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Attention Disorders

The marital and family functioning of adults with ADHD and their spouses
L. Eakin, K. Minde, L. Hechtman, E. Ochs, E. Krane, R. Bouffard, B. Greenfield and K. Looper
Journal of Attention Disorders 2004 8: 1
DOI: 10.1177/108705470400800101

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 The marital and family
functioning of adults with
ADHD and their spouses
L. Eakin, K. Minde, L. Hechtman, E. Ochs, E. Krane, R. Bouffard, B. Greenfield, and K. Looper

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital
adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control
participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on
the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein,
Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of
overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the
maladjusted range. The ADHD adults’ perceptions of the health of their marriages and families were more negative than their
spouses’ perceptions. The way in which spouses of ADHD adults compensated for their partners’ difficulties were explored through
clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family
functioning of adults with ADHD.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a
psychiatric disorder characterized by inattention and/or
hyperactivity-impulsivity (DSM-IV; Diagnostic and
Statistical Manual of Mental Disorders, American
Psychiatric Association, 1994). The prevalence of ADHD
in adulthood varies according to the criteria used and the
informant, and ranges from less than 10% to close to 70%
(Barkley, Fischer, Smallish, & Fletcher, 2002; Mannuzza,
Klein, Bessler, Malloy, & LaPadula, 1993, 1998; Weiss,
Hechtman, Milroy, & Perlman, 1985). Nevertheless, many
people with childhood ADHD continue to have some
disabling symptoms of ADHD in adulthood. Empirical
data are beginning to accumulate concerning the
demographic characteristics, symptom presentations, and
psychiatric comorbidities of clinic-referred adults with
ADHD (Barkley, Murphy, & Kwasnik, 1996; Biederman et
al., 1993; Biederman et al., 1994; Millstein, Wilens,
Biederman, & Spencer, 1997; Murphy & Barkley, 1996; Roy-
Byrne et al., 1997). Few of these studies, however, document
its impact on marital and family functioning.
The paucity of research on the relationship difficulties of
adults with ADHD is surprising given their psychiatric
profiles, the substantial anecdotal reports describing the
serious impact of the disorder on their relationships (Dixon,
1995; Nadeau, 1991; Ratey, Hallowell, & Miller, 1995; Weiss,
Hechtman, & Weiss, 1999), and the extensive research
documenting the impact of ADHD on the peer and family
relationships of children with the disorder (see Barkley,
1998).
Journal of Attention Disorders, Vol. 8, No. 1/August 2004 Copyright © 2004 Multi-Health Systems Inc. 1
The studies that have following children with ADHD to
adulthood that included measures of social functioning
have found a continuation of poor psychosocial adjustment.
Milman (1979) found that 67% of hyperactive adults (mean
age = 19 years) had social problems, and only 27% had
achieved heterosexual maturity (i.e.,were dating, engaged,
or married). Weiss and Hechtman (1993) reported that
hyperactive adults (mean age = 25 years) had significantly
poorer social skills than matched controls in all domains
assessed: job interviews, situations requiring assertive-
ness, and heterosocial interactions.
Clinicians report that marital problems are one of the most
common complaints of adults with ADHD seeking treatment
(Dixon, 1995; Weiss et al.,1999), yet only a few studies
have documented these difficulties. ADHD adults have
been found to have a higher incidence of separation and
divorce than normal controls (Biederman et al., 1993;
Biederman et al., 1994) and to get married more frequently
than non-ADHD clinic controls (Murphy & Barkley, 1996).
To our knowledge, only one study (Murphy & Barkley,
1996) evaluated the marital satisfaction of clinic-referred
adults with ADHD. Despite the limitation of small sample
sizes, there was a trend for adults with ADHD to report less
marital satisfaction than the non-ADHD clinic controls.
Further evidence to suggest that adults with ADHD may
be at risk for marital problems is the finding by Kelly and
Conley (1987) that the personality traits of neuroticism and
impulse control were the aspects of personality most

