Adult ADHD and the Effect on Relationships

Adult ADHD whether diagnosed or undiagnosed can have a profound impact on couples. Intimate relationships are hard work without the presence of a psychiatric or psychological disorder. When a disorder like Attention Deficit Hyperactivity Disorder is present, the strain on the relationship or marriage can often be unbearable.

In the absence of clear techniques, knowledge, and skills for navigating the challenges of adult ADHD, people can become resentful. Often people will attribute the struggles they are having with their partner to personality or spite. In fact, one of the most common complaints we see here at our ADHD clinic in the Silicon Valley is a strain on relationships.

The strain that ADHD can place on couples is often replicated in the workplace. Co-Founders, business partners, leaders and employees can often find themselves in very difficult situations due to lack of understanding and adequate tools to address ADHD in the workplace.

Regardless of the approach that is taken to manage adult ADHD, the first step is information. Knowledge around how common symptoms of ADHD manifest in couples and co-workers is critical. Unfortunately, the majority of adults with ADHD are living their lives undiagnosed and struggling. The good news is that proper assessment and treatment of ADHD combined with couples counseling can greatly improve one’s quality of life.

Mindfulness and Adult ADHD


Mindfulness has become a very big buzz word throughout the ADHD community. Unfortunately, many are left confused about what exactly mindfulness is and how it can be helpful in treating ADHD. Mindfulness is a practice of increasing awareness and focus of a particular feeling, action, situation, or decision. Increasing awareness and focus is critical to the management of adult ADHD. Mindfulness has been used in almost every culture for millennia, with different terms and descriptions.

Many people with ADHD understandably are skeptical of a practice that requires slowing down and focusing. However, most people very quickly experience the benefits of mindfulness without issue.

When mindfulness is used, it trains the brain to strengthen the pathways associated with attention, awareness, and focus. The trick is to use a technique that works for each individual’s current ability level. For example, if someone is highly impulsive and hyperactive, they may need to utilize a mindfulness practice that incorporates movement. If someone is highly distractible, they may need to use a practice that is brief. Regardless of where the person starts, they often find themselves developing the ability to be mindful fairly quickly.

Dan Siegel, MD of UCLA has a fantastic guided meditation called the Wheel of Awareness. Although it is not an ADHD specific practice, it can work wonders for training a person’s brain to use mindfulness, boost focus, and increase awareness.

At our clinic we incorporate some of our own mindfulness practices developed by our Clinical Director Phil Boissiere, MFT. We encourage you to seek a mindfulness practice that works for you in the management of your ADHD. A great place to dive in is the Mindfulness Prescription for Adult ADHD by Lidia Zylowska, MD. Her book is widely regarded as the definitive text on mindfulness and ADHD.

Combined Treatments Provide Greatest Change

There is considerable discourse in the media these days about ADHD treatment. Some are for medication management and some are against. Unfortunately, very little is being said about combining treatments, such as Cognitive Behavioral Therapy(CBT) alongside stimulant medication.

At our clinic we are dedicated to not only providing the most effective treatment, we are also dedicated to educating the community. During our presentations we often field questions about providing comprehensive treatment by combining CBT and skills training with medication. So let’s take a look at what the research says about combining CBT with medication in the treatment of Adult ADHD.

In 2001 Brynjar Emilsson found that combining CBT with ADHD medication provided significantly better results over time than medication alone and treatment as usual. Take a look at the graph above and you can clearly see the continued reduction in symptoms when combined treatments are used.

Similar results were found in another popular study years earlier by Steven A. Safren in 2005:

Across all of the primary outcome measures, those who were randomized to CBT showed significantly better ratings than those randomized to psychopharmacology alone.

He goes on to make this salient point in the support of skills training and CBT:

Although medicines are thought to help with the core neurobiological impairments, they do not ensure that patients will adopt compensatory strategies.

The results that Emilsson and Safren found are not only consistent with other academic research, they are consistent with the results we see at our clinic. Whether you are being treated in our clinic or by your own MD or clinician, we encourage you to explore the benefits of comprehensive combined treatment options.