Love, Sex and ADHD

Stephen V. Faraone, PhD on May 21, 2015

As a researcher who has devoted most of the past three decades to studying ADHD, I am surprised (and somewhat embarrassed) to see how little research has focused on how ADHD affects the romantic side of life. There are over 25,000 articles about ADHD listed on www.pubmed.gov, but only a few have provided data about love, sex and ADHD. Bruner and colleagues studied ADHD symptoms and romantic relationship quality in 189 college students. Those students who had high levels of both hyperactivity-impulsivity and inattentiveness reported that the quality of their romantic relationships was relatively low compared with students who had low levels of ADHD symptoms. Another study of 497 college students found that ADHD symptoms predicted a greater use of maladaptive coping strategies in romantic relationships and less romantic satisfaction. A study of young adults compared conflict resolution and problem-solving in romantic couples. It found that ADHD symptoms were associated with greater negativity and less positivity during a conflict resolution task and that higher symptoms predicted less relational satisfaction. But this was not true of the ADHD member of the couple only had inattentive symptoms, which suggests that the severity of ADHD symptoms might drive relationship problems. Unlike the studies of adults, the romantic relationships of adolescents with and without ADHD did not differ on levels of aggression or relationship quality, although only one study addressed this issue.


What about sex? The study of adolescents found that, irrespective of gender, adolescents with ADHD had nearly double the number of lifetime sexual partners. That finding is consistent with Barkley’s follow-up study of ADHD children. He and his colleagues found that ADHD predicted early sexual activity and early parenthood. Similar findings were reported by Flory and colleagues in retrospective study of young adults. Childhood ADHD predicted earlier initiation of sexual activity and intercourse, more sexual partners, more casual sex, and more partner pregnancies. When my colleagues and I studied 1001 adults in the community, we found that adults with ADHD endorsed less stability in their love relationships, felt less able to provide emotional support to their loved ones, experienced more sexual dysfunction and had higher divorce rates.


The research literature about love, sex and ADHD is small, but it is consistent.


 

REFERENCES

Bruner, M. R., A. D. Kuryluk, et al. (2014). “Attention-Deficit/Hyperactivity Disorder Symptom Levels and Romantic Relationship Quality in College Students.” J Am Coll Health: 1-11.

Biederman, J., S. V. Faraone, et al. (2006). “Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community.” J Clin Psychiatry 67(4): 524-540.

Canu, W. H., L. S. Tabor, et al. (2014). “Young Adult Romantic Couples’ Conflict Resolution and Satisfaction Varies with Partner’s Attention-Deficit/Hyperactivity Disorder Type.” J Marital Fam Ther 40(4): 509-524.

Rokeach, A. and J. Wiener (2014). “The Romantic Relationships of Adolescents With ADHD.” J Atten Disord.

Barkley, R. A., M. Fischer, et al. (2006). “Young adult outcome of hyperactive children: adaptive functioning in major life activities.” J Am Acad Child Adolesc Psychiatry 45(2): 192-202.

Flory, K., B. S. Molina, et al. (2006). “Childhood ADHD predicts risky sexual behavior in young adulthood.” J Clin Child Adolesc Psychol 35(4): 571-577.

Overbey, G. A., W. E. Snell, Jr., et al. (2011). “Subclinical ADHD, stress, and coping in romantic relationships of university students.” J Atten Disord 15(1): 67-78.

Myths About the Treatment of ADHD

Stephen V. Faraone, PhD on March 2, 2015

Myth: ADHD medications “anesthetize” ADHD children.
The idea here is that the drug treatment of ADHD is no more than a chemical straightjacket intended to control a child’s behavior to be less bothersome to parents and teachers. After all, everyone knows that if you shoot up a person with tranquillizers they will calm down.
Fact: ADHD medications are neither anesthetics nor tranquillizers.
The truth of the matter is that most ADHD medications are stimulants. They don’t anesthetize the brain; they stimulate it. By speeding up the transmission of dopamine signals in the brain, ADHD medications improve brain functioning, which in turn leads to an increased ability to pay attention and to control behavior. The non-stimulant medications improve signaling by norepinephrine. They also improve the brains ability to process signals. They are not sedatives or anesthetics. When taking their medication, ADHD patients can focus and control their behavior to be more effective in school and work and in their relationships. They are not “drugged” into submission.