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predictive of negative marital outcome, traits that have been
shown to be associated with ADHD symptoms (Barkley,
1997; Nigg et al., 2002).
It has been clinically observed that ADHD symptomatology
negatively impacts on the family by its association with
disorganization, difficulty modulating emotions, low
frustration tolerance, and communication difficulties (Dixon,
1995; Weiss et al., 1999). There are no investigations,
however, documenting the resulting family dysfunction.
Clinically, the level of functioning of spouses has been
identified as an important moderator variable in the
functioning of families of adults with ADHD (Dixon, 1995).
Families of ADHD adults often depend upon the non-
ADHD spouse who becomes responsible for planning,
organizing, setting limits, making financial decisions, and
maintaining family harmony (Dixon, 1995; Weiss et al., 1999).
Although the spousal support may work to the advantage
of the ADHD adult, their non-ADHD spouses often report
feeling resentful and overwhelmed due to the unequal
distribution of responsibilities in their families and the lack
of emotional support available to them (Weiss et al., 1999).
The present study sought to gain a better understanding
of the psychosocial functioning of clinic-referred adults
with ADHD within a family context. We first examined the
marital adjustment and family functioning of married adults
with ADHD, hypothesizing that both marital adjustment
and family functioning would be impaired in the adults
with ADHD relative to the comparison adults. Secondly,
we evaluated the adjustment of the spouses. The ratings
of marital and family functioning of spouses of ADHD adults
were expected to be similar to that of their ADHD partners,
and significantly worse than the comparison spouses’
ratings. Finally, we qualitatively analyzed the spouses’
descriptions of how their ADHD partners’ difficulties
affected them.
Method
Participants
The participants in the study were 33 adults with ADHD,
32 of their spouses, 26 comparison adults from the
community, and 26 of their spouses. The participants were
selected from a larger study examining the psychosocial
functioning of 83 adults with ADHD who were referred to
an adult ADHD clinic located in a university affiliated
hospital. This study was reviewed and approved by the
hospital’s Institutional Review Board. Since the study
focused on family life, the 33 adults from the larger study
who were married or in common-law relationships (i. e., had
2 Journal of Attention Disorders, Vol 8, No. 1/August 2004 Copyright © 2004, Multi-Health Systems Inc.
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been living with their partner for at least 12 continuous
months, as per Revenue Canada, 1999) were included.
Criteria included for both ADHD and comparison adults
were described in detail in a previous article (Minde et al.,
2003). Participants were initially screened for ADHD
symptomatology based on self-rating or knowledgeable
informant ratings on the Patient’s Behavior Checklist
(Barkley, 1991) or the Conners’ Adult ADHD Rating Scale
(CAARS; Conners, Erhardt, & Sparrow, 1994). If respond-
ents scored in either the mild or moderate range on any of
these measures, they completed a comprehensive assess-
ment at the Clinic. To obtain a diagnosis of ADHD for this
study, participants had to have significant ADHD
symptomatology in childhood and had to meet DSM-IV
criteria for ADHD as adults assessed through a structured
interview. ADHD symptomatology in childhood was
obtained by means of the ADHD module of the Diagnostic
Interview Schedule (DIS 4.0; Robins, Cottler, Bucholz, &
Compton, 1997). Additional childhood ratings were
obtained through self - and parent reports on the Wender-
Utah Rating Scale (Ward, Wender, & Reimherr, 1993).
Participants were judged to have met criteria for ADHD in
childhood if they met criteria on the DIS 4.0 or obtained a
score of 36 or higher (by self- or informant ratings) on the
Wender-Utah Rating Scale (Ward et al., 1993). Since no
DSM-IV-based structured interview existed for the
determination of ADHD in adults, the DIS 4. 0 was modified
to assess current (in the past 6 months) symptomatology.
Of the 131 adults who passed the initial screen and
completed a comprehensive assessment, 83 (63%) were
given a diagnosis of ADHD. Of these, 33 participants (40%)
were married or in common-law relationships and included
in this study. Their spouses were then asked to participate.
One female spouse declined participation and two female
spouses completed only the questionnaire portion of the
assessment. None of the spouses met criteria for current
ADHD (although one spouse met childhood criteria).
Twenty-six comparison adults and their spouses, recruited
through local advertisements and newspapers, were
reimbursed $50 each for their participation. Two spouses
(one of each gender) completed only the questionnaire
portion of the study. None of the control participants met
criteria for ADHD.
The adults with ADHD, their spouses, the control
participants, and the controls’ spouses all completed the
same assessment protocol that included a psychiatric
assessment, psychological testing, structured and semi-
