Sadly, multiple stressors are wreaking havoc on many couples impacted by ADHD.  I’m hearing reports that after making good progress they are returning towards past struggles they hoped they had left behind.  ADHD symptoms are back, and responses to those symptoms are back, too.  What’s going on, and what do you do about it?

More stress, more symptoms

Stress makes ADHD symptoms worse, so strategies (and medications) that used to create a balance for couples are not being quite as effective.  This results in surprise behaviors that trigger negative interactions.  Unfortunately, our memories of past interactions that felt horrible remain, which means that when the symptomatic behaviors show up again it’s easy to trigger old patterns:

"Our marriage had been seriously compromised for years because of explosive anger/flooding, but getting on an antidepressant was LIFE CHANGING.  Yesterday, my husband exploded at our son.  It's the worst I’d seen in a long time...I was SO mad. I still am...now we’re not okay. Again...So, here we are, cooped up in the house for weeks, trying to function during a national crisis under very stressful conditions, and I feel like I used to before he started medication. Angry. Festering.”

With the help of the right medication this woman thought they were through these sorts of interactions.  Yet here is the old pattern – his emotional dysregulation (a part of his ADHD) and her very human responses to his explosion.

What to do

This woman has more tools and better understanding than she used to have.  Instead of confronting her husband while he was flooded and unable to respond to her in a productive way, she left the scene and wrote her husband a letter that he could process when calmer.

They also both know that medication helps with his anger management.  He can (and should) talk with his doctor immediately about the possibility of increasing his dose temporarily during this particularly stressful time.  This would help reassure her that he takes his responsibility to remain calm and respectful to his family seriously.  He may have been caught unawares once by the increase in his symptoms due to the stress, but no one has to suffer twice.  Think of it as an alcoholic rejoining AA after a single relapse, and recommitting to sobriety.

It sounds as if there has been a single ‘relapse’ in this situation.  It’s serious.  Therapy would be a good idea (I have noticed that Internal Family Systems (IFS) therapy seems particularly well adapted to issues of ADHD and anger) and monitoring the situation to see if it’s resolvable is needed.

Medication has been stopped

It’s possible that the reason the man above exploded was that he has actually stopped his medications but didn’t tell his wife.  I’ve been seeing a fair amount of that lately.

“My husband has been sitting around and playing video games for 12 hours a day – he is completely zoned out around the family, even though I hear him laughing and talking with the others on the games.  It’s been a complete mystery.  Finally he told me that a few weeks ago he stopped taking his anti-depressants.  Said it was something about his doctor not wanting to give him any more, though he’s been seeing this doc for over a year, so that doesn’t make sense…”

It is my belief that partners have a right to know when a partner has decided to take a break from medications, particularly if that medication helps with behavioral issues.  Stopping an anti-depressant cold turkey is particularly a concern because it has very real negative emotional consequences.  People go through a withdrawal that usually makes them irritable, mean, depressed, zombie-like and/or very hard to live with.  For this reason, medical experts recommend titrating off an anti-depressant slowly to minimize the havoc this change can make.

I’ve experienced this twice in my life when my husband suddenly stopped his own medications.  It’s not pretty.  It’s also incredibly confusing.  Suddenly the bad behaviors are back, and the partner has no idea why.  And notifying the ADHD partner that you don’t like those behaviors doesn’t make any difference if the ADHD partner doesn’t associate the behavioral changes with the medication shift.  That’s pretty common – as with the old patterns, the ADHD partner may start by blaming their anger and poor behavior on the other partner rather than realize it’s the meds.

What to do

If your partner takes medications for ADHD, talk with him or her at a calm time to request that if they change their treatment regime it would be very helpful if they shared that with you.  Make it clear that you are not trying to control their treatment, only wanting to be notified about changes so that you aren’t caught by surprise.

Behavioral coping strategies are no longer available

Part of managing ADHD is finding ways to be in your life that help you stay organized and productive.  Ned Hallowell, for example, writes books both because he has lots to say that helps people and because it helps him organize his time and productivity.  One man just told me:

“I am able to spend a lot of time in my own head, which can become kind of obsessive.  I’m beginning to realize that one way that I’ve dealt with that has been to work in jobs in which I am interacting with others a lot.  The talks, tours, answering questions all got me outside of my head and helped me organize my thoughts…now I don’t have access to that and I’m much more back inside my head again…”

Here's another example.  Like many, my husband uses exercise as a behavioral strategy to manage his ADHD emotional regulation.  While he still can do this, those cooped up in apartments in locked down areas can’t do the same.

What to do

The contrast between now and your regular life can be an opportunity to learn which coping strategies you have had without realizing that’s what they were.  Think about what you miss the most, and why, as well as the benefits that activity provided.  In the future you can not only return to that activity, but prioritize it as an effective part of your treatment.

In the meantime, if you’ve been relying on something you can’t do right now (for example, exercise) talk with your partner about what that means to you, and consider setting a verbal cue so that if you are suddenly irritable or hard to be with, your partner can gently notify you with the cue and you can, in turn, back down…understanding that this isn’t about your partner, but about your own lack of having your normal coping strategies.

Overwhelmed and amped up

“During this crisis I find that my husband is repeating himself and becoming self-centered. He’s not remembering what he’s telling us and is inconsistent w/what he says. He packs each minute of every day and seems to be rushing around and scatter brained. He is losing weight.  Irritability due to spreading himself thin w/ the other boaters (we deliver boats for a living) but also seems more affectionate w/ me as the day winds down…”

One response to the extreme stimulation that this crisis places upon us is being hyped up, and that may be what is going on here.  He is amped up, going in every which direction, forgetting to eat, and probably getting worse sleep, too. 

There is some physiology here.  Our brains can only take so much information, then they move into an overwhelmed state.  Even those who don’t have ADHD experience this – so much so that Ned Hallowell wrote a book about it at one point (CrazyBusy) in which he argued that brain overload mimics ADHD (though is not true ADHD.)

The good news is that the added stimulation may also allow him to express more positive emotions at the end of the day as things are winding down.

What to do

Take advantage of the end of the day period of affection to ‘lean in’ to being calm together, reassuring each other, and being close.  This may help your partner sleep better.  In addition, find out if there are things you can do to ease his sense of overwhelm, including making meals.  This is a temporary increase in symptoms.  If you have the bandwidth, you can help lessen the overwhelm, possibly improving the irritability and stress.