After the spirited discussion about my two posts on ADHD symptoms, I felt eager for more experience working with someone who considered himself “ADD”; my intake on Friday with a new Skype therapy client did just that and, even in the first session, provided many details that pointed toward a psychological explanation for his ADHD symptoms.
Adam told me he had been diagnosed as an adult for having a history of difficulties in the areas of concentration, classroom behavior, and for performing below his ability level. He has taken medications for two years.
Over the course of the session, Adam described his struggles in several different areas. His main concern — the reason for beginning treatment — is his recent infidelity, uncovered by his wife, which is jeopardizing his marriage. He also talked about problems at the law firm where he is a first-year associate.
In preparing for a recent trial, he “went AWOL” in order to be with his wife on a day when she was awaiting some important test results. He told no one at the firm he’d be away, he just simply disappeared. The partner on the case kept calling and texting him throughout the day but Adam ignored him. He felt the other associate on the case could handle the trial prep that day and they didn’t need him.
When he returned to the office, the partner was furious. As a summer associate at a different firm two years ago, Adam had run into similar difficulties with the higher-ups and didn’t follow through on assignments; at the end of the summer, he did not receive an offer to return once he finished law school.
Adam also talked about a minor history of stealing as a child — nothing big, but he recalled the excitement of taking something that he wanted without paying for it. Throughout grade school, because he’s extremely bright and things come easily to him, he often felt bored; as a result, he disrupted the class or failed to turn in assignments because they didn’t interest him.
When we returned to the issue of infidelity, he said he had known better than to cheat, but that he somehow managed to convince himself that it was no big deal. I can’t remember exactly when the light bulb went off, but it felt clear enough to put forward a hypothesis: there’s a ruthless part of Adam that just wants what he wants whenever he wants it, who feels that rules are for other people and doesn’t care how his behavior may affect them.
Another part of him cares very much — his love for his wife and his concern that he’s jeopardizing their marriage — but it’s this anti-social part of him that causes so much trouble.
He accepted this idea right away, confirming it with other examples from his past. I suggested to him that what he referred to as his ADHD symptoms might be related: he turns away from what he finds boring or too frustrating because a part of him feels he shouldn’t have to pay attention or work hard the way that other people do.
This made sense to him and he commented that, when he and his wife had been looking at possible psychological explanations for his behavior online, they had both identified “anti-social personality disorder” as having many features that sounded relevant. His wife has recently described him as cold and heartless. We agreed there was little value in the label, but that there was a side of him that could behave in very anti-social ways.
So … ADHD symptoms as a turning away from reality when it doesn’t conform to what you want; the rejection of the experience that feels too frustrating or boring inevitably breaks your concentration and undermines your performance. Of course this is only one possible origin for such symptoms.
It will also be important that Adam understand this isn’t a kind of blaming in the old sense — that those with ADHD symptoms simply need to “try harder.” Instead, we need to bring “anti-social Adam” into the light and show how that side of him causes trouble.
Toward the end of the session, we also talked about that side of him as a “con man” who convinces him that doing whatever he wants in the moment is acceptable, so effectively that he doesn’t realize he is making a choice. Making this process more conscious will help Adam to make better choices.