Interacting with Others: Tips for Adults with ADHD

People with attention-deficit/hyperactivity disorder (ADHD) often have social problems. They may have problems with relationships and may be rejected by other people. The problems often come from their symptoms, which include inattention (not being able to pay attention); impulsivity (doing and saying things before they think); and hyperactivity (being overly active).

These social problems can be painful to people with ADHD. They also may contribute to other psychiatric disorders such as depression or anxiety.

This What We Know sheet will help adults with ADHD by:

• describing how symptoms of ADHD can result in social and relationship issues
• suggesting ways to find out whether an adult with ADHD interacts well with others
• suggesting ways to help adults with ADHD get along well with other people

ADHD and Interacting with Others

It is not hard to understand why people with ADHD often have a hard time interacting with other people. Fifty percent to 60 percent of children with ADHD have difficulty getting along with other children. Adults with ADHD very often are lonely and isolated because they haven't learned the social skills others expect them to have, such as listening, polite behavior and following through on responsibilities.

To get along well with others, people must be able to pay attention, to be responsible, and to control their impulses. Adults with ADHD are often inattentive and forgetful, and they generally do not have good control over their impulses.

ADHD is not a disability that others can see, so people who don't know what it is may think that the behavior of someone with ADHD is simply rudeness or laziness or just being self-centered or irresponsible. These and other negative labels can lead to rejection of the person with ADHD.

Rejection by others such as coworkers, family members and friends causes emotional pain, which can lead to low self-esteem and many other problems throughout life. Inappropriate behaviors may anger a friend or spouse and the friend or spouse may eventually "burn out" and give up on the friendship or marriage.

Teaching people with ADHD, their loved ones and their friends about ADHD and how it affects social skills and behavior can help lessen the blame, conflicts and rejection. People with ADHD can learn to interact well with others and to improve their social lives.

Learning the Skills to Get Along with Other People

Social skills are generally learned by watching people, copying the behaviors of others, practicing and getting feedback. This normally begins in childhood and improves as one gets older.

People with good social skills are accepted by others. People with ADHD or who don't have such skills are often rejected -- and rejection and isolation gives them even fewer chances to learn how to behave with family and others. This cycle leads to even more rejection, and so on. People begin to avoid the person or use other ways to show disapproval. Because it's considered rude to point out social errors, people with ADHD are left on their own to improve something they may not even understand.

The Impact ADHD Symptoms have on Interacting with Others

There are three major symptoms of ADHD that can affect the way individuals get along with other people:

• Inattention -- an individual has difficulty with paying attention, organization and following through on tasks
• Impulsivity -- an individual has difficulty with talking or acting before thinking, or with self-control
• Hyperactivity -- an individual is unusually active or restless

Inattention

An adult with ADHD may miss important information in a conversation or in a social setting if they have difficulty paying attention, and others may get frustrated or annoyed if they believe the adult with ADHD wasn't listening on purpose.

Here are some tips for adults with ADHD to understand others and gain social skills:

• Pay close attention to what others do and say. Know that sometimes people don't say what they really mean. Look for clues to understand what is really meant. Try to "read between the lines."
• Be aware of body language, tone of voice, behavior, or the look in someone's eyes to better understand what they are saying and meaning.
• Notice a person's choice of words to better understand real meaning. "I'd love to go" probably means "Yes." "If you want to" probably means "No, but I'll do it."
• Actions speak louder than words. If someone's words say one thing but their actions say another, suspect that their actions might be telling you their real feelings.
• Find someone to help you with this hidden language. Compare your understanding with their understanding. If you don't agree, try the other person's interpretation and see what happensespecially if you usually get it wrong.
• Learn to see beyond polite behavior. Polite behavior sometimes disguises actual feelings.
• Be alert to what others are doing. Look around for clues about proper behavior, dress, seating and talking.

Impulsivity

Impulsivity -- speaking or acting without thinking first -- can damage relationships. Not stopping to think first often causes unwanted situations for others.

Speaking without thinking first often results in opinions and thoughts being expressed in their raw form, without the thoughtful "being nice" that is socially appropriate. Interrupting others is common with impulsive people and not appreciated.

Rapid speech and talking too much can also be a sign of impulsivity. The rapid-fire speech of someone with AD/HD leaves little room for others who might want to speak too. This behavior can lead to losing friends and missing needed information.

Acting without thinking first can also cause problems. Doing something instantly and without thought often means poor decision-making. Impulsive actions include taking reckless chances, not studying or preparing for school or work, having affairs, quitting jobs, deciding to relocate, overspending and even aggressive actions such as hitting others or throwing things.