structured interviews, and the completion of questionnaires.
A psychiatric assessment was conducted by one of four
board-certified psychiatrists or a psychiatry research fellow.
All participants were given oral and written explanations of
the study and provided informed consent. The psychiatrists
obtained information on past and current medical,
psychiatric, and family histories, and adaptive functioning.
During these interviews, the adults with ADHD and their
spouses were asked several additional questions concerning
the impact of ADHD symptoms on their lives. A subset of
the questions administered to the spouses of ADHD adults
were analyzed for the present study. They were: (a) “What
are your concerns about your spouse’s behavior?” (b) “How
do your partner’s ADHD symptoms affect you?” (c) “Do
you have any complaints with regard to your spouse?” and
(d) “Do you compensate for your partner’s difficulties? If
yes, how?” Concerns, complaints, and compensation efforts
were categorized according to the following categories:
general organization/time management, child rearing, work
or school, finances, marital relationship, emotional regulation,
and self-esteem/underachievement.
Axis I diagnoses of all participants were determined via the
Diagnostic Interview Schedule for DSM-IV (DIS 4.0; Robins
et al., 1997) administered by doctoral students in clinical
psychology. Intelligence was estimated by a four-subtest
short form of the WAIS-R: Information, Arithmetic, Picture
Completion, and Block Design (Wechsler, 1981; see also
Reynolds, Willson, & Clark, 1983).
Participants completed several questionnaires assessing
current psychological distress (see Minde et al., 2003). The
results of the Dyadic Adjustment Scale (DAS; Spanier, 1989)
and the Family Assessment Device (FAD; Epstein, et al.,
1983) are reported in the current study. The DAS is a 32- item
inventory that contains a global measure of relationship
distress and subscales assessing dyadic consensus, dyadic
satisfaction, affectional expression, and dyadic cohesion. It
has a widely established cut-off score between adjusted and
maladjusted marriages (Burger & Jacobson,1979; Kahn,
Coyne, & Margolin, 1985). The FAD is a 60- item self-report
instrument based on the McMaster Model of Family
Functioning (MMFF; Epstein, Bishop, & Levin, 1978). The
FAD was developed to assess the six dimensions outlined
in the MMFF: Problem Solving, Communication, Roles,
Affective Responsiveness, Affective Involvement, and
Behavior Control. In addition, the FAD yields a General
Functioning score. The FAD was administered only to
couples with children aged 6 years and over.
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Analyses
Continuous variables were analyzed by means of t-tests.
The data were examined for assumption violations and
found to be normally distributed. In the few analyses
where variance heterogeneity was found (using Levene’s
test), unequal variance t-tests were used. Categorical
variables were analyzed with chi-square tests. Chi-square
tests were Yates corrected when expected frequencies
were less than 5. Due to the small sample size, the risk of
Type II errors (failing to detect true differences) was
considerable; thus, statistical significance was defined at
the .05 level. This means that statistical levels are
presented without adjusting for multiple comparisons.
Due to the resulting risk of Type I errors (detecting
differences that are not real), effects that are between
p = .01 and p = .05 are cautiously interpreted.
Results
Participants
Demographic Characteristics. There were no significant
differences between groups on the demographic varia-
bles (Table 1).
Marital adjustment and family functioning. The adults
with ADHD reported significantly poorer overall marital
adjustment than comparison adults (Table 2). Their ratings
were consistently poorer in all areas of marital life;
satisfaction, consensus, affectional expression, and
cohesion. Furthermore, a significantly greater proportion
of the adults with ADHD had scores that fell within the
maladjusted range (p < . 01; odds ratio = 4. 46). The spouses
of ADHD adults’ ratings of marital adjustment (Table 3)
did not differ from the ratings of the spouses of controls,
with the exception of their perceptions of marital
satisfaction (p < .05). Nonetheless, the proportion of their
scores that fell within the maladjusted range was greater
than the comparison spouses (p < .05; odds ratio = 3.76)
Contrasted with comparison adults, those with ADHD
also reported significantly poorer general family
functioning. The specific areas of family life that were
rated more negatively were affective involvement, roles,
communication, and problem solving. The only area that
did not reach significance was affective responsiveness
(Table 4). In contrast, ADHD spouses’ and comparison
spouses’ perceptions of family functioning did not differ
significantly on any of the areas assessed by the
FAD (Table 5).
To determine whether the adults with ADHD and their
spouses perceived their marital adjustment and family
functioning differently, paired samples t-tests were
Table 1: Demographic Characteristics of ADHD Adults, their Spouses, and the Comparison Participants

