ADHD Couple & Family Relationships

Enhancing Communication through Imago Relationship Therapy

Relationship Skills Deficits

Adolescents and adults with ADHD often experience social skills deficits and have poorly developed communication skills. Accurately reading and interpreting social cues (body language, facial expression), a crucial component of developing good social skills, is often challenging to ADHD individuals. Their distractibility, impulsivity, sensitivity, over-reactivity, self-focus, and poor self-regulation can interfere with learning these important skills. Children with ADHD often miss the important details involved in mastering social skills through observing, copying, practicing, and receiving feedback.

Adults may have learned some of these skills, but they have often missed important pieces and may not even know they are missing them. Many ADHD individuals have suffered from social isolation or rejection due to having had their ADHD behaviors misattributed to selfishness, lack of caring, thoughtlessness, laziness, stupidity, or craziness. For example, when an ADHD individual is late, others tend to attribute this to a lack of caring or selfishness, rather than understanding that time management is a chronic problem for many people with ADD.

Low self-esteem is a contributing factor to the development of relationship deficits in ADHD individuals. For many, they have experienced a life replete with broken relationships. They have often felt disliked by parents, teachers, and peers. Many of their problematic behaviors, such as tantrums, arguments, and poor anger management, are indicators of relationship problems that continue into adulthood in the form of loud, angry arguments with family, friends, and even bosses.

When growing up, children with ADHD were frequently bombarded with countless criticisms over behaviors that bother adults, with little or no focus on what the child needs. Others typically don’t understand how an ADHD individual experiences the world, and thus they often do not feel heard or understood. Having a parent understand and hear how hard it is for adolescents to do their chores, start their homework, turn off the television or videogame, get themselves to bed, and get out of bed in the morning may make it more likely that parents and their children will engage in problem solving, rather than blaming, criticizing, and arguing.

ADHD parents typically compound the problem due to their own difficulties tuning into social cues, being distracted, and generally being busy, hurried, and disorganized. This cycle of frustration, blame, criticism, and lack of understanding forms the core experience of many ADD individuals in relationship with others, beginning in childhood and continuing though adulthood.

For some ADHD individuals, maintaining an orderly and clutter-free home environment is essential for them to function effectively. Without it, they experience significant anxiety about losing control — not seeing important bills and papers among the piles of clutter, forgetting critical events, or losing key items. A boisterous family’s typical noise and chaos can be overstimulating for many ADHD sufferers. Likewise, stressful home environments in which there are high levels of conflict, tension, or depression can exacerbate already challenged executive functioning and overload highly sensitized receptors.

Another common family stressor is the tendency to take on too many activities, resulting in stressful over-scheduling. These over commitments can intensify ADHD difficulties with time management, lateness, and forgetfulness, as well as not leave any down time to recuperate from life’s daily stresses. These issues illustrate the bilaterality of the relationship impact between ADHD individuals and those who share their environment.

ADHD Behaviors That Impact Relationships

The development of poor communication skills probably results from a combination of social skills deficits and other typical ADHD behaviors, which interfere with healthy communication in relationships. Many ADHD individuals feel under-stimulated and may attempt to self-stimulate by seeking conflict and provoking others. Some seem to always need to have the last word, to create arguments, and to be unable to refrain from arguing once they have begun. Their inattentiveness can result in divided attention while listening to significant others, only hearing parts of what was being communicated. The tendency to have difficulty holding onto thoughts, combined with impulsivity, may result in interruptions, speaking over others, and failing to communicate, believing they already had (“I thought I told you”).

Another common challenge among ADHD individuals is emotionally sensitivity and overreactivity. Many have a “hair-trigger” reactivity and may be prone to outbursts and moodiness. They are easily irritated, offended, and hurt due to their being instinctively responsive to the smallest changes in the environment, both physical and emotional. This hypersensitivity and subsequent hyper reactivity can be off-putting to spouses, family members, and others in the community. Others may respond by downplaying or negating what appear to be excessive reactions, by criticizing the individual as too thin-skinned, defensive, or sensitive, or by retreating from the intensity of the emotional response. This intense reactivity prevents ADHD individuals from being fully emotionally available to hear others, which often leads to further exacerbation of the conflict or power struggle.

