Although less described than its childhood counterpart, Attention Deficit Hyperactivity Disorder (ADHD) in adults also occurs frequently. Adults sufferers can exhibit similar characteristics to children--agitated restlessness, impulsive behaviour, difficulty in concentrating--but they are more likely to suffer additional psycho-behavioural conditions such as depression, anxiety and obsessive-compulsive disorder. A most pressing issue, however, is anger: ADHD adults can switch rapidly from apparent calm to extreme states of rage, reacting excessively to apparently small triggers. If you work or live with an adult suffering with ADHD, remember a few essential steps for calming anger and communicating safely.
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Avoid sounding or looking upset, shocked or angry, even if a vase has just been smashed, a door slammed so violently it's become damaged, or a chair has been kicked over. Your general response in any from of ADHD management should be "C.P.R."--stay Calm, remain Patient and be Restrained. "Losing it" is frightening, upsetting and humiliating for the ADHD adult, and responding with anger or panic will pour gas on the flames. Try to keep still and composed.
Wait until the angry words have started to peter out before you say anything; interrupting the flow with your own comments, no matter how well intended, can intensify the frustration and add to the anger. Patience really is a virtue in a situation like this; effective ADHD management depends on it. The chances are that the angry adult will have experienced countless scenarios as a child where his inability to regulate his temper met with angry, frightened or punitive responses (or all three at once). He'll be anticipating the same reactions, so don't fulfil his expectations.
Don't offer advice or correct any misconceptions with wordy explanations in the heat of the moment. The psychoanalyst Fred Pine, in his work with patients who struggle to regulate their emotional balance and behaviour, recommended: "Strike while the iron's cold." Leave discussion and debate until the heat of the outburst has well and truly cooled, which could be several hours later or even the next day. Restraint is more effective than instant rectification when the emotional temperature's high.
Keep your comments simple and short. Psychoanalyst Jeffrey Seinfeld, in his 1990 book "The Bad Object," suggests that it's wisest to be very sparing verbally when you're in a fraught situation with someone of precarious emotional balance. An angry ADHD adult is overwhelmed with angry feelings--in "send" mode only, not "receive"--and will hear complex verbal responses very differently to the way you intend them. Psychoanalysts would say that she is overwhelmed with "transference" in moments like this, unable to see the real situation because she's become flooded with humiliation and rage transferred into the present from innumerable previous incidents. So, for instance, you might say "Not the paperweight," calmly and clearly, rather than "I'd rather you didn't throw the paperweight at the window because it'll cause a lot of damage and someone might get hurt." In "ADHD anger," there just isn't enough mental space available for the extra words; rage and distress will simply multiply if you try.
Leave all discussion about the episode, including future prevention strategies, until well after the angry incident is over. This means several hours, preferably a day, not least because the ADHD adult is likely to be awash with adrenalin, even if he superficially appears calmer a few minutes later. He's likely to explode again at the slightest trigger as a result--adrenalin at these blood concentrations takes hours, not minutes, to metabolise safely. Preventing violence often means leaving sufficient "cool down" time. It's a real milestone when an adult ADHD sufferer reads his own bodily signals in advance and voluntarily takes "time out" instead of erupting.
Tips and warnings
- Anger in ADHD is more related to panic than malice; an adult sufferer is emotionally much closer to a toddler having a tantrum than a hoodlum enjoying a fight, so someone else has to hold on to the adult position and remain calm through the storm.
- When anger erupts in an adult with ADHD, your priority is to restore calm, not to create insight or secure an apology. Immediate attempts to reach these results will usually seriously exacerbate the angry outburst, making it a potentially dangerous situation.
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