Myth: ADHD medications cause drug and alcohol abuse
We know from many long-term studies of ADHD children that when the reach adolescence and adults they are at high risk for alcohol and drug use disorders. Because of this fact, some media reports have implied that their drug use was caused by treatment of their ADHD with stimulant medications.
Fact: ADHD medications do not cause drug and alcohol abuse
It is true that some ADHD medications use the same chemicals that are found in street drugs such as amphetamine. But there is a very big difference between these medications and street drugs. When street drugs are injected or snorted, they can lead to addiction, but when they are taken in pill form as prescribed by a doctor, they do not cause addiction. In fact, when my colleagues and I examined the world literature on this topic we found that, rather than causing drug and alcohol abuse, stimulant medicine protected ADHD children from these problems later in life. One study from researchers at Harvard University and the Massachusetts General Hospital found that the drug treatment of ADHD reduced the risk for illicit drug use by 84 percent. These findings make intuitive sense. These medicines reduce the symptoms of the disorder that lead to illicit drug use. For example, an impulsive ADHD teenager who acts without thinking is much more likely to use drugs than an ADHD teen whose symptoms are controlled by medical drug treatment. After we published our study, other work appeared. Some of these studies did not agree that ADHD medications protected ADHD people from drug abuse but they did not find that they caused drug abuse.

Myth: Psychological or behavior therapies should be tried before medication.
Many people are cautious about taking medications and that caution is even stronger when parents consider treatment options for their children. Because medications can have side effects, shouldn’t people with ADHD try a talk therapy before taking medicine?
Fact: Treatment guidelines suggest that medication is the first line treatment.
The problem with trying talk or behavior therapy before medication is that medication works much better. For ADHD adults, one type of talk therapy (cognitive behavioral therapy) is recommended, but only when the patient is also taking medication. The Multimodal Treatment of ADHD (MTA) study examined this issue in ADHD children from several academic medical centers in the United States. That study found that treating ADHD with medication was better than treating it with behavior therapy. Importantly, behavior therapy plus medication was no more effective than medication alone. That is why treatment guidelines from the American Academy of Pediatrics and the American Academy of Child and Adolescent recommend medicine as a first line treatment for ADHD, except for preschool children. It is true that ADHD medications have side effects, but these are usually mild and typically do not interfere with treatment. And don’t forget about the risks that a patient faces when they do not use medications for ADHD. These untreated patients are at risk for a worsening of ADHD symptoms and complications.

Myth: Brain abnormalities of ADHD patients are caused by psychiatric medications
A large scientific literature shows that ADHD people have subtle problems with the structure and function of their brains. Scientists believe that these problems are the cause of ADHD symptoms. Critics of ADHD claim that these brain problems are caused by the medications used to treat ADHD. Who is right?
Fact: Brain abnormalities are found in never medicated ADHD patients.
Alan Zametkin, a scientist at the US National Institute of Mental Health was the first to show brain abnormalities in ADHD patients who had never been treated for their ADHD. He found that some parts of the brains of ADHD patients were underactive. His findings could not be due to medication because the patients had never been medicated. Since his study, many other researchers have used neuroimaging to examine the brains of ADHD patients. This work confirmed Dr. Zametkin’s observation of abnormal brain findings in unmedicated patients. In fact, reviews of the brain imaging literature have concluded that the brain abnormalities seen in ADHD cannot be attributed to ADHD medications.
 

REFERENCES
Wilens, T., Faraone, S. V., Biederman, J. & Gunawardene, S. (2003). Does Stimulant Therapy of Attention Deficit Hyperactivity Disorder Beget Later Substance Abuse? A Meta-Analytic Review of the Literature. Pediatrics 111, 179-185.

Humphreys, K. L., Eng, T. & Lee, S. S. (2013). Stimulant Medication and Substance Use Outcomes: A Meta-analysis. JAMA Psychiatry, 1-9.

