Relationships: Turning Toward or Away

I know relationships from both a work and personal perspective. What I want to share as a level-2 certified PACT therapist (https://thepactinstitute.com/dividedpage/what-is-pact/) applies to intimate relationships with or without the influence of ADHD. PACT stands for Psychobiological Approach to Couple Therapy (fancy, I know).

When a couple enters into troubled territory, its members can turn to each other for solace and connection, right? Even when the trouble is each feels hurt and misunderstood by the other.

Right? Yes, some couples can. The secure functioning ones. The ones who understand that their relationship depends on this.

Many couples, however, do the opposite. They turn away. Each member feels too hurt, misunderstood, blamed, and afraid. Afraid of more of hurt, more of the same. Too caught up with thoughts of how the other one should know. Should know what I’m feeling, what I want. My hurt and mind. So the members turn away from each other and toward others and other interests to meet his/her own needs. One goes out with friends. The other delves into a creative venture. One joins a club. The other travels alone. Again and again looking outside the relationship for more and more. Each, little by little, turning away, and forgetting how to turn toward, each other. Until…it’s over.

If this is your relationship and you want to turn it around before you and your lover/partner/spouse kill it, try turning toward. Start by doing this physically. Get face-to-face, eye-to-eye with your partner, close enough to see each other’s pupils. Hold for a few minutes. Keep your faces soft and friendly. It may sound simple but can be really hard for couples to do. So no judgments. Of yourself or your partner. Approach it playfully. Then rinse, wash, repeat, as Stan Tatkin, the developer of PACT, likes to say.

My hope is that, for each member, this may be a start to turning toward, and getting to know, the person you once loved fiercely and may find yourself loving fiercely again.  

Two Awesome ADHD Resources

One resource focuses on children and teens; the other is for adults. Both can be remarkably useful for those with ADHD.

The first is understood.org (here) for “learning and attention issues.”  What it offers is vast and, though, it’s targeted to parents of children and teens with ADHD, many adults with ADHD can find it of use. Much of what’s suggested for teens applies to adults, except for the context (e.g., work vs. school).  Also, given that 25-35% of parents of youth with ADHD are likely to have ADHD (source), parents using the site may want to use the recommendations for themselves as well as their children.

The second resource is JAN, Job Accommodation Network (here), which is all about workplace accommodations for employers and employees needing or wanting to know what the American with Disabilities Act (ADA) encompasses, including job coaches…even the possibility of free ones.  Who knew? From what I can tell, fewer than would have liked to have known.

I hope something here is of use to you.

Mindfulness & Psychoeducation: “Everybody has won, and all must have prizes”?

The Dodo bird quote from Alice’s Adventures in Wonderland came to mind as I read the results of a recent study.  A randomised, controlled fMRI study of the effects of mindfulness and psychoeducation on the working memory of adults with ADHD found they both worked (for more on working memory, see What predicts ADHD symptom reduction over time?).  art-creative-flying-17679.jpg

After 8 wks, both interventions were found to increase working memory performance and to increase task-related right parietal lobe brain activity to a similar degree (study here).  Although I’d like to see the results for a third group who received neither intervention (to rule out any placebo effect), the good news is that, under both conditions, working memory increased.  What would be interesting to see next is what happens when we combine mindfulness and psychoeducation.

ADHD and Relationships

We know intimate relationships are hard.

When you have ADHD, they’re even harder.

How so?

Research suggests discontent and disloyalty among the reasons, but, hold off on nodding knowingly.  The discontent and disloyalty may be on a different side than you imagine.

Research suggests that it’s the partner with ADHD who’s likely to be unhappy.  Again, the one with ADHD (the opposite of what many might guess).

One study found that adults with ADHD had more negative perceptions of their relationships and families than their non-ADHD spouses did.  These perceptions were also more negative than members of couples where neither had ADHD (see here).

Research also indicates that ADHD’s associated with a higher rate of infidelity.  One study delved into this a little and found that “relational alternatives” were of “greater interest” when adults’ inattentive symptoms were high (see here).  (This same study found that when either inattentive or hyperactive-impulsive symptoms were high, adults showed “less constructive responses” to a partner’s “bad behavior.”)

There’s more, but the picture painted is that relationships are harder.  Namely, harder to sustain (versus start).

So does this mean couple therapy early on? Probably a good idea.

But choose carefully.

Some couple therapies depend on out-of-session assignments, and this could be a set up for failure.

Fights might become about who does the homework and how much of it.

Some couple therapies, however, focus on experiencing useful ways of relating during the session.  When my group members ask me about couple therapy, this is the kind that I suggest.  One of these is Psychobiological Approach to Couple Therapy (PACT).

There’s no research-tested ADHD-specific couple therapy of which I am aware.  Instead, there are therapists who understand ADHD and offer couple therapy/counseling.

One of these is Melissa Orlov, the author of The ADHD Effect on Marriage.  Her book describes common patterns of relating between partners when only one has ADHD, and she offers couple counseling through her website (here).

Whatever you choose, I wish you happiness.

MIT & NYU Study: Your Input Gatekeeper may be to Blame for your “Distractibility”

Some people with ADHD have a Ptchd1 gene mutation (more often these are males).  MIT and NYU scholars studied the Ptchd1 gene using mice and discovered that its loss may be the basis for symptoms of ADHD (as well as autism spectrum disorder and schizophrenia).

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Why?

Because its loss most significantly affects the part of the brain responsible for keeping out sensory input that’s irrelevant.  This part of the brain is the thalamic reticular nucleus (TRN).

