Adult ADHD

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Dear Dr. Darcy:

My wife has been nagging me for years to see a doctor because she thinks I have ADD [attention deficit disorder]. She’s mad that I’ve been out of work for almost 6 months and am not Mr. Mom now that I’m home all day. Her attitude towards me has gotten so bad that I don’t even want to have sex with her anymore.

I’ve wondered on and off my whole life if maybe I have ADD, but I don’t want to see a doctor who’s going to put me on medication that will change who I am. I want to be Me, even if being me is flawed. Do doctors ever just prescribe therapy without drugs for ADD?

ANSWER

Good doctors do. Most do not.

It’s much easier (and more lucrative) for a psychiatrist to write out a prescription than to turn away a new patient / refer the patient out for therapy.  And most psychiatrists aren’t trained themselves to provide therapy, so the alternative to writing out a script would mean losing the patient. You can see how this sets up a conflict, right? But let’s get back to you:

You’ve got a problem, and it’s not just your wife. It takes 2 people to nag: One to ignore and the other to nag. If you’d do something different, she would too. You sound like you’re in a power struggle and that there’s a parentified dynamic going on with your wife playing the mom role and you playing the child role. No one wants to sleep with Mommy, so it’s no surprise to me that sex isn’t happening. Know that it’s within your control to make a decision to act differently which will, over time, result in her acting differently.

Now if your behavior is beyond your control, it’s time to see a shrink. Start with an ADHD specialist to determine whether or not you meet criteria for the diagnosis. If I were you, I’d see an LCSW or a PhD. I would not see an MD/psychiatrist for the exact reasons I described in the first paragraph of my response. If it turns out that you do have ADHD, I strongly recommend that you first work with your specialist on ADHD coaching to learn how to compensate behaviorally for your disability. Once you’ve got some new behavioral patterns in place, I’d suggest you consult with the shrink to see if he/she still believes that you need medication. At that point, I see no reason why you shouldn’t introduce a low dose medication to use in conjunction with the ADHD coaching. Used together, you are much more likely to have a positive prognosis.

I understand that you don’t want to change who you are. ADHD medication shouldn’t do that. I don’t think I’ve ever worked with a client whose personality changed as a result of ADHD meds. With that said, you keep yourself at a disadvantage in your refusal to determine once and for all whether you have this disorder. If you have ADHD and you're not being treated for it, it's like trying to drive a car on square wheels. Get yourself an evaluation so that you know what's what and then get to work on your marriage and on your career.

Writer’s Stats: Male, Straight.