Impulsive behavior can also significantly impact ADHD relationships. There appears to be little mediation between the impulse to do something and the logical brain centers that allow us to slow down and think it through first. It is challenging for ADD individuals to learn to “put on the brakes,” or “stop, look, and listen” before acting. The resulting impulsive behaviors can take many forms, such as crossing the street or changing lanes without looking, taking on too many activities, making plans or purchases without consulting spouse or family, and making poor decisions. Impulsive spending can be a huge problem in many ADD families, potentially leading to bankruptcy and/or divorce. The combination of poor self-control, stimulation seeking, and self-medication can lead to compulsive or addictive behaviors as well.

Executive dysfunction, creates yet another set of problematic interpersonal behaviors. Organizational and memory problems contribute to relationship conflicts, both within couples and between adolescents and parents. Disorganization and forgetfulness lead to piles of unfinished laundry, clutter, chronic lateness, lost keys, missed events, and unpaid bills. These behaviors decay trust over time; the ADHD individual cannot be counted on to “execute.” Disappointment sets in and often results in causing the spouse to feel unimportant.

Imago Relationship Therapy: The Couple’s Dialogue

Little has been written about how to help individuals with ADHD in relationships, but several authors have written about the application of Imago Relationship Therapy and similar communication strategies with ADHD couples. My ADHD husband and I attended an intensive Imago Couples Weekend Workshop, where I experienced the power of the process firsthand. I have now incorporated Imago Relationship Therapy into my ADHD clinical practice and find it extremely ADD-friendly, although it can be quite challenging at times to help some ADD clients calm their reactivity sufficiently enough to fully hear their partners. However, once they learn the process, they too appreciate the benefits of it. Imago Relationship Therapy (IRT), a couple’s treatment, was originally developed by Harville Hendrix, Ph.D., and popularized in his book Getting the Love You Want: A Guide for Couples (1990).

The primary tool used to teach couples to communicate more effectively is called The Couple’s Dialogue. It is a structured process that helps create the emotional safety required for people to communicate their needs or vulnerabilities to each other, without being defensive. It restores empathic connection, which allows us to relax our defenses.

Most of us resort to angry criticism, loud repetition, outbursts, tears, or defensiveness when communicating to a loved one about a “hot topic.” When we survey our environment and experience it as safe, we feel free to play, nurture, and mate. However, if our reptilian brain senses “danger” (a critical spouse/parent), we tend to respond in characteristic self-protective patterns. Some of us will “hide” in our shells like a turtle and withdraw, isolate, disengage, or avoid — these are the minimizers. Others of us will maximize our energy outwardly and go after our loved one demanding to be heard, yelling, lecturing, or becoming overly emotional.

These instinctive reactive patterns exist in all dyads and tend to exacerbate conflict or power struggles. The goal of using the dialogue process is to have individuals learn to calm their reactivity and to listen to their partner in an attempt to understand, validate, and empathize. This internal reactivity is typically even stronger in relationships in which one or more of the individuals have ADHD.

The Couple’s Dialogue process is ADD-friendly because it slows things down, provides structure, reduces reactivity, and helps the receiver be fully present so that the sender can be fully heard. It facilitates understanding and problem solving by creating emotional safety. While the dialogue procedure is quite simple, it is very important that the format be carefully followed. The overall dialogue process consists of three parts: mirroring, validating, and empathizing.

