How to Help Your Child (or Partner) with ADHD
Attention-deficit/hyperactivity disorder (ADHD) negatively impacts both the person with the disability and family 
members who live with him. If the family works together with the proper mindset, however, a lot of frustration, anger, shame, and guilt can be avoided. This is why I consider ADHD a relationship issue. Relief is available if this disorder is treated as an individual problem with an interpersonal solution.
So what is the fix? It is creating short-term incentives to motivate your child or partner to action. Why is this effective?
Books will tell you that the most important thing you need to know about people with ADHD is that they have a cognitive impairment in their frontal lobes that affects their executive function. But a more useful way of understanding this impairment is that people with ADHD are not motivated by long-term rewards. In most of our brains, the neural pathways connecting immediate tasks with awareness of long-term rewards flow smoothly. But for people with ADHD, the part of the brain that connects up the thought process “If I do X now, I will reap the rewards of Y later” does not work. This makes it challenging for them to plan for future-oriented tasks because the benefits of this organization lie so far off on the horizon that they are effectively out of the ADHD person’s cognitive field of view.
Here, for instance, is a common scenario. Parents take the time and energy every night to help their ADHD child with his homework. After a month, these parents get a call from the teacher who says: “Your child is failing my class. He hasn’t handed in homework for the past month.” “How is that possible?” exclaim the parents. “We’ve been sitting with him at the kitchen table every night until he completes each day’s assignment!”
When the parents go upstairs to confront their son, they find a pile of completed, but unsubmitted, homework in his closet. The ostensibly easy task of handing in completed homework has not been accomplished because their child is literally not registering its long-term positive effect (viz., getting a good grade at the end of the semester). This can be very frustrating for parents because often their children are extremely smart, but seem so incompetent to complete the simplest tasks. It is not a problem of intelligence. Rather, the issue is that they are not motivated by long-term planning and, thus, are not good at planning, organization, and execution.
And while family members often experience frustration because they have to pick up the pieces of uncompleted tasks, unmet expectations, and unrealized potential, the child suffers too. A universal experience for ADHD children is that regular tasks, which everyone else seems to manage easily, feel overwhelming. And because schools emphasize homework and assignments, these children (even those who are extremely intelligent) feel incompetent and can suffer from depression and low self-esteem.
How does the lack of long-term planning rear its head in the adult relationship? Seventy percent of children with ADHD continue to exhibit symptoms throughout their lives. Children with ADHD grow up to be husbands and wives. I see many couples whose source of frustration is that one partner is not functioning in terms of managing finances, doing taxes, promoting their career, etc. These tasks are often part of the dynamic described above – an innate lack of motivation by long-term goals.
For instance, the ADHD partner might commit to taking on a household task such as paying taxes but, come April, accounting statements and receipts are in complete disarray and the filing deadline has been missed. The gratification of the long-term goal (getting a refund check) is too far in the future, elusive, and not internally motivating. In general, an ADHD partner may “zone out” during conversations, not remember being told things, or have trouble getting started on, and underestimating the time needed to complete, a task (or not complete the task at all).
The non-ADHD partner feels like she needs to pick up the pieces of every household responsibility because there is another “child” in the house who needs “parenting” and on whom she cannot rely. She interprets these characteristics as irresponsible, and the failure to carry out commitments as a sign that her ADHD partner does not care for or love her. As a consequence, she feels unsupported and angry, and often blames her partner for his shortcomings.
The ADHD partner experiences these complaints as constant and withering judgment. He feels guilty and his self-esteem plummets, causing him to withdraw emotionally. As a result, the non-ADHD partner feels unsupported and abandoned, leading to a new round of angry recriminations. Adults with ADHD have higher than average rates of divorce, job-related difficulties, and substance abuse. Without a larger context to understand what is going on, this cycle can continue indefinitely.
So, how can you alleviate the symptoms of ADHD in both the parent-child and adult relationship?
You need to accept that ADHD requires an incentive “crutch” to motivate your child or partner to action. Short-term rewards and regular feedback need to become the new organizing principle of your relationship. This reward system will keep the motivation fires burning and help reduce the overwhelming feeling that accompanies long-term tasks.
In the case of children, for instance, if you want your child to help around the house, make a list of chores. On the left side of the paper write a “To Do” list and on the right side put a “Reward” list. For every task you have assigned to your child, encourage them come to you and negotiate a reward to be enjoyed that day if and when the task gets completed. Tack this list to his bedroom door to create a prominent visual reminder of your expectations and the prize for getting it done.
If your child is responsible for long-term projects (such as those required by school), show him how to break down the assignment into daily tasks. Create a calendar with a “To Do” list of what needs to be accomplished each day and assign a reward for each daily task. This can be as simple as a well-liked dessert, a favorite TV show, the right to play 30 minutes of video games, or the freedom to use Facebook.
In adult relationships, set up a system that creates regular positive feedback for the ADHD partner. For instance, ADHD partners are often great at short-term gestures – e.g., doing things with the children in the moment, cleaning up after dinner, making a meal, etc. That is because the gratification for the individual is immediate (connecting with another human being, seeing the look of pleasure on the partner’s or children’s face, etc.) and, therefore, is motivating. I would recommend dividing household responsibilities by short- and long-term assignments. Delegate to the partner with ADHD household responsibilities that have a natural, instantaneous reward – any chore where the adult is likely to get immediate feedback, such as “Thanks for dinner, that was great!” or any task where the children’s daily needs are involved.
For long-term projects, collaborate with your partner to create a calendar as described above. Buy a whiteboard and break down each week’s responsibilities. Agree on regular mini-rewards for tasks accomplished – e.g., a massage after working on a home improvement project, a night out with the guys after paying the most recent bills, a favorite snack after balancing the checkbook. Put this whiteboard on prominent display. And remember to give your partner lots of positive feedback every day for tasks completed. Ultimately, the goal is for the person with ADHD to manufacture the schedule and incentives himself for all his responsibilities, thereby fundamentally shifting the interpersonal relationship.
Included below are other resources about ADHD which might be helpful.
Books:
Smart But Scattered by Peg Dawson and Richard Guare
ADD-Friendly Way to Organize Your Life by Judith Kolberg and Kathleen Nadeau
Mastering Your Adult ADHD (Treatments That Work) by Steven A. Safren
Websites:
Robert Terris 