Chang, Z., Lichtenstein, P., Halldner, L., D’Onofrio, B., Serlachius, E., Fazel, S., Langstrom, N. & Larsson, H. (2014). Stimulant ADHD medication and risk for substance abuse. J Child Psychol Psychiatry 55, 878-85.

Nakao, T., Radua, J., Rubia, K. & Mataix-Cols, D. (2011 ). Gray matter volume abnormalities in ADHD: voxel-based meta-analysis exploring the effects of age and stimulant medication. Am J Psychiatry 168, 1154-63.

Rubia, K., Alegria, A. A., Cubillo, A. I., Smith, A. B., Brammer, M. J. & Radua, J. (2014). Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Biol Psychiatry 76, 616-28.

Spencer, T. J., Brown, A., Seidman, L. J., Valera, E. M., Makris, N., Lomedico, A., Faraone, S. V. & Biederman, J. (2013). Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of magnetic resonance imaging-based neuroimaging studies. J Clin Psychiatry 74, 902-17.

Myths About the Diagnosis of ADHD

Stephen V. Faraone, PhD on February 12, 2015

Myth: The ADHD diagnosis is very much “in the eye of the beholder.”

This is one of many ways in which the ADHD diagnosis has been ridiculed in the popular media. The idea here is that because we cannot diagnose ADHD with an objective brain scan or a blood test, the diagnosis is “subjective” and subject to the whim and fancy of the doctor making the diagnosis.

Fact: The ADHD diagnosis is reliable and valid.

The usefulness of a diagnosis does not depend on whether it came from a blood test, a brain test or from talking to a patient. A test is useful if it is reliable, which means that two doctors can agree who does and does not have the disorder, and if it is valid, which means that the diagnosis predicts something that is important to the doctor and patient such as whether or not the patient will respond to a specific treatment. Many research studies show that doctors usually agree about who does and does not have ADHD. The reason for this is that we have very strict rules that one must use to make a diagnosis. Much work over many decades has also shown ADHD to be a valid diagnosis. For details see: Faraone, S. V. (2005). The scientific foundation for understanding attention-deficit/hyperactivity disorder as a valid psychiatric disorder. Eur Child Adolesc Psychiatry 14, 1-10. The short story is that the diagnosis of ADHD is very useful for predicting what treatments will be effective and what types of problems ADHD patients are likely to experience in the future.


Myth: ADHD is not a medical disorder. It’s just the extreme of normal childhood energy

The mental health professions use the term “disorder” to describe ADHD, but others argue that what we view as a disorder named ADHD is simply the extreme of normal childhood energy. After all, most healthy children run around and don’t always listen to their parents. Doesn’t the ADHD child or adult simply have a higher dose of normal behavior?

Fact: Doctors have good reasons to describe ADHD as a disorder

The idea that the extreme of a normal behavior cannot be a disorder is naïve. Consider hypertension (high blood pressure). Everyone has a blood pressure, but when blood pressure exceeds a certain value, doctors get worried because people with high values are at risk for serious problems, such as heart attacks. Consider depression. Everyone gets sad from time to time, but people who are diagnosed with depression cannot function in normal activities and, in the extreme, are at risk for killing themselves. ADHD is not much different from hypertension or depression. Many people will show some signs of ADHD at some times but not all have a “disorder.” We call ADHD a disorder not only because the patient has many symptoms but also because that patient is impaired, which means that they cannot carry out normal life activities. For example, the ADHD child cannot attend to homework or the ADHD adult cannot hold a job, despite adequate levels of intelligence. Like hypertension, untreated ADHD can lead to serious problems such as failing in school, accidents or an inability to maintain friendships. These problems are so severe that the US Center for Disease Control described ADHD as “a serious public health problem.”


Myth: The ADHD diagnosis was developed to justify the use of drugs to subdue the behaviors of children.

This is one of the more bizarre myths about ADHD. The theory here is that, in order to sell more drugs, pharmaceutical companies invented the diagnosis of ADHD to describe normal children who were causing some problems in the past.

Fact: ADHD was discovered by doctors long before ADHD medications were discovered.