Initiating a Dialogue

The person who wants to send a message would initiate the dialogue by asking the other person: “I would like to have a Dialogue. Are you available now?” It is the Receiver’s job to agree to have a dialogue as soon as possible, now optimally. If not now, the Receiver must set a time to do so and commit to it. If available, the Receiver replies: “I am available now.” The Sender then begins to send the message, preferably by focusing on expressing the emotional impact of a situation/behavior/event on themselves, rather than by attacking or criticizing the other. Ideally, the couple should be facing one another during the dialogue and maintaining eye contact as much as possible.

Mirroring

After hearing the message, the Receiver then mirrors back what he heard by saying: “If I heard you correctly…or if I’ve got it right, you said…” and then paraphrasing the Sender’s message. It is important that the Receiver not be allowed to edit any of the material or react to it as he is mirroring it back. The “mirror” must be neutral (accurate), not concave or convex; otherwise the reflection will be distorted, as in a fun house. The Receiver then asks, “Did I get it?” The Sender then says “Yes,” or corrects the Receiver as needed. The Receiver mirrors back the correction and asks again if he got it. Once he has accurately reflected back the Sender’s material, the Receiver then asks “Is there more?” This needs to be asked in a tone that conveys a genuine desire or willingness to know more, rather than an exasperated tone conveying that the Receiver cannot handle anymore. The Sender then continues sending the message until it is completed and the Receiver continues to mirror, check the accuracy of it, and invite the Sender to say more until the Sender says “No, there is no more.” At this point, the Receiver summarizes the Sender’s entire message saying: “Let me see if I got all of that…” and then checks for accuracy “Did I get it all?” The Sender listens to the summary and then gives the accuracy check (e.g. “Yes, you got it all.” Or, “You got most of it but you missed…”).

Validating

Once an accurate summary has been made, the Receiver goes on to validate the Sender’s point of view by saying: “You make sense, because…” and then briefly stating the logic of the Sender’s message. The Receiver is to make sense of the Sender’s message without necessarily having to like it or agree with it or even make sense of all of it. It is important that the Receiver not go off on a lengthy discourse interjecting his own reaction or opinion at this stage. The Receiver merely states what part makes sense.

Empathizing

Lastly, the Receiver must empathize with the Sender by saying: “I imagine you might be feeling…” or “I can see that you are feeling…” if feelings are obvious. The Receiver chooses two or three feeling words (i.e., angry, hurt, frustrated, disrespected) in guessing how the Sender feels or felt and then checks for accuracy. “Is that what you are feeling?” or “Did I get it right?” The Sender then confirms the guesses, adds to them, or corrects them. The Receiver mirrors this back and, if appropriate, asks: “Is there more about that feeling?”

Exchanging roles

When the Receiver has gone through all three parts (mirroring, validating, and empathizing) then s/he would say: “I would like to respond now.” The Receiver now becomes the Sender and vice-versa.

The process described above is effective for helping dyads connect and understand one another in ways that typical “conversations” do not allow. It delights me to bear witness to the transformation in empathic connection when couples use this approach. What one moment seemed like an insurmountable obstruction melts into a genuine understanding of the other’s perspective. This technique is also very effective for parent-child dyads, and between friends, associates, or colleagues.

To better illustrate how this process works both with couples and in parent-teen dyads, I will describe two different cases in which the Couple’s Dialogue was used to enhance communication.

Case Illustration with Adolescent Client and Parent

This case focuses on a parent’s need to serve as a frontal lobe for their ADD teen. Many parents have a difficult time knowing when to back off and allow adolescents to manage themselves and learn to separate. These parents have been managing their children for years, serving as their executive functioning (frontal lobe). It is often difficult for parents to scale this back and watch their child “screw up.” This sets up a self-defeating cycle because the adolescent needs to engage in the struggle to self-manage and “grab life by the horns,” yet the parent will often hold him back in an effort to save him from himself.

In the following case, a 15-year-old ADHD boy is locked in this battle with his mother, who has been micro-managing him for years. She typically phones him multiple times each afternoon, between the end of his school day and her return home from work. Each call is a reminder to perform certain tasks or to attend a specific appointment. With each call, he becomes increasingly resentful, speaking to her in a rude manner or not answering at all. She is convinced that if she does not provide constant reminders, he will forget to do important tasks (e.g. let the dog out). He would like to be left alone, arguing that he knows what he needs to do without her reminders.

