It is not only women who find that ADD syndrome can unexpectedly disrupt life in the middle adult years. One man with unrecognized ADD sought consultation at age forty-three when his wife shocked him by announcing that she wanted to end their sixteen-year marriage. When the couple came for consultation together, the wife quietly presented her long pent-up frustration and her reasons for wanting to leave:
I've just reached a point where I am fed up with too much giving and not enough getting back. I feel like I've been raising not just two children, but three. My husband does a good enough job at work, and he's a good provider, but at home he's just like one of the kids. I have to struggle with him to get him up and off to work every morning and I have to remind him to get off the computer every night so he won't stay up playing games until 2 or 3 a.m. I've given up on his taking care of the monthly bills because he never remembers to pay them on time. We were getting threatening letters and calls from creditors because he forgot to pay. There was enough money in the bank and he had said he would take care of it.
Once in a while he'll start a project at home, but then he never finishes it. For two years we've had bare two-by-fours in our bedroom where he keeps saying he's going to put in new plasterboard. Mostly when he's home, he's on the computer or watching sports on TV. He never remembers anybody's birthday or our anniversary and he says he'll come to the kids' sports events, but then forgets to show up. When I try to talk with him, he listens for maybe a minute or two and then he's drifting off talking about something else. Even in those times when he starts to say something to me, he gets off the point before his third sentence. He's not a heavy drinker and he's not abusive, but he is neglectful. I've been married to him for sixteen years, but all that time I've felt neglected by this man. He seems to need a mother to take care of him day by day more than he needs or wants a wife.
The husband did not dispute his wife's complaints. He cried. He acknowledged his recurrent forgetfulness and his frequent neglect of tasks, events, and concerns that were important to his wife and to his children.
You're right! I make a lot of promises to you and the kids that I don't follow through on. And I do depend on you to keep me organized and to remind me about what needs to be done and when to do it. I've never been good at stuff like that. When I was a kid, even all the way through high school, my mother had to hassle me every day to get up in the morning. If she didn't, I would sleep through school. I've never been able to get myself up with an alarm clock. And she had to keep pressuring and reminding me to get my homework and chores done. Even though
I wanted to, I just couldn't manage that stuff myself. You help me with so much, and you're not even mean about it. I just don't know if I can change the way I've been for so many years. I don't know if it's something that can be changed.
The complicated causes of the crisis in this marriage had been festering for many years before they erupted in the wife's threat to separate. Initially the husband claimed and believed that he had not been unhappy in the marital relationship. Later he gradually recognized that his wife's frequent reminders and supports were frustrating and sometimes very irritating to him, even though they were also helpful protection against his own tendencies to live too much in the moment.
As they talked further about their mutual frustrations, this couple saw that they had become trapped in maladaptive efforts to cope with the husband's unrecognized ADD syndrome. During childhood and adolescence his mother had provided intensive support and structure without which this man probably never would have finished high school. Shortly after high school he met and quickly married his wife, who gradually took over his mother's caretaking role, supporting him through his college studies, maintaining a household, and eventually carrying most of the responsibility for caring for their two children.
Both partners agreed that they had shared many satisfactions and good times in their sixteen years of marriage, but they also recognized that their relationship could not continue without major changes. The change most urgently needed was for the husband to begin treatment for the ADD syndrome that had plagued him since childhood; it had never been recognized in school or at home, probably because he had never been hyperactive or disruptive. As they learned about the nature of ADD, the couple recognized that symptoms of this syndrome had contributed substantially to the husband's serious underachievement in school, his very marginal performance in college, and his continuing erratic performance on the job.
When he began appropriate medication treatment, the husband experienced dramatic, rapid improvement in many of his ADD symptoms. This did not suddenly resolve all the couple's marital problems, but it cre ated and sustained conditions under which they were able gradually to work out a very different, more reciprocal style of relationship. In the process they also recognized that the increasing underachievement of their fourteen-year-old son in high school was virtually a carbon copy of his father's problems at that time in his own life. Both father and son benefited from ADD treatment in ways that produced a much more satisfying life for the entire family.
In looking at the development of this family, one might wonder how this particular husband and wife happened to find each other. How did this man so early in life find a partner so willing and able to provide him the scaffolding previously created and sustained by his mother? Why would this woman choose to attach herself so early in her life to this man with such great needs for a parent-like partner? Why did she continue so long in this pattern? And why did she then become so frustrated with their established patterns of interaction after sixteen years of married life together? Adequate answers to these questions are beyond the scope of this book, but the questions highlight factors that are relevant and important to the experience of many adults with ADD syndrome.