ADHD Comparison
(N = 33) (N = 26)
Characteristic M (SD) M (SD) df t p

Age (Years) 38.65 (6.77) 38.77 (6.33) 57 .05 .96

Age of Spouse (Years)a 39.84 (8.04) 38.19 (6.99) 56 .82 .41
Years married (or common-law) 11.00 (6.40) 9.77 (6.41) 57 .73 .47
Socioeconomic status (Family)b 2.12 (.65) 2.15 (.88) 44.64c -.16 c .88
Children per family (N) 1.76 (1.12) 1.54 (1.07) 57 .76 .45

N (%) N (%) df χ2 p
Gender (Male) 21 (64) 16 (62) 1 .03 .87
Gender of Spouse (Male)a 11 (34)d 10 (38) 1 .10 .75
Couples with children 26 (79) 22 (85) 1 .06 .82

a
N = 32 for spouse of ADHD group.
b
Based on Hollingshead Four Factor Index of Social Position (Hollingshead, 1975).
c
Based on t-test for unequal variance.
d
One adult with ADHD was in a same-gender (female) relationship.

Table 2: Marital Adjustment of ADHD and Comparison Adults

ADHD Comparison
(N = 33) (N = 26)
DAS Subscale M (SD) M (SD) df t p

Satisfaction 33.97 (7.33) 39.00 (3.95) 51.04a –3.37a .001

Consensus 43.73 (7.81) 49.23 (7.09) 57 –2.80 .007
Affectional expression 7.27 (2.80) 8.88 (2.07) 56.80a –2.54c .01
Cohesion 13.97 (3.62) 16.12 (3.71) 57 –2.24 .03
Overall adjustment 99.21 (16.95) 113.23 (13.31) 57 –3.46 .001

N (%) N (%) df χ2 p
Maladjustedab 17 (52) 5 (19) 1 6.48 .01

Note. Lower scores indicate poorer adjustment.

a
Based on t-test for unequal variance.
b
Overall adjustment score below 100.

Table 3: Marital Adjustment of Spouses of ADHD and Comparison Adults

Spouse Spouse
of ADHD of Comparison
(N = 32) (N = 26)
DAS Subscale M (SD) M (SD) df t p

Satisfaction 35.09 (6.88) 38.58 (4.98) 56 –2.16 .04

Consensus 47.13 (7.63) 49.23 (7.41) 56 –1.06 .29
Affectional expression 7.88 (2.93) 8.96 (1.87) 53.72a –1.72a .09a
Cohesion 14.19 (4.62) 16.00 (4.77) 56 –1.46 .15
Overall adjustment 104.28 (17.69) 113.19 (16.65) 56 –1.97 .06

N (%) N (%) df χ2 p

Maladjustedab 13 (41) 4 (15) 1 4.41 .04

Note. Lower scores indicate poorer adjustment.

a
Based on t-test for unequal variance.
b
Overall adjustment score below 100.

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Table 4: Family Functioning of Adults with ADHD and Comparison Adults

ADHD Comparison
(N = 20) (N = 19)
FAD Subscale M (SD) M (SD) df t p

Behavior control 1.91 (.34) 1.50 (.33) 37 3.79 .001

Affective involvement 2.09 (.32) 1.70 (.43) 37 3.26 .002
Roles 2.40 (.33) 2.04 (.39) 37 3.09 .004
Communication 2.09 (.28) 1.83 (.39) 37 2.41 .02
Problem solving 2.11 (.43) 1.80 (.42) 37 2.27 .03
Affective responsiveness 1.99 (.40) 1.84 (.56) 37 .95 .35
General functioning 2.04 (.36) 1.70 (.42) 37 2.70 .01

Note. Higher scores indicate poorer functioning.