I chose to engage them in a couple’s dialogue process to foster a better understanding of each other’s perspective. To illustrate how a specific request is made for a behavioral change, I will begin by inviting “mom” to be the sender, although generally I begin by having the teen express his frustration first.

Mom: I know that you get upset when I call to remind you about your chores or schedule, but I know that if I don’t, you will forget something important. I worry that Buster (the dog) won’t get let out in time, and you know that she is old and has a hard time waiting for us to come home to let her out. I really don’t want to have to clean up her messes when I get home. I’m afraid that you will keep missing your doctor’s appointments and lessons if I don’t call to remind you. You get so distracted by turning on your computer games and instant messaging your friends that I worry you will put off your homework too long and not finish it.

Therapist: OK, Mom, let’s pause here and let John catch up with you. John, let’s see if you’ve got that so far.

John: OK (takes a deep breath and sighs) …So, what I think I heard you say is that you have to always remind me of everything because otherwise I will forget (sighs heavily) …let’s see…you think I won’t let Buster out in time (like I would ever forget about Buster!)…and I will miss my lessons or doctor’s visits. You think I am on the computer too much and that I forget to do my homework…Did I get it?

Mom: Mostly, but I want you to understand that I am trying to help you and that I really get worried that you will forget something important if I don’t call you. You even forget things when I do remind you! I would feel responsible if you messed up and I had not tried to help you to stay on track. It is really hard for me to let go of that responsibility.

John (interrupting): But Mom, I am 15 years old!

Therapist (interjecting): John, please just mirror your mother without commenting on what she is saying. (Gesturing toward John to begin mirroring and feeding him the sentence stem…) What I heard you say is…

John: What I heard you say is that you think I can’t handle things by myself and that even when you remind me I forget things anyway…Then, you said something about how hard it is for you to let go of trying to tell me what to do because you think I will screw-up if you don’t… Did I get it?

Mom: Yes, mostly, except that I hope you know that I am doing this to help you.

John (rolls eyes): You nag me because you think it helps me. Is there more?

Therapist (interjecting): Mom, help John understand more about why it is so hard for you to let go. [It is easier to get John to empathize with her if she can express her feelings more]

Mom: OK, I’ll try. It scares me to let go because it pains me to see you suffer the consequences of your mistakes or oversights. I want to help you to be successful and happy, and when I see you not following through on important tasks, it really worries me. I know how important it is for you to go to a good college, and it is hard for me not to help you do all that you can do to have that opportunity.

John: So, you said that it hurts you to see me make mistakes or not follow through on things because you worry that I won’t get into a good college or be successful. Did I get it?

Mom: Yes, you got it.

John: Is there any more?

Mom: No, not really. I just wish we could find a way to work together so that I could help you without you being so resentful.

John: So, you’d like to find a way to help me without being a nag.

Mom: Yes.

John: Is there any more?

Mom: No, not for now.

Therapist: John, now you need to summarize everything that you heard mom say.

John: OK, I’ll try, but it is hard to remember it all. I think you said that you are worried about me because I forget things and don’t follow through… so you feel responsible for nagging me about everything… so that I can be successful and go to a good college. Did I get it all?

Mom: Mostly. I also said that I wish we could find a way to work together so that you don’t get so upset with me.

John: Oh, yeah, you want to find a way to tell me what to do without me getting mad about it.

Mom: Something like that.

John: Is there more?

Mom: No.

Therapist: John, now you need to validate your mom by telling her what makes sense about what she said, in one or two sentences. Please refrain from commenting on what she said.

John: I guess it makes sense that you want to try to help me and that it is hard for you to see me mess up.

Therapist: OK, now I would like you to imagine how your mom might be feeling about all this. I imagine you might be feeling…

John: Let’s see… worried… frustrated…concerned.

