Lukenotes, Fall 2019
The Challenge of ADHD in Adulthood
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobiological disorder that usually presents in early childhood characterized by various combinations of problems with attention deployment, heightened physical activity level and lack of emotional or behavior self-control. Recent estimates suggest a prevalence of about 8.4 percent in children.
The manifestations of ADHD, occurring in 4.4 percent of adults, can vary over time. For example, the rambunctious, high energy, overactive child may become an outwardly calm and quiet, but internally restless adult. The disorder can be easily misdiagnosed in adults. Several of its symptoms occur in non-ADHD individuals, although at relatively lower levels of intensity and duration. Also, certain psychiatric and medical disorders have symptoms similar to ADHD, including major depression, anxiety, bipolar disorder, autism spectrum disorder, learning disorder, sleep apnea, hypothyroidism and hypoglycemia.
To further complicate matters, ADHD has a higher than average rate of co-occurring with anxiety/depression or undiagnosed sleep apnea. Although not included among the ADHD diagnostic criteria in the most recent revision of the Diagnostic and Statistical Manual published by the American Psychiatric Association (DSM-5), problems with identifying and regulating emotions occur more frequently in ADHD populations than in people who do not have ADHD. Examples of these would include mood swings, poor frustration tolerance, and difficulty censoring strong reactions. Research studies have shown that individuals with ADHD are at greater risk of having low emotional intelligence (EI) than non-ADHD individuals.
Emotional Intelligence
Though the concept of emotional intelligence dates back to the early 1960s, it was only popularized with the 1995 publication of the Daniel Goleman book, Emotional Intelligence: Why it Can Matter More than IQ. John Mayer and Peter Salovey played a primary role in developing EI as a psychological theory with their 1990 article, “Emotional Intelligence,” published in the journal Imagination, Cognition, and Personality. Mayer and Salovey defined EI as “the ability to perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions so as to promote emotional and intellectual growth.”
Emotional intelligence is comprised of various abilities present at birth, and acquired skills learned through experience and practice. Acquired EI skills appear to have nearly unlimited potential for growth throughout an individual’s lifetime. Thus, being born with low emotional intelligence is not a life sentence. One’s EI can be transformed in ways that markedly enhance success in interacting with one’s self or with other human beings.
The Importance of Emotional Intelligence for Healthy Relationships
Individuals with low emotional intelligence tend to experience stress easily, hold grudges, lack empathy, feel misunderstood and think that other people are overly sensitive. They do not understand how other people feel, refuse to listen to other points of view, and encounter more than usual difficulty coping with emotionally-charged situations. They make assumptions quickly and defend them vehemently.
By contrast, individuals with high EI have great social skills, are highly motivated, understand how people feel, and pay attention to what they are feeling. They are able to regulate their emotions, willing and able to discuss their feelings with others, and able to correctly identify their underlying causes of their emotions.
The Essential Contribution of Attention Abilities to Emotional Intelligence
ADHD symptoms negatively impact emotional clarity. In general, people with ADHD tend to have difficulty with social skills. When hyperactive/impulsive ADHD symptoms are predominant, the ability to actively improve negative emotions suffers. As is evident with ADHD, people who have low emotional intelligence encounter difficulty reading and responding to nonverbal cues that guide acceptable behavior in social or novel situations.
Self-awareness and the capacity for empathy are foundational components of EI. Both abilities are compromised in individuals with ADHD. Thus, treating ADHD while ignoring the potential negative impact of low emotional intelligence significantly limits an individual’s ability to realize their full potential. In similar fashion, failing to identify and remediate low EI in the absence of ADHD is associated with similar risks.
The Importance of Diagnosing Adult ADHD
Evaluation of EI is a primary component of a comprehensive ADHD assessment because of the strong connection between the two. Efficient diagnosis and treatment of ADHD requires determination of, and if needed, counseling specifically focused on improving EI.
Gary Thompson, Ph.D., is a retired member of the clinical staff at Saint Luke Institute.