Table 5: Family Functioning of Spouses of ADHD and Comparison Adults

Spouse of Spouse of
ADHD Comparison
(N = 19) (N = 19)
FAD Subscale M (SD) M (SD) df t p

Behavior control 1.74 (.55) 1.64 (.30) 36 .69 .50

Affective involvement 1.82 (.37) 1.82 (.36) 36 .01 .99
Roles 2.26 (.46) 2.07 (.43) 36 1.38 .18
Communication 1.88 (.38) 1.80 (.40) 36 .65 .52
Problem solving 1.91 (.49) 1.81 (.31) 30.19a .79a .44a
Affective responsiveness 1.74 (.49) 1.71 (.46) 36 .20 .84
General functioning 1.78 (.41) 1.63 (.40) 36 1.11 .27

Note. Higher scores indicate poorer functioning.

a
Based on t-test for unequal variance.

conducted. The adults with ADHD (M = 98.81, SD = 17.07)
were found to have poorer overall reported marital
adjustment than their spouses (M = 104.28, SD = 17.69),
t (31) = -2.02, p = .05. In contrast, the ratings of overall
marital adjustment did not differ between the comparison
adults (M = 113.23, SD = 13.31) and their spouses
(M = 113.19, SD = 16.64), t (25) = .01, p = .99. Similarly, the
adults with ADHD perceived the general functioning of
their families as significantly worse (M = 2.06, SD = .35)
than their spouses (M = 1.78, SD = .41), t (18) = 3.15,
p = .006. There were no significant differences between the
general family functioning scores of the comparison
participants (M = 1.70, SD = .42) and their spouses
(M = 1.63, SD = .40), t (18) =. 81, p =.43.
We then asked whether current psychiatric comorbidity
was associated with marital and family functioning. As seen
in Table 6, no significant intergroup differences were found
on self ratings when we compared participants with ADHD
with no current Axis I comorbidity to those with one or
more additional disorders (which include mood disorders,
anxiety disorders, Oppositional Defiant Disorder, Conduct
Disorder, drug use disorders, and alcohol use disorders).
Surprisingly, the spouses of ADHD adults with comorbid
disorders perceived their families as functioning better than
those adults whose spouses met criteria only for ADHD.
Although this was the only score that reached statistical
significance (p < .05), all scores were in the opposite
direction of what was predicted, indicating better
functioning for the group with comorbidity. In contrast,
when the spouses with current psychiatric disorders (which
include mood disorders, anxiety disorders, Oppositional
Defiant Disorder, drug use disorders, and alcohol use
disorders) were compared to the spouses who did not meet
criteria for any psychiatric disorders (Table 7), the spouses
with psychiatric disorders perceived their marriages and
families as functioning significantly worse. The ratings of
their ADHD partners, however, did not differ significantly.
Similar comparisons were not conducted with the
comparison group as few participants met criteria for
current psychiatric disorders (i.e., 1 comparison participant
and 4 of their spouses).
Complaints, concerns, and compensation strategies of
spouses with an ADHD partner. Responses from the semi-
structured interview questions are summarized in Table 8.
Ninety-six percent of spouses reported that their ADHD
partners’ behavior interfered with their functioning in one
or more domains (without demonstrating gender
differences; ps > .05). Their most frequently reported
complaints and/or concerns fell within the domains of
general household organization/time management, child

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Table 6: Marital and Family Functioning of ADHD Adults with and without Comorbidity
ADHD Adult ADHD Adult
with Comorbidity without Comorbidity
(N = 21) (N = 12)
Measures M (SD) M (SD) df t p

ADHD Adult
Marital adjustmenta 101.95 (18.01) 94.42 (16.12) 31 -1.24 .23
Family functioning,bc 1.97 (.42) 2.19 (.32) 18 1.31 .21

Spouse
Marital adjustmenta 105.20 (17.59) 102.75 (18.53) 30 -.38 .71
Family functioning,bc 1.65 (.36) 2.06 (.37) 17 2.28 .04

Higher marital adjustment scores indicate better functioning. Lower family functioning scores indicate better functioning.
a
Overall adjustment scale of DAS.
b
General functioning scale of FAD.
c
N = 14 for ADHD adult with comorbidity, N = 6 for ADHD adult without comorbidity.