Mom: Right, you got it.

Therapist: Now, John, you are the sender. You can start by responding to what your mom said, or you can bring up another frustration.

John: Hmmm. I’ll try to respond to what she said. Mom, I know that you nag me because you think that you are helping me and that you want me to do well, but it is really hard for me to deal with. It makes me feel like you think I’m a stupid idiot, who can’t do anything for myself. Yeah, I sometimes forget things, like everybody does, but I can handle things on my own. I don’t need your help. It really pisses me off when you keep bugging me. I can’t stand to even be in the same house as you, or even talk to you on the phone. Please leave me alone!

Mom (sighing): OK, let me see it I got all of that. You hate it when I nag you because it makes you feel like you must be an idiot or something. You want me to leave you alone because you think that you can handle things without my help. Did I get it?

John: Yeah.

Mom: Is there more?

John: Just let me deal with things myself and back off.

Mom: You want me to just let you handle things your own way and stay away.

John: That’s right.

Mom: Is there any more?

Therapist: John, to help mom better understand what you really want her to do, I’d like you to come up with a specific request that would help to meet your need to be left alone.

John: OK, I’ll try. (Long pause) What I really want you to do is to let me handle my regular daily chores without you bugging me about them at all. If you must, you can remind me about things that are different in my schedule or extra stuff that comes up.

Therapist: OK, to make this really specific, how about if you propose that mom not phone you or remind you about any of your regular daily tasks for one month, and then we can all reassess if that works for both of you.

John: OK, that sounds good. Mom, I’d like you to let me show you that I can handle my own regular chores without you reminding me about them for the next month.

Mom: So, you want me not to remind you about your regular chores for the next month.

John: Yes.

Therapist: OK, mom, please validate what John has been saying and let him know if you accept his request.

Mom: It makes sense that you want the chance to do your regular daily chores on your own, without me bugging you about them, and I agree to not call or remind you about them for the next month.

John: Great. Thank you.

Therapist: Mom, please empathize with John and try to imagine how he feels about what he described to you earlier.

Mom: I imagine that you feel frustrated, angry, and… maybe belittled? Did I get it?

John: Yeah, that sounds about right.

Therapist: OK, now we have a plan to try that will hopefully work for both of you.

This dialogue format allowed John and his mother to communicate in a structured manner, which served to contain their typically reactive styles. It enabled them to hear one another without using criticism, yelling, or avoiding, and helped them to come up with what could be a win-win solution.

Case Illustration with Adult Client Couple

This couple struggles with the common ADHD conflicts of cleaning up after oneself and completing projects that have been started. Jan is an organized, detail-oriented individual who appreciates a tidy, well-run home. She is married to Roger, who was diagnosed with ADHD a year ago and is currently taking stimulant medication and an anti-depressant. Jan, who works full time, is helping Roger to raise his three ADHD children from a previous marriage. She is often left in charge of running the household, enforcing rules and chores, and organizing everyone. Jan becomes hurt and resentful when Roger leaves messes in various locations around the house, which are typically the result of an incomplete project still in progress. Roger, having a lifetime of criticism behind him, is hypersensitive to Jan confronting him about these messes and becomes enraged. Through using the IRT Couple’s Dialogue process, they have been learning how to break this destructive cycle and really hear and understand one another’s needs and feelings. The following contains excerpts from one such dialogue.

Jan: I feel really frustrated and upset when you leave piles of materials all over the house from unfinished projects. It seems like you don’t care about keeping the house in order and that leaves all the work on my shoulders. I just can’t handle everything myself, it is too overwhelming for me.

Roger: If I hear you correctly, you are saying that you get really frustrated and angry with me when I leave junk all over the house from my projects, and that it makes you feel overwhelmed. Did I get it?

Jan: Yes, that’s right.

Roger: Is there more?

