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On the last track, we discussed interfacing on the job. We have also discussed the four challenging areas for the ADHD adult in the workplace. These four challenging areas were Written Rules, Unwritten Rules, Communication, and Managing ADHD Symptoms.
On this track, we will discuss boundaries and communication in the ADHD family. As you know, ADHD tends to run in families and dramatically alters the dimensions of the family unit. This can create a number of challenges for the ADHD family regarding both physical and emotional boundaries, as well as non-verbal communication. At the end of this track, we will discuss the "Message Center" tool that could be beneficial for an ADHD family.
John, age 43, and Helen, age 42, have been married for 15 years. Both are diagnosed with ADHD, but each exhibits different symptoms. John’s primary symptom is hyperactivity, while Helen is mostly inattentive and disorganized. Their three children have also been diagnosed with ADHD. Melanie, age 13, is intelligent but a chronic underachiever. Melanie’s primary ADHD symptom is noncompliance; she constantly creates trouble. Robert, age 10, has been diagnosed not only with ADHD, but also with a learning disability.
Robert also suffers from several physical health problems: asthma, severe allergies, and frequent stomach aches. Finally, the youngest daughter, Tiffany, age 8, has inherited her father’s hyperactivity in her ADHD. Tiffany does poorly in school and is content to be the class clown. Sound like a family you may be dealing with?
In a recent session, John and Helen mentioned a disagreement they had had, and a war that had recently erupted between the three children, during one morning’s events. John had been sitting at the breakfast table reading a newspaper and drinking coffee when Helen began talking to him.
John stated, "There I was, trying to wake up with my coffee and get the news before work, and Helen had to come in, chattering. I tuned her out and kept reading. Partway through my reading, I remembered that it was garbage day, and I reminded her to take the trash out. She got angry and said she had just told me to do that a few minutes ago, but I wasn’t listening. But we’ve been married 15 years! She should know better than to talk to me when I’m still waking up!"
Helen added, "If that wasn’t enough, Tiffany ran in and just jumped on me for a hug. I was still annoyed with John, so I got angry at her." Helen explained that after she sent Tiffany away, Tiffany ran into Melanie’s room and jumped on her bed to kiss her. Helen stated, "Melanie’s not a morning person, either, so she pushed Tiffany off the bed." John explained that after Tiffany had awakened her, Melanie decided to take a shower, and had just gotten undressed when Robert walked in to brush his teeth. John stated, "We could hear her yelling all the way downstairs." Helen added, "That morning was a nightmare!"
As you know, most ADHD families experience some degree of difficulty in their interactions. In the above ADHD family describe, each member has difficulties understanding boundaries and communicating well with other members of the family. I stated to John and Helen, "Families who live under the same roof share both physical and emotional spaces. It seems that some members of your family have a poor sense of these physical and emotional boundaries." I explained to them that awareness of these boundaries relies on good non-verbal communication skills.
"Message Center" Technique
I stated, "Put this board in a prominent place, like the kitchen. It might also be helpful if it’s next to a phone." I explained that they should then divide the board into six sections, one for each John, Helen, Melanie, Robert, and Tiffany, and a general section for everyone to share. I stated, "Keep an ample supply of paper and pens near this board." I explained that every message posted should include a signature of the person who posted the message, as well as the date and time that the message was posted.
I stated, "Everyone should be encouraged to make a habit of checking the ‘Message Center’ several times a day, including when they come home. Once someone has read a message, he or she should remove it from the board." As you know, removing old notes will reduce visual clutter and improve the odds that no one will overlook posted messages. Finally, I explained to John and Helen how the general section might work.
I stated, "If someone adds a message to the general board, he or she could initial it. As each member of the family reads that message, he or she may also initial it. When the last reader has read that message, he or she will know that he or she was the last one, and can remove the message from the board." Does the "Message Center" sound like a tool that might be useful for the ADHD family you are currently treating? Would playing this track be beneficial in your next session? The "Message Center" is an obvious idea but one that can be easily overlooked.
On this track, we have discussed the challenges the ADHD family faces regarding boundaries and communication. We also discussed the "Message Center" tool.
On the next track, we will discuss common comorbid conditions that adults with ADHD may face.
Peer-Reviewed Journal Article References:
Atherton, O. E., Lawson, K. M., Ferrer, E., & Robins, R. W. (2020). The role of effortful control in the development of ADHD, ODD, and CD symptoms. Journal of Personality and Social Psychology, 118(6), 1226–1246.
Becker, S. P., Mossing, K. W., Zoromski, A. K., Vaughn, A. J., Epstein, J. N., Tamm, L., & Burns, G. L. (2020). Assessing sluggish cognitive tempo and ADHD inattention in elementary students: Empirical differentiation, invariance across sex and grade, and measurement precision. Psychological Assessment. Advance online publication.
Bottini, S., Polizzi, C. P., Vizgaitis, A., Ellenberg, S., & Krantweiss, A. R. (2019). When measures diverge: The intersection of psychometric instruments and clinical judgment in multimodal adult attention-deficit/hyperactivity disorder assessment. Professional Psychology: Research and Practice, 50(6), 353–363.
Fabiano, G. A., Schatz, N. K., Morris, K. L., Willoughby, M. T., Vujnovic, R. K., Hulme, K. F., Riordan, J., Howard, M., Hennessy, D., Lewis, K., Hawk, L., Wylie, A., & Pelham, W. E., Jr. (2016). Efficacy of a family-focused intervention for young drivers with attention-deficit hyperactivity disorder. Journal of Consulting and Clinical Psychology, 84(12), 1078–1093.
Raz, S., & Dan, O. (2015). Behavioral and neural correlates of facial versus nonfacial stimuli processing in adults with ADHD: An ERP study. Neuropsychology, 29(5), 726–738.
Sibley, M. H., Graziano, P. A., Kuriyan, A. B., Coxe, S., Pelham, W. E., Rodriguez, L., Sanchez, F., Derefinko, K., Helseth, S., & Ward, A. (2016). Parent–teen behavior therapy + motivational interviewing for adolescents with ADHD. Journal of Consulting and Clinical Psychology, 84(8), 699–712.
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