Hyperactivity

Physical hyperactivity can make it hard to take part in leisure activities. Being unable to sit still and concentrate for concerts, sports events, religious ceremonies, educational events, or even on vacations may be seen by others as not caring or not being concerned.

Evaluating Your Ability to Get Along with Others

During an evaluation for ADHD, a health professional will do a complete evaluation to see how the adult interacts with others. Interviews and questionnaires are usually used to determine what social skills and problems an adult with ADHD has. The questionnaire may include items like those listed here:

• Not paying attention when spoken to; missing pieces of information
• Seeming to ignore others
• Not taking turns in conversation (interrupting frequently)
• Not following through on tasks and/or responsibilities
• Not using proper manners
• Missing social cues
• Having a disorganized lifestyle
• Sharing information that is inappropriate to share
• Being distracted by sounds or noises
• Becoming flooded or overwhelmed, "shutting down"
• Having disorganized or scattered thoughts
• Rambling or straying off topic during conversations
• Ending conversations abruptly

Ways to Treat AD/HD

Medications are often helpful for managing ADHD symptoms. In many cases, medication will give an adult with ADHD the boost in self-control and concentration he or she needs to use newly learned social skills at the appropriate time. However, medications alone usually are not enough to gain the necessary skills. Once an adult knows what social skills to work on, working with a therapist or coach who understands how ADHD affects social skills should be considered. (A doctor or other professional may be able to recommend someone. For additional information on coaching, see What We Know #18, Coaching for Adults with ADHD.")

Adults with AD/HD should think about the following when seeking help with social skills:

• Knowledge. To learn better social skills, an adult with ADHD needs to understand them and know which skills he or she needs to improve. Books that can help include What Does Everybody Know That I Don't (Michele Novotni), ADD and Romance (Jonathan Scott Halverstadt) and You, Your Relationship, & Your ADD (Michael T. Bell).
• Attitude. Adults with ADHD should have a positive attitude and be open to improving their social skills. It is also important to be open to -- and to appreciate -- feedback from others.
• Goals. Adults with ADHD may want to work on one goal at a time. Others close to the adult can help evaluate skills and problems. Tackling skills one at a time will help an individual master each skill before moving on to the next one.
• The echo. Those who struggle with missing pieces of information because of problems paying attention in conversations may want to learn to check what they heard with others by saying and asking things like "I heard you say that...Did I get it right?" "Is there more?" or by asking others to check after giving important information. They could help by saying, "Please tell me what you heard me say." This is a good way to avoid social errors because of inattention.
• Watching others. Adults with ADHD can learn a great deal by watching others -- both at work and in their personal life -- do what they need to learn to do. Television may also provide role models.
• Role playing. Practicing new skills with others is a good way to get feedback about what was learned.
• Rehearsing. Individuals can rehearse by imagining themselves in a situation to practice skills by picturing the place and the people who will be there. This practice should be repeated as many times as possible to "overlearn" the skill and increase chances for success.
• Using prompts. Using prompts to focus on particular goals helps, too. The prompts can be an index card with notes, a vibrating watch set every four minutes to remind a person to be quiet, or a gesture someone makes (such as rubbing his or her head) to remind the individual with ADHD to work on a particular skill.
• Increasing "likeability." Researchers have found that people who are likeable have certain characteristics. They are sincere, honest, understanding, loyal, truthful, trustworthy, intelligent, dependable, thoughtful, considerate, reliable, warm, kind, friendly, happy, unselfish, humorous, responsible, cheerful and trustful. Developing or improving any of these "likeability" characteristics should help improve the overall social life of an adult with ADHD.

Summary

Although ADHD certainly brings unique challenges to social relationships, information and resources are available to help adults with ADHD improve their social skills. Most of this information is based upon sound clinical practice and research on social skills and ADHD in children and teens; there is a great need for more research on social skills and ADHD in adults. Adults with ADHD are encouraged to seek help through reading, counseling or coaching and, above all, to build and maintain connections with other people.

The information provided in this information and resource sheet was supported by Cooperative Agreement Number R04/CCR321831-01 from the Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. It was adapted from What We Know #15, "Social Skills in Adults with AD/HD," developed by the Attention Deficit Disorder Association, and approved by CHADD's Professional Advisory Board in 2003.

© 2003 Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).

For further information about ADHD or CHADD, please contact:

National Resource Center on ADHD
Children and Adults with
Attention-Deficit/Hyperactivity Disorder
8181 Professional Place, Suite 150
Landover, MD 20785
800-233-4050
www.help4adhd.org

Please also visit the CHADD Web site at
www.chadd.org