Emotional Problems ADD ADHD NYC

“My wife is the Jekyll and Hyde of Staten Island. She can go from lovely to livid in seconds. Sometimes I think our 3-year-old has greater frustration tolerance than she does.” — Jack, New York

Jack’s wife has ADD/ADHD. The traditional view of ADD/ADHD as a problem of attention and focus has broadened in the last decade to include significant challenges in emotional functioning. In his book, ADHD and the Nature of Self-Control, Dr. Russell Barkley, a leading researcher in the field, suggests that a better description for ADD/ADHD is a “self-regulation disorder.” He offers that the main problem in individuals with ADHD is one of self-control, and that issues of attention are secondary to larger difficulties in self-regulation.

Dr. Barkley theorizes that as children develop, their behavior is less influenced by external forces (e.g., fear of parental punishment) and more directed by internal codes of conduct learned from family, peers and society. The essence of adult self-control is controlling one’s behavior based on these internal set of rules and standards. This is why most of us don’t steal from stores, hang up on our parents when annoyed or smash a glass when angry. An internal voice tells us this is inappropriate behavior.

For individuals with ADD/ADHD, the formation of these internal standards may be well-developed, but accessing this information quickly may be problematic, leading to a breakdown in self-regulation. Putting it another way, those with ADD/ADHD know what to do, but have a hard time actually doing it. It’s as if the internal voice of reason is too weak to be heard.

Dr. Barkley gives this example: Getting reprimanded by a superior at work tends to evoke a strong emotional response. The difference between people with ADD/ADHD and others is in their ability to regulate themselves during that event. Most people know how to control their impulses and immediate reactions. This buys them a few seconds to think about a healthy response. Individuals with ADD/ADHD are more likely to lash out, create a scene, and immediately express the intense emotions they are feeling. The emotions they feel are appropriate. The way they act on them is not.

Emotional Problems ADD ADHD NYC

One major reason for this lack of emotional control has to do with the internal wiring of the ADD/ADHD brain. Someone with ADD/ADHD has difficulty communicating to themselves a desired set of actions; e.g., “Don’t yell at boss.” This process of self-talk is also called by Dr. Barkley the “internalization of speech.”

Imagine a pathway between the frontal lobe of the brain and the much more primitive portions of our brain where action and raw emotions reside. For most of us, this pathway is a four lane highway, recently paved and accessible to even the largest trucks. Information flows freely and is managed in a generally adaptive manner. Most importantly, we have the ability to move at will, maneuver freely between lanes, and make choices quickly and safely.

For those with ADD/ADHD, this pathway is like a two-lane highway packed with cars. The traffic is overwhelming the route and is not allowing helpful information to get through. There’s a feeling of being stuck with no choices. Since the pathway is blocked, the only way forward is on a loud motorcycle, cutting dangerously through traffic to get to the front. This is what it’s like with ADD/ADHD.  You’re moving through quickly on the less desirable path and infuriating people left and right.

For partners of individuals with ADD/ADHD, witnessing this poor emotional self-control and low frustration tolerance is painful, with even simple mundane conversations turning ugly and ending in emotional outbursts.

Mark, from Brooklyn, NY, writes about his wife with ADD/ADHD.

“She gets angry very quickly. When I want to talk something out, she can’t control herself from raising her voice, saying mean things and blaming me. No matter how nice I try to speak to her, there is no stepping outside herself. It’s like trying to feed a wild animal. Get too close and you might lose an arm or leg.”

Being aware of and in control of one’s emotions is really the hallmark of psychological health. For men and women with ADD/ADHD, this is a daily struggle. Even the slightest hiccup in one’s day can cause the top to blow and explode all over co-workers, loved ones and even the kind woman at the bank. (This is actually an unofficial diagnostic question at the Sachs Center: “Do you lose your temper often with bank tellers and customer service representatives?”)

It is not surprising that some adults with ADD/ADHD come to the Sachs Center thinking they are actually suffering from Bipolar Disorder. ADD/ADHD can be confused with Bipolar Disorder, as both involve emotional dis-regulation. The difference between Bipolar Disorder and ADD/ADHD is in the timing of these emotional outbursts. For individuals with Bipolar Disorder, their intense emotional state is not always related to a particular event and often appears out of the blue. Bipolar mood swings can also last for days. For individuals with ADD/ADHD, however, the emotional reactivity is generally directly related to an event or interaction, and usually doesn’t last too long. In short, it makes sense to others why they’re emotional, but what’s confusing is the degree to which these emotions are visible and take hold of their life.

You might assume that if you have ADD/ADHD you’re destined to be an emotional mess. Or since you have this disorder, you’re entitled to major meltdowns. Research shows that with concerted effort, change can happen.