People who believe this myth do not know the history of ADHD. In 1798, long before there were any drugs for ADHD, Alexander Crichton, a Scottish doctor described a “disease of attention,” which we would not call ADHD. ADHD symptoms were described by a German doctor, Heinrich Hoffman, in 1845 and by a British doctor, George Still, in 1902. Each of these doctors found that inattentive and overactive behaviors could lead to a problem that should be of concern to doctors. If they had had medications to treat ADHD they probably would have prescribed them to their patients. But a medication for ADHD was not discovered until 1937 and even then, it was discovered by accident. Dr. Charles Bradley from Providence Rhode Island had been doing brain scanning studies of troubled children in a hospital school. The scans left the children with headaches that Dr. Bradley thought would be relieved by an amphetamine drug. When he gave this drug to the children after the scan, it did not help their headaches. However, the next day, their teachers reported that the children were attending and behaving much better in the classroom. Dr. Bradley had accidentally discovered that amphetamine was very helpful in reducing ADHD symptoms and, in fact, amphetamine drugs are commonly used to treat ADHD today. So, as you can see, the diagnosis of ADHD was not “invented” by anyone; it was discovered by doctors long before drugs for ADHD were known.


Myth: Brain scans or computerized tests of brain function can diagnose ADHD.

Someday, this myth may become fact, but for now and the near future it is a solid myth. You may think this is strange. After all, we know that ADHD is a brain disorder and that neuroimaging studies have documented structural and functional abnormalities in the brains of patients with ADHD. If ADHD is a biological disorder, why don’t we have a biological test for the diagnosis?

Fact: No brain test has been shown to accurately diagnose ADHD.

ADHD is a biologically based disorder, but there are many biological changes and each of these is so small that they are not useful as diagnostic tests. We also think that there are several biological pathways to ADHD. That means that not all ADHD patients will show the same underlying biological problems. So for now, the only officially approved method of diagnosing ADHD is by asking patients and/or their parents about ADHD symptoms as described in the American Psychological Associations Diagnostic and Statistical Manual.

Myths About the Causes of ADHD

Stephen V. Faraone, PhD on January 26, 2015

Myth: ADHD is caused by poor parenting or teaching.
Parents and teachers are popular targets for those who misunderstand ADHD. This myth posits that ADHD would not exist if parents and teachers were more effective at disciplining and teaching children. From this perspective, ADHD is a failure of society, not a brain disease.
Fact: ADHD occurs when genes and toxic environments harm the brain.
Blaming parents and teachers for ADHD is wrong. We know from research studies that many parents of ADHD children have normal parenting skills and even when we train parents to be better parents, ADHD does not disappear. In fact, many parents of ADHD children have a non-ADHD child that they raised with the same discipline methods. If bad parenting causes ADHD, all of the children in the family should have ADHD. Equally important, decades of research studies have shown that genes and toxic environments cause ADHD by harming the brain. I’m not saying that all parents and teachers are perfect. In fact, by teaching parents and teachers special methods for dealing with ADHD can help children with ADHD.

Myth: Watching Television causes ADHD.
This myth hit the media in 2004 when a research group published a paper suggesting that toddlers who watched too much TV were at risk for attentional problems later in life.
Fact: The study was wrong.
Sometimes researchers get it wrong. But fortunately science is self-correcting; if an incorrect result is published, subsequent studies will show that it is wrong. That’s what happened with the ADHD television study. After the first study made such a media splash, several other researchers did similar studies. They found out that the original study had errors and that watching too much TV does not cause ADHD. But, because the popular media did not pick up the later studies, the myth persists. I’m not recommending that toddlers watch a lot of television, but rest assured that, if they do, it will not cause ADHD.

Myth: Too much sugar causes ADHD.
This idea is based on common sense. Many parents know that when their children and their friends have too much sugary food, they can get very active and out of control.
Fact: Sometimes, common sense is wrong.
As a parent, I thought there was some truth to the sugar myth. But when a colleague, Dr. Wolraich, reviewed the world literature on the topic, he found that there have been many studies of the effect of sugar on children. These studies show that sugar does not affect either the behavior or the thinking patterns of children. Having too much sugar is bad for other reasons, but it does not cause ADHD.
 