According to one of the senior authors of the study, the TRN determines what input reaches the cortex, where thinking and planning occurs.  “We receive all kinds of information from different sensory regions, and it all goes into the thalamus,” Feng says. “All this information has to be filtered. Not everything we sense goes through.”

Except when Ptchd1 mutations lead to TRN defects.  Then, more of everything can go through, leading to, you guessed it, being distracted and overwhelmed.

Can you imagine no filter or one that loosely functions? For some, there’s no need to.

Last year, the prestigious science journal Nature published the study.

Find a summary of it here.

How to Make ADHD worse

When you have ADHD, here’s your recipe for disaster:  Mix sleep deprivation with carnival food.  Deep fry.

Hold the physical exercise and Omega-3s.

No one says, “I want to be my worse self.”  Yet many of us are doing exactly what we need to get us there or keep us there.

When you have ADHD, sleep deprivation makes your symptoms worse, carnival-like food makes your symptoms (particularly forgetfulness) worse and lack of physical exercise and Omega-3s keeps them from getting better.

If you want to give yourself the best chance at optimal brain functioning, here’s the winning combination:  sleep enough, eat healthy food (including Omega-3s), and exercise regularly.  This is true for all us but is essential when you have ADHD.

Consider that chronic sleep deprivation looks like ADHD.  Imagine what happens when you combine them.  Check out recent research on ADHD and circadian rhythms here.

Omega-3s matter so much, there’s even an Omega-3 prescription for ADHD called Vayarin.  See specifics on the Omega-3 and ADHD connection here:  Something Fishy.

For a recent review and meta-analysis on use of Omega-3s for ADHD, go here.

As for exercise, namely cardio exercise, check out this recent review.

Try the winning combination for even just one week and see what you notice.  I bet your brain will thank you.

Understanding ADHD

Per Russell Barkley (RB), ADHD guru (i.e., scholar and scientist):

ADHD is a disorder of self-regulation that can also be described as a “disorder of age-inappropriate behavior” that looks like inattention and lack of inhibition.

Though I want to clarify that the inattention depends on what you are doing; another guru of ADHD, Thomas Brown, says the “central mystery” of ADHD is that those with it can pay attention to some things and seem incapable of paying attention to other things.white-matter-fibers-hcp-dataset-red-corpus-callosum

But back to RB and ADHD as a disorder of self-regulation.

RB defines self-regulation as “self-directed action intended to alter subsequent behavior so as to change the probability of a future event or consequence” (to improve your longer-term welfare).

For example, say you have a problem with money and keep getting into debt by living off credit.  You want to pay off your debt (self-directed action) to be able to cancel your credit card and limit spending (subsequent behavior) to reduce the chance you’ll get into debt again (change the probability of a future event).

Where does ADHD fit? With ADHD one has the intention to alter behavior (e.g, limit spending) to change the future (e.g., live debt-free) but struggles with the self-directed action (e.g., paying off debt) required for this.

Barkley says it’s a disorder where knowledge fails to guide performance.  You know what to do but struggle to do it.

WHY?

RB highlights that ADHD brains show prefrontal cortical network differences (these networks are responsible for Executive Functioning and self-regulation is the core of Executive Functioning).  Here is where the differences exist and what comes into play:

  • Frontal-striatal circuit, the “what” network (what we think influences what we do) Here lives…
    • Freedom from distraction
    • Working memory
    • Organization and planning
  • Frontal-cerebellar circuit, the “when” network (timing of thought, behavior)
    • With ADHD, there’s “time blindness,” and
    • A “myopia to the future”
  • Frontal-limbic circuit, the “why” network.  Here lives…
    • The decision-maker of the brain (if you have multiple goals, which do you pursue? this circuit, as RB puts it, “makes the final call”)
    • Motivation
    • Emotional control or dyscontrol

These network differences show up as self-regulation differences that encompass

Self-directed action, Self-awareness, Self-motivation, Self-directed attention, Self-restraint, Self-directed sensing, Self-directed emotions, and Self-directed play.

WHAT TO DO?

Outsource these brain functions.

RB calls this externalizing the brain functions where there are deficits.  For example, he says, use “artificial prosthetic cues to substitute for working memory deficits.”

Ideally, this is what ADHD coaches will help you do (for more on this, see Does ADHD Coaching Work?)

Here are some pointers for externalization:

  1. Per RB, the externalization of brain functions is needed at the point of performance and within your natural setting (e.g., if you struggle to write a report at work, you need external factors to guide your attention at work at the time you need to write); and
  2. To externalize, change your environment (think planners, alarms, points, signs).

Replenish your self-regulation (think self-control) resource pool.  It’s depleted by simple use as well as stress, drug abuse, illness.  Replenish through

  • Rewards, positive emotions
  • Positive self-talk
  • 10 minute breaks between tasks requiring self-control
  • 3 minutes of relaxation or meditation
  • Glucose ingestion (Gatorade, lemonade, sugar water) while working on tasks requiring self-control
  • Daily physical exercise

Also, break lengthy or complicated tasks down.  One of my favorite reminders of this, though I really like elephants, is, “How do you eat an elephant?”

Answer:  one bite at a time.

RB adds that accommodations or scaffolding and the compassion and willingness of others to make accommodations are “vital” to your self-regulation effectiveness.

Sources:  Two talks by Russell Barkley on ADHD, one from 2013 entitled, “The Importance of Emotion in Understanding and Managing ADHD (here) and one from 2012 entitled, “ADHD, Self-Regulation, and Executive Functioning:  Theory and Implications for Management” (the part of it I used is here).

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