Gina and her husband at their wedding(GINA PERA)

When journalist Gina Pera married a man with undiagnosed attention deficit hyperactivity disorder (ADHD), she embarked on a wild ride that took her from frustration and confusion to understanding and advocacy. Today she runs support groups for people with ADHD and their partners, and her book Is it You, Me, or Adult A.D.D.? was published in 2008.

Q: How did you realize that your husband had ADHD?

A: My husband is a brilliant scientist, and I had never dated a scientist before I met him. You know the stereotypical absent-minded professor? At first I figured that he must be it.

When we first started dating, he used to miss our exit all the time when driving down the freeway in San Diego. Then he had two fender benders in probably the first three weeks we were dating. ADHD tends to create problems with driving because it involves concentration on so many levels. The first time he said it was because he was so excited to have me in the car with him. And I made logical excuses for him: He grew up using the subway; hed learned to drive, in Paris, only the previous year. Its not that there werent little red flags everywhere; I just didnt know what they were.

But those red flags soon became bigger problems. Promises were ignored and not even acknowledged. He was doing really thoughtless things and I knew he wasnt a thoughtless person. We tried counseling, and the therapists just loved to hear our stories: They could tell we loved each other and they were thoroughly entertained by our problems, but they just couldnt give us any good suggestions.

One day at the library I came across the book Change Your Brain, Change Your Life by Daniel Amen, MD. I was fascinated by his description of ADHD and the way it physically affects the brain; it really seemed to describe my husband all the way back to his childhood. I took the book home and said to my husband, "Do you think this could be you?" And he said, "You know what? This really makes sense."

[ pagebreak ] Q: In the title of your book, you used the outdated term "ADD." Why that instead of ADHD?

A: I have several issues with the name ADHD, as I know a lot of doctors and researchers do too. First, the "H" for hyperactivity: Most adults dont exhibit these hyperactive symptoms, and because of that a lot of people dont ever consider the fact that they could have this condition. Thats why the official name is AD/HD, with a slash, to indicate that the hyperactivity is optional; that its a subtype of a larger condition.

My husband has what I call "stealth ADHD" because I always thought he was so relaxed; his eyes werent even ever open all the way when I first met him. Turns out, he was just exhausted because his time was managed so poorly.

In general, both terms (ADD and ADHD) present obstacles to understanding the true nature of the condition. For example, "attention deficit" isnt exactly true, because people with ADHD can still focus on certain things. In fact, they often hyperfocus—spending way too much time on one thing, like playing video games or reading about hang gliding on the Internet for eight hours straight. They stay up all night; theyre sleep deprived the next day. Its not an attention deficit problem; its an attention regulation problem.

Q: What are the biggest issues that get in the way when one partner in a relationship has ADHD, based on your experience with support groups?

A: Not knowing that ADHD is involved is probably the biggest and most detrimental problem, because both people misattribute each others behaviors. The partners will conclude “He doesnt love me; shes so selfish; he doesnt care about our family,” while the people with ADHD think they are being unfairly criticized, because, not realizing that they have ADHD or what it truly means, they have tunnel vision and think everyone functions the same way they do.

Money is also huge, especially in this economy. One large survey showed that ADHD costs adults $77 billion a year in lost household income, due to lower education levels, lower-level jobs, and unemployment. Even if someone is employed, they might be missing out on promotions or raises because theyre constantly in trouble, missing deadlines, or getting bogged down with little details.

The third thing is just the unreliability of a person with ADHD. A lot of spouses I know complain about having a partner whos like another child: They feel like they have to scold them constantly and remind them to clean up their messes, they cant rely on them to pick their kids up from school, theyre always worried about another car accident or surprise credit card bill. That can be a real relationship killer, and it can cause a lot of bitterness.

[ pagebreak ] Q: Besides problems at work, how else can ADHD affect a familys financial situation?

A: Some people with ADHD do a lot of self-medicating with shopping, for example. In my support groups, we always laugh at the number of people who have closets at home filled with eBay or as-seen-on-TV products. Scientists know that dopamine, the brain chemical released in anticipation of buying something or trying to win something, also has something to do with attention disorders. So some people with ADHD are more drawn to the thrill of spending money—even though once they get the actual product they lose interest.

Even if theyre not chronic spenders, many people with ADHD tend to have other financial problems. In my house, we spent a ton of money just on overdue library books. My husband would forget to mail his mothers birthday present ahead of time, so wed spend a fortune overnighting it to Canada. Unpaid bills, late fees, speeding tickets, higher insurance rates due to car accidents—all these things can add up to big problems.