Jan: I don’t understand why you get so angry with me when I calmly point out the mess and tell you what is bothering me about it. I am the one who is upset about it, and when I tell you that, you blow up at me, like I did something wrong. It really hurts me and makes me feel unimportant and unappreciated when you do that.

Roger: OK, you feel hurt when I get mad at you for pointing out my messes.

Therapist (interjecting): and you feel… (leading Roger).

Roger: And you feel… unimportant and unappreciated when I do that. Did I get it?

Jan: Yes.

Roger: Is there more?

Therapist: Jan, tell Roger what you’d really like from him to help you feel more appreciated or important.

Jan: (pauses to think): I guess what I’d really like is for you to just let me vent for a minute about seeing the mess and how much it upsets me, without getting angry with me.

Therapist: Let him know if you would like him to mirror you when you vent about it.

Jan: Yes, I would like that. I’m not really angry with you, Roger; I just get overwhelmed by the extra work I have to do. I think it would help if you could just mirror me.

Roger: You would like me to just let you vent and then mirror you when you are upset.

Jan: Yes, I would like that very much. That would feel good.

Roger: Is there more?

Jan: No, that’s all.

Therapist: Roger, please summarize all that you have heard Jan say.

Roger: OK. What I heard you say is that you get upset when you see extra messes that I leave around the house. It seems overwhelming to you. Then, when I get angry with you for fussing at me, you feel … let’s see… unimportant and unappreciated. What you would really like is for me to just let you vent and then mirror you without getting upset myself. Did I get it all?

Jan: Yes, you got it!

Therapist: Now please validate Jan in one or two sentences. What makes sense about what she said?

Roger (thinking): It makes sense that you feel overwhelmed by all the work you have to do around the house, what with the kids and all, and that you get upset about seeing more messes around from me. And, I can see why you would like me to just mirror you without getting angry with you. That makes sense.

Therapist: And I imagine all that leaves you feeling… (leading him to empathize with Jan).

Roger: Let’s see… you feel hurt, frustrated (pause) …unappreciated and unimportant. Did I get it?

Jan: Yes.

Therapist: OK, now it is Roger’s turn to be the sender. Roger, you can either respond to Jan, or express another frustration.

Roger: I’d like to respond to what Jan brought up. It really upsets me when you keep criticizing me. I get so angry that I can’t stand it, and then I know I say some pretty hurtful things to you. I don’t mean to do that, but I don’t know how to stop from getting so very angry when you come after me like that.

Jan: So, if I heard you right, you get very angry when I vent about something that you did, and you feel criticized. Did I get it?

Roger: Yes.

Jan: Is there more?

Therapist: Roger does that feeling remind you of anything in the past?

Roger: Yes. My father was so critical and was always finding fault with everything I did. He was a real yeller and he was pretty intimidating. I could never do anything right.

Jan: So, your father used to yell at you and criticize you a lot as a kid. It seemed like you could never do anything right. Did I get it?

Roger: Yes, mostly. It was really scary as a kid.

Therapist: Tell Jan if it is scary when she yells at you.

Roger: Yeah, it is pretty intimidating. You get so passionate about your feelings that it overwhelms me and makes me feel like a little kid who is being yelled at all the time for screwing up.

Jan: So when I vent my feelings it feels pretty overwhelming and intimidating, kind of like you felt as a scared little kid when your dad came after you.

Roger: Right.

Jan: Is there more?

Therapist (leading Roger): What I’d really like from you…

Roger: What I’d really like is for you to just calmly tell me to please pick up my stuff, or whatever you’d like me to do, if you see something that bothers you. Just tell me to take care of it and I will.

Jan: So, you would like me to just tell you to pick up your mess when I see something that upsets me. Did I get it?

Roger: Yes.

Jan: Is there more?

Roger: No, that’s all.

Therapist: Jan, please summarize all that you heard Roger say.