Table 7: Marital and Family Functioning of Spouses (of Adults with ADHD) with and without Psychiatric Disorders

ADHD Adult ADHD Adult

with Comorbidity without Comorbidity
(N = 8) (N = 22)
Measures M (SD) M (SD) df t p

ADHD Adult

Marital adjustmenta 89.50 (13.87) 101.86 (16.12) 28 1.92 .07

Family functioning,bc 2.21 (.35) .95 (.31) 16 -1.57 .14

Spouse
Marital adjustmenta 90.25 (12.26) 108.23 (17.38) 28 2.68 .01
Family functioning,bc 2.12 (.32) 1.62 (.35) 16 -2.77 .01

Higher marital adjustment scores indicate better functioning. Lower family functioning scores indicate better functioning.
a
Overall adjustment scale of DAS.
b
General functioning scale of FAD.
c
N = 5 for spouse with psychiatric disorder, N = 13 for spouse without psychiatric disorder.

rearing, and communication and/or marital relationship.
Overall, 92% of the spouses felt they compensated in some
way for their ADHD partners’ difficulties (80% of the male
spouses, and 100% of the female spouses), χ2 (1, N = 26) =
1.22, p = .27. The spouses reported most often
compensating for difficulties with general household
organization and/or time management, child rearing, and
financial management. Chi-squares revealed no differences
in percentages of men and women who reported
compensating in the different domains (ps >.05).
Discussion
The present study found that adults with ADHD reported
significantly poorer marital adjustment and family
functioning than comparison adults. This is consistent with
the few previous studies that documented more divorces
and more marriages in this population compared with
controls (Biederman et al., 1993; Biederman et al., 1994;
Murphy & Barkley, 1996). Although the spouses of ADHD
adults reported poorer marital satisfaction than controls,
and more of their ratings of overall marital adjustment fell
within the clinical range, other subscales of marital
adjustment and family functioning did not differ
significantly from controls. It is important to keep in mind
that due to the small sample size of this study and the
resulting lack of adequate power, we cannot conclude that
these differences do not exist. Nonetheless, our data do
suggest that the adults with ADHD have more negative
perceptions of their marital and family lives than their
spouses. There are several possible explanations for this
discrepancy. Since negative affectivity has been linked to
the attributions individuals make for their partners’
behaviors (Karney, Bradbury, Fincham, & Sullivan, 1994),
one possibility is that greater negative affect in the ADHD
adults (Rosenbaum & Baker, 1984) may have negatively
influenced their perceptions of their marriages and family
life, as contrasted with the more positive views of their
spouses. Another possibility is that the spouses may have
felt that their efforts to compensate for their ADHD partners
were benefiting their marriage and families, which in turn
may have led them to evaluate their marriages more
positively than their ADHD partners. This is also consistent

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Table 8: Complaints, Concerns, and Compensation Strategies of Spouses with ADHD Partners
General Household Organization and Time Management

Complaints/Concerns (92%) Compensation Strategies (65%)

Trouble organizing/maintaining home, procrastinates, Keeps track of appointments, gives frequent reminders, provides
does not initiate or complete chores. structure, finishes tasks.
Poor sense of time, frequently loses and misplaces things, Organizes home, completes all the chores, cleans up after him/her.
forgetful of tasks that must be done.

Child Rearing

Complaints/Concerns (55%)a Compensation Strategies (50%)a

Impatient, easily frustrated, loses temper with the children.
Forgetful of important child rearing tasks. “Entertainment Dad,”
lack of involvement in discipline.
Lacks judgment (excessive rough play, makes impulsive decisions,
rigid expectations, insensitive).
Takes care of all child-related tasks, keeps children quiet
Organizes children, plans activities, helps with homework, calls
teachers.
Protects children from “blow-ups,” settles children down when
spouse has wound them up.

Communication and Marital Relationship

Complaints/Concerns (54%)
Frequent arguments, disagreements, misunderstandings, not available
or supportive as a partner.
Lack of follow-through, does not keep promises.
Problems with intimacy, commitment, sexual relations, difficulty
expressing feelings.
Imbalance in roles (dependent on spouse to make all important
decisions).

Work or School

Complaints/Concerns (39%)b Compensation Strategies (26%)b

Disorganized, appears lazy, incompetent, inflexible. Manages finances, makes customer contacts, organizes work,
Interpersonal difficulties with coworkers/clients, poor coping/ quits own job to assist.
problem-solving skills. Assists with reading and writing, explains concepts, organizes
homework, hands in papers.