Most individuals do not choose a life partner or other important voluntary relationships at random. People tend to seek out and pursue relationships with others to whom they feel attracted and with whom they feel comfortable. When discussing their choice of marriage partners, people often describe the attractions of physical appearance, but usually far more important are mutual attractions due to many complicated, unrecognized features of personality and interpersonal style. Such elements can have a powerful effect on interpersonal attraction and/or conflict, often in ways that are noticeable only over time as the attachment develops more fully.
John Bowlby (1978), a pioneer developer of attachment theory, wrote about the persistence of early experience in such choices throughout the lifespan. He used the term "representational models" to refer to individuals' persisting personal views of self and others—their aggregated expectations, complex and only partly conscious, of persons to whom they are attached, which includes their image of who a person is and of what that person wants, intends, and will do.
Whatever representational models of attachment figures and of self an individual builds during childhood and adolescence tend to persist relatively unchanged into and throughout adult life. As a result one tends to assimilate any new person with whom he may form a bond—a spouse, child, employer or therapist—to an existing model and often to continue to do so despite repeated evidence that the model is inappropriate. Similarly, one expects to be perceived and treated by others in ways that would be appropriate to his self-model and to continue with such expectations despite contrary evidence. Such biased perceptions and expectations lead to various misconceived beliefs about other people, to false expectations about the way they will behave, and to inappropriate actions intended to forestall their expected behavior. (p. 16)
In this passage Bowlby emphasizes problematic ways in which expectations from earlier relationships can carry over into formation of adult relationships. But the same processes sometimes bring a good fit, or at least, a mixed bag. A person may unwittingly seek out and develop a relationship with another person amazingly well-suited and motivated to continue, at least up to some point, patterns of interaction familiar from early family life.
In this couple, the man found a woman who was attracted to him for many reasons, one of which was that he needed and wanted the nurtu-rance and support that she was motivated by her earlier life experiences to provide. He was strongly motivated to become bonded to a caring person who would provide the scaffolding earlier provided by his mother to compensate for persisting impairments of his ADD syndrome. And she found and joined herself to this man whose need and wish for her to provide such intensive scaffolding was, at least initially, appealing and rewarding to her. Over the many years of their marriage, the wishes and needs of each partner changed, resulting in the conflict that threatened to disrupt their marriage.
One primary source of change in most marital relationships is the birth and development of a child. Usually each new member added to a family profoundly changes the routines and dynamics of the family. The newborn infant's very survival depends on the parents adequately arranging their schedule and activities to see that the child is carefully watched over, fed, comforted, rested, played with, and cared for throughout each day and night. Usually this involves not only a rearrangement of schedules, but also massive sacrifices of time, energy, and freedom by the parents, often far more from one parent than from the other. And when a new child arrives in a family that already includes one or more children, sacrifices are inevitably forced on the older children as well.
The entry of a new child into a family does not only mean sacrifice, however; it also enriches the lives of parents and any siblings. Donald Winnicott, the extraordinary British pediatrician (1965), put it this way:
The parents, in their efforts to build a family, benefit from . .. the integrative tendencies of the individual children. It is not simply the loveableness of the infant or child; there is something more than that, for children are not always sweet. The infant and child flatter us by expecting a degree of reliability and availability to which we respond. ... In this way, our own capacities are strengthened and brought out, developed, by what is expected of us from our children. In innumerable and very subtle ways, as well as in obvious ways, infants and children produce a family around them, perhaps by needing something, something which we give. (p. 47)
Since the needs of children are not static, but change dramatically as the child grows older, the effects of the child's needs and of his giving to the parents continually evolve, causing ongoing change in the parents, both in themselves and in their interactions with one another. In the couple described earlier, the wife's frustrations with her husband escalated as their children entered adolescence. As the children appropriately became less engaged at home and developed more independent adolescent lives, the mother acutely felt the loss of the precious satisfactions of providing a competent and caring scaffolding for them. And as her children became more private and more independent from the family, this mother felt more intensely the lopsidedness, frustrations, and loneliness in her marriage. Consequently, she began increasingly to resent the continuing lack of mature reciprocity in her relationship with her husband.