Q: Can ADHD cause a spouse to neglect his or her partner?

A: Yes, and it can be as sudden and dramatic as a light switch going off. Some people with ADHD can get really fired up during courtship; the experts call it "hyperfocusing." They meet a new person, they want to be together all the time and have sex all the time, and they pursue their new love like crazy—but then once theyve "got" him or her, once that dopamine stops flowing, they cant help but move on to a new obsession, like a video game or yet another hobby.

Q: Are you a big advocate of medication for ADHD?

A: Surprisingly, I am. But my first inclination is to always do things holistically. My mother is Italian, and we grew up eating healthy foods, drinking lots of water, and not taking medicine unless absolutely necessary. So with my husband, at first I thought, "It must be his terrible diet." I gradually encouraged him to cut out his coffee and sugar, and then we tried an herbalist, an acupuncturist, various supplements, more exercise, and so forth. We tried everything, and nothing worked.

I was amazed what a difference medication can make when its prescribed properly. My husband is now the attentive, caring person I always knew that he was deep down. Equally important, he is much happier in his life and in his work, where he is exponentially more productive and fulfilled. I will never say that everyone needs medication to control their ADHD, but I also think its definitely worth a try if behavioral techniques and lifestyle changes dont help.

[ pagebreak ] Q: Whats different about the female in a relationship having ADHD, versus a male?

A: ADHD has traditionally been diagnosed more in men, but scientists have realized that it may be just as common—and often missed—in women. And in my support groups, I often have the most compassion for the men who are seeking help for their female partners with ADHD.

Why? Because in our culture, the conventional wisdom is that women are caretakers. Its normal for them to get their husbands to see the doctor, to notice health issues, to nag their husbands about excessive TV watching or sloppy habits. But the idea of a man encouraging his wife to see a doctor or a therapist, and complaining that shes messy, or that she lets old food collect in the fridge, or that she cant do laundry because she leaves the clothes in the washer and they get moldy? People look at him and think, "What a chauvinist pig! Youre mad that your wife is a bad housekeeper."

But hes not complaining for selfish reasons; hes genuinely concerned about his wifes habits and the effect its having on their marriage. A lot of these men are earning the money, working full time, and doing all of the chores, getting the kids to school, and paying the bills, because their wives cant manage. I knew one young father who got a job closer to home so he could visit at lunchtime to check and make sure his wife wasnt asleep while their toddler was up.

Thats an extreme case, of course, But I think most men shy away from seeking "support"—because they might see it as a sign of weakness that they cant handle the situation. So by the time I see a concerned husband at one of my support groups, I know his wife probably has pretty severe symptoms. Thats starting to change more recently, though, as women with ADHD who themselves have initiated the diagnosis are asking their partners to become educated.

Q: Can living with an ADHD person make you feel like you have a problem as well?

A: If you had a friend whom youd arranged to meet for lunch at 1, and you go to the restaurant and she never shows, and later she says, "Did we say 1? No, I think we said 2," your immediate impulse is to think that maybe you were wrong. Living with someone who has ADHD is like that all the time: You second-guess yourself, you lose sleep because of your partners irregular sleep patterns, you get frustrated with the lack of organization and order, and youre constantly trying to put out fires set by your ADHD partner.

But then people say, "Relationships take work; give it time; you need to compromise more," so you brush things off and give your partner the benefit of the doubt. But meanwhile, youre getting more and more turned around because of his or her habits. A lot of spouses I know joke that they have "ADHD by osmosis."

[ pagebreak ] Q: What can the partner do to ensure that their ADHD spouse is receiving the right treatment?

A: If your partner sustained a blow to the head and was walking around with brain trauma—forgetting things and miscommunicating—would you leave him or her alone to get treatment? ADHD is a physical condition in the brain that can affect self-observation and perception. Thats why its important for a doctor to get input from other people in the patients life in order to see the whole picture: The patient may not always realize what the problem is and may unwittingly mislead the doctor by putting blame on other people or claiming that everything is fine.

And even once your partner gets diagnosed and decides to try medication, you cant just sit back and wait for the treatment to start working. Far too often I see irresponsible and shoddy prescribing practices—doctors just say, "Heres some Adderall," and ask the next month, "How do you feel?" First doctors and patients should work together on establishing treatment targets so they have a method for assessing the medications effectiveness. Also, many doctors start their patients on very high doses of stimulant medications, and thats when side effects occur. People decide, "Whoa, the treatment is worse than the condition. No thanks! End of discussion."