Jan: OK, if I’ve got it all, you said that you get scared and intimidated when I vent about things I see that bother me in the house. You get really angry and feel like you can’t stop yourself from saying hurtful things when you get like that. You explained that it reminded you of how it was as a kid when your father yelled at you and made you feel like you could never do anything right. Then, you asked me to just tell you to pick up your stuff instead of getting upset about it like I do.

Roger: Right, you got it.

Jan: Is there more?

Roger: No, that’s it for now.

Therapist: Jan, please validate Roger and then empathize with him.

Jan: It makes sense that you get upset and intimidated when I vent because it reminds you of how scary your father was when you were a kid. It makes sense that you might feel criticized when I do that since you never felt like you could do anything right as a kid. I will try not to vent and just calmly ask you to pick up your mess.

Roger: Thanks.

Jan: I imagine that you must feel intimidated, upset, and maybe hurt, when I vent after seeing a mess you made around the house.

Roger: Yeah, you got it.

This dialogue process allowed Roger and Jan to more deeply understand how their behavior impacts one other, and to learn specific ways in which they could change their behavior to avoid the typical “dance” they do.

Summary and Conclusion

Most ADHD individuals experience some relational challenges with partners, children, friends, and employers. However, there are effective strategies available to enhance good communication and strengthen relationships.

Imago Relationship Therapy (IRT) is a brain-based approach that is highly compatible with ADHD. It facilitates healthy communication by slowing down the process, providing structure, and containing reactivity, so that the participants can fully hear one another. It encourages the development of stronger listening skills and better self-control to enhance understanding and problem solving. Other strategies include encouraging clients to perform caring/loving behaviors for their partner, such as calling them at lunch time, massaging their feet, or bringing them coffee. Going on regular dates together and finding ways to laugh and have fun together are also very important. Giving each other surprises, such as flowers, goodies, love notes or tickets to a favorite event, also enhance relationships. Couples, and parents, are encouraged to express appreciations daily, acknowledging the efforts of loved ones and thanking their spouse or children for performing certain task/behaviors, and complementing one another.

Finally, it is important for ADHD individuals to take responsibility for managing their ADHD by taking prescribed medications faithfully, exercising regularly, and maintaining an ADD-friendly lifestyle, in order to reduce the impact of the disorder on their loved ones when possible. Spouses of ADHD individuals must also educate themselves about the disorder to avoid misinterpreting their partner’s behavior, or contributing to the creation of an ADDunfriendly environment for them.

Select References and Recommended Readings

• Cohen, C. Raise your child’s social IQ: Stepping stones to people skills for kids. Silver Spring, MD: Advantage, 2000.
• Frederick, B.P., & Olmi, D.J. Children with attention-deficit hyperactivity disorder: A review of the literature on social skills deficits. Psychology in the Schools, 1994.
• Halverstadt, J. Romantic relationships for women with ADHD. In K. Nadeau & P. Quinn (Eds.), Understanding women with ADHD (pp. 409-424). Silver Spring, MD: Advantage, 2002.
• Halverstadt, J. A.D.D. & romance: Finding fulfillment in love, sex, & relationships. Dallas: Taylor, 1998.
• Hendrix, H. Getting the love you want: A guide for couples. New York: Harper Row, 1990.
• Hendrix, H., & Hunt, H. Giving the love that heals: A guide for parents. New York: Pocket, 1997.
• Landau, S., & Moore, L.A. Social skills deficits in children with attention-deficit hyperactivity disorder. School Psychology Review, 1991.
• Mate, G. Scattered: How Attention Deficit Disorder originates and what you can do about it. New York: Plume, 1999.
• Nadeau, K. Understanding girls with ADHD. Silver Spring, MD: Advantage, 1999.
• Novotni, M. What does everybody else know that I don’t? Social skills help for adults with attention-deficit hyperactivity disorder (ADHD). Plantation, FL: Specialty Press, 1999.
• Robin, A., & Payson, E. Can your marriage survive ADHD? Presented at the CHADD National Conference, Chicago, 2000.