REFERENCES
Wolraich, M. L., Wilson, D. B. & White, J. W. (1995). The effect of sugar on behavior or cognition in children. A meta-analysis. JAMA 274, 1617-21.

Stevens, T. & Mulsow, M. (2006). There is no meaningful relationship between television exposure and symptoms of attention-deficit/hyperactivity disorder. Pediatrics 117, 665-72.
Evans, S. W., Langberg, J. M., Egan, T. & Molitor, S. J. (2014). Middle School-based and High School-based Interventions for Adolescents with ADHD. Child Adolesc Psychiatr Clin N Am 23, 699-715.

Pfiffner, L. J. & Haack, L. M. (2014). Behavior Management for School-Aged Children with ADHD. Child Adolesc Psychiatr Clin N Am 23, 731-746.

ADHD Success Story #1: Eva

p p on March 18, 2014

Eva O’Malley, ADHD Adult: My son’s ADHD was diagnosed when he was six and I call it his gift to me because it eventually got me to where I am now. After so many years of researching and looking for answers and going to doctors, I started to become very clear about some of these behaviors that are existing in my world as well.

Adults with ADHD often get labeled with some very mean things like “lazy”, “rude”, “crazy” – things that you know are attributable to some of their symptoms, and it hurts. I’m guilty of doing this to my children because my daughter was diagnosed when she was 20.

I couldn’t understand why a 20-year old could not do these basic things. 

After I was diagnosed it was easier for me to be aware that people’s behavior is not necessarily all that’s going on. And just to look past the behavior and to look into what’s driving the behavior is more important. So those labels then fall off of the people that are “rude” and the people that are “lazy.”

My daughter’s issues all of a sudden became crystal clear once I was diagnosed. It wasn’t selfishness, it wasn’t laziness. It was ADHD.

Editor’s note: Subscribe to our YouTube Channel for frequent video updates.



ADHD Success Story #5 – James

Anthony L. Rostain, MD MA on March 4, 2014

Let me tell you about a patient of mine named James who is 27 years old and has had a history of some serious substance abuse problems. Now James was diagnosed with ADHD in elementary school, and around middle school decided he didn’t want to take medications anymore. Beginning in late middle school and early high school he started experimenting with marijuana and alcohol, and eventually began to use other substances like cocaine, and finally, by the time he was finishing high school – and he barely graduated – James was using prescription opiates.


After high school he worked for a few years as a janitor, but this addiction to OxyContin got the better of him. He finally was in an accident, got a DUI, and was court mandated for treatment; and they discovered that he not only had an alcohol abuse problem, he also had marijuana and opiate addition. For this he was given the diagnosis of polysubstance abuse and was started in an outpatient treatment in our facility.


So James was started on suboxone to help him withdraw from opiates, and he was also started on citalopram because he was complaining of depression; and he was able to maintain sobriety, but he had a real tough time concentrating and getting simple things done. He wasn’t completing simple tasks around the house. He tried to go back to work and found it very difficult to stay focused on his job duties, and was reprimanded for coming in late.


So as a result, we then were asked to consult with, and lo and behold, we realized that, even though he was being treated for addition, he still had the ADHD that plagued him as a child. So we added OROS methylphenidate, and we began having him come for weekly cognitive behavioral therapy sessions in which he relearned what ADHD really is for someone his age, and where we began to help him overcome some of his negative attitudes about learning routines and doing things that required mental effort.



James had dreams, wanted to do something with his life, but had always avoided them and had turned to substances to help him with things that made him anxious like social relationships.


As time went on, James began to talk about wanting to start his own business, and lo and behold, he was able to get started in this business. He sells collectibles online, and over the last few months he’s been so successful that he’s actually hired an assistant. What James likes to say now is that he wished that he had continued his treatment for administered; maybe he would have avoided substance use disorder. But he takes it all in stride.


He’s got a wonderful attitude, feels very positive about his life, and actually has offered to go and talk to some of the other patients in the recovery program to help them realize that some of them may, in fact, have ADHD that they ought to get treated.