Doctors should be starting patients off on a very low dose of medication and tracking their symptoms and improvement or side effects. Its frustrating to think that a person who has so much trouble organizing and prioritizing now also has to manage his or her doctor as well, and thats why its important to get the partner involved and make it a team effort.

Q: Whats the difference between a spouse who has ADHD and a spouse whos just insensitive, forgetful, or lazy?

A: Symptoms of ADHD are often missed because ADHD does indeed resemble the human condition: We all procrastinate, we all forget, we lose sight of the big picture and get distracted by little things. But with ADHD, its an order of magnitude more—these incidents happen more often and to a greater scale. Until you live with the person, you may not see the full extent of it. Many people with ADHD put their best face forward in the public light, and its only when you see their personal lives do you realize the extent of their challenges.

I started dating my husband during the '90s dot-com era, when everyone was just starting to amp up on cell phones, PDAs, electronic gadgets, and double espressos. I thought for a while that his distractibility and irritability were just products of these; that everyone in high-tech was getting wigged out by all this stimulation. But for a lot of people with ADHD, these gadgets are their lifeblood; theyll play with them for hours because they provide the higher amounts of constant stimulation they crave. It took me a while to realize, though, that not everyone was affected the way he was.

[ pagebreak ] Q: Have you seen a lot of relationships end because of ADHD?

A: In my support groups, Im used to seeing the people who have figured it out—the partner whos realized whats going on and is willing to consider ADHD and really wants to save the relationship. I also moderate a local group for adults with ADHD, and there are adults in that group who are getting help even though their spouses know little about ADHD; some think its an excuse or they just dont think they need to learn about it. Many in the adult groups are, in fact, high-functioning, so that may be the case.

When the adult with ADHD is in denial, thats really tough. Thats a lot of what we deal with in the partners support group. Many people dont want to be evaluated for ADHD because they think it means theyre crazy or weak, and many dont even believe that ADHD exists. And theyve been like this their entire lives: They dont know that theres any other way to be. And thats really sad, because ADHD is considered the most impairing outpatient disorder—even more so than anxiety or depression—but its also highly treatable.

I believe that most people can be reached; they just have to be acknowledged first. Sometimes its the partners of adults who dont want to learn about ADHD. I can spot them in my lecture audiences; theyve been dragged there by their partner with ADHD, and they sit there with their arms folded and jaws set, looking resistant. Theyre afraid Im going to be another one of those experts who say, "You just have to understand your partners differences, their gifts." But once I can acknowledge their own personal experiences, their own real frustrations, and emphasize that ADHD is not an excuse for bad behavior, they are more likely to be receptive to learning more and working on strategies with their partner.

Q: Does anyone ever come to your support groups and then decide that their partner really doesnt have ADHD?

A: I expected to see a lot more of that, but Id say that about 90% of the time if someone does the research and becomes educated on the symptoms and suspects that the person he or she is living with has ADHD, thats probably correct. Yes, ADHD can mimic symptoms of depression and anxiety, so its important to consult a qualified expert who can consider all of the possibilities. But if the spouse has gone this far to seek out a support group, he or she generally has a good idea of the problem.

To clarify, its not like they want to know that their partner has ADHD. They dont! They often dont want to know that their partner has a brain condition. Theyve spent years thinking that if they just help their partners change their habits and attitudes, or that if they just organized the home differently or set up their schedules differently or communicated differently or stood on their head and spit wooden nickels, that they could fix things. Usually by the time I meet people in support groups, theyve been to four or five therapists to try and solve things another way.

Q: Are you saying that traditional marriage therapy probably wont work?

A: If the underlying issue is not addressed, namely ADHD, therapy is only going to be a very temporary solution—and it can often make things much worse. Ive talked to women who have gone to marriage therapists or pastoral counselors, where theyve been told things such as, "Let your husband be the man. Give him his power back; let him manage the money." "You need to embrace his creative ADHD nature; accept him for who he is."

Without knowing what the real problem is, its easy for either partner in these relationships to get depressed, to become isolated, and to lose their faith in marriage. When youre raising kids, its that much worse—especially because theres a high likelihood that your children can have ADHD symptoms as well. So instead of just acting as a passive caretaker and accepting the chaos thats dragging all of you down, its important to take charge, get the facts and realistic strategies, and really help turn the situation around.