said.

2. There are three legs to treatment: physiological, habitual and interactive.

“The first leg is physiological which includes exercise, getting better sleep, medications, fish oil … things that change the chemistry of the brain so that you can focus better and manage ADHD symptoms better,” Orlov said.

“There is a leg of behavioral changes and habit changes: things like making lists, using a calendar, setting alarms and reminders … having certain systems you put in place,” Orlov said. “The ADHD mind is very unstructured. Creating structures externally helps.”

“The third leg, for couples, is the interactive things. How do they interact around chores? What kind of systems will they have?”

3. Meet with a mental health professional before getting a prescription.

“One of the perceptions in the world about over-diagnosis and over-medication thing comes from the poor diagnosis issue,” Crenshaw. “People go in and have a seven minute conversation with their primary care physician and walk out with a bottle of Adderall and really that’s not how anyone recommends you do it. But that’s the most common example. We strongly urge you go in and work with a mental health professional who is trained and has experience in diagnosis and treatment. Then get a referral for medication and learn techniques for medication that are not commonly taught.”

4. Create “as minimalist of a life as you can.”

“One of things I recommend is: to the extent possible, create as minimalist of a life as you can,” Crenshaw said. “I’m not saying to put your kids up for adoption, but you probably want to get your life down to the most essential things you want to do. Too often with ADD, getting stuff is cool and getting rid of stuff isn’t — whether that is too many job assignments or too many things in the home, or whatever. As life becomes more complex, it also becomes overwhelming. With ADHD, being overwhelmed, whether in a relationship, social relationship or work…it is a big concern.”

St. Louis on the Air brings you the stories of St. Louis and the people who live, work and create in our region. St. Louis on the Air host Don Marsh and producers Mary Edwards, Alex Heuer and Kelly Moffitt give you the information you need to make informed decisions and stay in touch with our diverse and vibrant St. Louis region. 

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Kelly Moffitt joined St. Louis Public Radio in 2015 as an online producer for St. Louis Public Radio's talk shows St. Louis on the Air.

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