So, I bring up this story of James in order to get you to think about the fact that maybe some of your patients who are in your office with other problems like substance use or alcoholism, or people who can’t quit smoking, maybe some of them have ADHD underlying all of their difficulties, and it would be worthwhile for you to learn how to assess them and maybe begin them in treatment because it could make a huge difference to their lives.

ADHD Success Story #2: Robert’s Story

p p on February 27, 2014

Robert Tudisco: I was diagnosed with ADHD after a number of problems that I had in my life. Coming out of law school, I got what I think was probably the perfect job for someone with ADHD. I was a prosecutor in the South Bronx and it was tailor made for someone with ADHD. Everything was an emergency, the motto in the office was “baptism by fire,” and it was just an exciting place to be. When I left the DA’s office and I started a private practice, that’s when I really had some problems. I had to keep track of my time, I had to bill my clients, I had to run an office. It was all of those administrative tasks that were really a problem.

At the same time, I thought I was setting a bad example for my son and I was having some difficulty in my marriage. And so, I sought some help, I found out about ADHD, and I was diagnosed pretty quickly, and that was about 14 years ago and it started this whole journey. My ADHD diagnosis was a major turning point in my life. It really helped me understand a lot about how I grew up and the struggles that I had as a child. I always knew, when I was a child, that there was a lot more going on behind my eyes than I was getting credit for and that was enormously frustrating for me.

I really think that a lot of adults would benefit from a diagnosis and it’s just one of the barriers, I think, to a lot of adults getting diagnosed is that there aren’t more clinicians that are diagnosing adults with ADHD. I think it’s important to manage ADHD as an adult or a child in a multimodal way. I take medication for my ADHD. I actually take two types of medication but that’s just a part of a multimodal approach. I run religiously to manage my ADHD. I employ a lot coping mechanisms that I’ve developed over the years that work for me. They may not work for somebody else but that was a process that I went through.

I think the important thing to stress about medication is that it’s not a cure for ADHD. When it works, it can be a very effective tool that helps people make positive changes in their life. I also think it’s important to give myself permission to fail and kind of let myself off the hook. It’s very important for adults to have a sense of humor about their ADHD. And when something doesn’t work, try to look at why it didn’t work and that may help you come up with a better way to solve that problem. And so don’t piece it as a failure-failure, it’s a learning experience.

ADHD Success Story #3 – Parallel Interviews

p p on February 20, 2014

In two separate interviews, a clinician and an ADHD adult describe the two sides of ADHD symptoms and ADHD diagonsis.


Lenard Adler, MD: I can think of an adult in their forties, a male, who came in after having their seven year old child diagnoses with ADHD, and in fact identify that, as he’s having his symptoms, he coped with them not all that well, was in a managerial position but not functioning optimally, had been passed over for promotions on numerous occasions mainly because he didn’t met his deadlines.

Robert Tudisco, Esq, ADHD Adult: I had to keep track of my time, I had to bill my clients, I had to run an office. It was all of those administrative tasks that were really a problem. At the same time, I thought I was setting a bad example for my son and I was having some difficulty in my marriage. And so, I sought some help, I found out about ADHD.

Lenard Adler, MD: In discussing things with the patient and his wife, she described lots of instances around at home where he didn’t listen to her, to do lists just weren’t completed, things weren’t being done on the weekend and she kind of felt that she was not only taking care of their seven-year-old son but also taking care of the husband. So the diagnosis of ADHD became clear after thorough evaluation and, in fact, this individual went on to treatment with a non-stimulating medicine and actually did quite well.

Robert Tudisco, Esq: There have been so many benefits since I’ve been diagnosed with ADHD. I think I’m a better father. I’m certainly a better husband. My relationship with my wife is much more relaxed because we understand each other a lot better. We also understand that ADHD is not an excuse for what happens and we understand where the behaviors come from so we can kind of work around them in the future. And I really think that a lot of adults would benefit from a diagnosis and it’s just one of the barriers, I think, to a lot of adults getting diagnosed is that there aren’t more clinicians that are diagnosing adults with ADHD.