Changes in the life situation outside of the family can also alter the effects of ADD symptoms on adult lives. A fifty-seven-year-old man, chief executive officer of a multinational corporation, brought his son for consultation after the boy had failed out of university. The boy had done fairly well in an exclusive prep school where his daily routine had been tightly organized for classes, sports, and supervised homework. In the very competitive college that enrolled him, however, he failed miserably during his first year. At the suggestion of a perceptive professor, the father brought his son to be evaluated for a possible attention disorder.
The boy fully met diagnostic criteria for ADHD and responded well to appropriate medication treatment as he took courses in a local college. He returned to the university on probationary status and was quite successful with the support of continuing treatment. A few months later, the boy's father called me, requesting an appointment to be evaluated himself. When we met, he explained his motivation.
I've been very successful in my career for several reasons. First, I'm a good idea man: I can envision how things can be developed in a creative way. I'm also a good troubleshooter, identifying problems and finding effective ways to fix them. But most important, I know how to pick good lieutenants.
I have several very competent administrative assistants who keep me organized and help me do my job. They keep my calendar and remind me of what needs to be done when. They help to organize and prioritize my work. They track my correspondence and edit my dictation. Without them I could never stay on top of all I have to do. If my son had someone like that to assist him in college, he never would have flunked out.
Not many people know this, but I never finished university. I flunked out at the end of my third year. I lasted a little longer than my son did in his college studies, but mine was an easier school. We both failed for very similar problems.
I want this evaluation for ADD because I know I still have the same problems my son has. I could see that when I was here as you asked him all those questions in his evaluation. I've made all the money I need and I'm planning to take early retirement next year. My goal for retirement is to return to university and finish the degree I wasn't able to complete before. But I know I can't take any administrative assistants into courses with me, and there is just no way I will be able to do that work unless my attention and memory problems are fixed. I want you to evaluate me and see if you agree that I have ADHD too. If so, I'd like to arrange to get the same medication my son is being helped by. I believe, no—I know—that the medication will be helpful to me. I've already tried it.
This very successful executive did, in fact, fully meet diagnostic criteria for the predominantly inattentive type of ADHD, and he did respond well to treatment as well as finally complete a university degree. His story illustrates how some fortunate individuals with untreated ADD syndrome can achieve extraordinary success, even in very demanding and responsible positions, when they have sufficient help to compensate for their executive function impairments.
In this case, the administrative assistants in the corporation supported this talented man in leading his massive corporation to international success. While rising to the top of his corporation's administrative ladder, he had also benefited from the work of many other secretaries and subordinates who helped him to do tasks that he continued to find very difficult. But when he anticipated his early retirement, he realized that his persisting problems with executive functions would prevent him from completing a degree, just as they had thirty-six years earlier, unless they were alleviated.
Not every adult with untreated ADD syndrome is fortunate enough to have salaried assistants to help compensate for executive function impairments. But many do have coworkers, spouses, or others from whom they obtain needed assistance. Sometimes help comes in the form of a simple redivision of labor, whereby an employer allows a worker with ADD syn drome to be responsible for aspects of the job in which that worker has strong interest and talent, while assigning other parts of the usual portfolio to another worker with complementary gifts and limitations. Sometimes a spouse without ADD syndrome takes responsibility for managing the family's financial affairs, while the spouse with those impairments takes on other household responsibilities.
The value of such supports often is not recognized until, for some reason, they are withdrawn. One interior decorator with untreated ADD syndrome had a flourishing business until his junior partner suddenly died from a heart attack. The business began to collapse after the younger man's death as the senior partner failed to monitor income and expenditures, did not follow up promptly on inquiries from prospective clients, did not write up and send his estimates, failed to collect on accounts receivable, invested in excessive inventory, and mistreated his office assistants.
For twenty years these partners had thrived in a business where the senior partner employed his strengths in imaginative use of color, design, and arrangement while the junior partner provided steady management of their business finances, guided the flow of inventory, oversaw interaction with clients, and provided guidance and support for their office assistants. After the loss of his partner, the decorator received useful advice from his office staff, but his problematic personality style and ADD impairments, accentuated by his grief, caused him to ignore their advice and drove them and several successors to resign. Only after the business had virtually collapsed did the decorator finally recognize limitations from his ADD syndrome and seek appropriate treatment.
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