Financial Management

Complaints and Concerns (39%) Compensation Strategies (35%)

Doesn’t contribute enough financially and has poor financial Does all the accounting, gives working spouse a weekly allowance.
management.

Emotional Regulation

Complaints/Concerns (35%)
Quick-tempered, unpredictable, moody, irrational, impatient,
easily frustrated, never calm, can’t relax

Self-Esteem and Underachievement

Complaints/Concerns (31%)
Lacks confidence, feels inferior and incompetent, self-critical, makes
self-denigrating comments.
Underachieving symptoms interfere with success, lacks ability
to face challenges.

N = 26 due to missing information. Categories are not mutually exclusive.

a
N = 22 (adults with at least one child).
b
N = 23 (ADHD adult is currently working or in school).

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with the finding that those spouses who were suffering
from a psychiatric disorder, and perhaps less able to
compensate effectively for their ADHD partners’ difficulties
due to their own emotional needs, perceived their marriages
and families as functioning significantly worse than the
spouses who did not meet criteria for a psychiatric disorder.
In contrast, the ADHD adults were found to be less
sensitive to the added factors of their own comorbidity or
their spouses’ mental health. Their perceptions of the
marriages and families did not differ when these additional
factors were examined.
Surprisingly, the partners of adults with ADHD who had
one or more additional psychiatric diagnoses perceived
their families as functioning better than the spouses of
those adults who had ADHD as their sole diagnosis. There
were no intergroup statistical differences in the ADHD
adults’ self-ratings, or their spouses’ ratings of marital
adjustment. These scores were consistently in a direction
indicating better functioning in the families of ADHD adults
with additional psychiatric disorders than in the families of
adults with ADHD as their sole diagnosis. Although in
need of replication with a larger sample, this counterintuitive
finding suggests that perhaps there is something unique
about the spouses of ADHD adults, particularly those
married to ADHD adults with additional psychiatric
disorders. The spouses were not found to differ in terms of
psychiatric health (4 were disordered in each group), but
may differ in other ways not measured in this study (i.e.,
exhibit co-dependency, take on roles of caretaker or
rescuer). Most of the participants were in marriages of at
least 5 years duration with an average duration of 11 years.
It is plausible that the individuals who choose to remain
married to adults with ADHD with comorbid conditions are
particularly committed to their families and have found
adaptive ways of coping with their partners’ mental health
issues.
Through analyzing several interview questions admin-
istered to the spouses of adults with ADHD, the authors
gained a better understanding of the difficulties that the
spouses experienced living with ADHD partners. Although
it was not surprising that more than half of the spouses
compensated for difficulties with general household
organization/time management and child rearing, the fact
that many of them also compensated for their partners’
difficulties at work or school was unexpected. It was not
uncommon for spouses to participate in the organization
of clients, the writing of reports, and the financial
management of their partners’ businesses. Of even greater
concern is that several spouses reported needing to protect
their children from their partner’s emotional outbursts.
8 Journal of Attention Disorders, Vol 8, No. 1/August 2004 Copyright © 2004, Multi-Health Systems Inc.
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These findings highlight the need for interventions to
include family members and to address the needs of the
whole family system.
Clinical Relevance and Limitations
The present study has both strengths and limitations. The
results of this study need to be interpreted cautiously due
to the small sample size and the risk of Type I errors that
result from not controlling for multiple comparisons.
Nonetheless, the current assessment of the ADHD
participants and their spouses was comprehensive and
allows for a better understanding of the quality of their
interpersonal relationships. Although our controls were
volunteers and were not randomly selected, their mean
marital adjustment score was very close to the mean score
obtained in the norming of the DAS (Spanier, 1989) and
was equivalent to a T-score of 49. Their level of marital
adjustment appears to be fairly representative of the general
population. In addition to comparing ADHD participants
and their spouses to randomly selected normal controls, it
would be particularly informative for future research to
compare them to other clinical groups. It is also important
to note that only 5 (15%) of the ADHD participants had
been in their current relationships 5 years or fewer and the
mean duration of their marriages was 11 years. Therefore,
this study primarily examines the long-term relationships
of ADHD adults. Couples that have remained together may
have adapted relatively well to the ADHD adults’ difficulties
and the data may not reflect common struggles of newer
relationships.
The analysis of specific interview questions provided
information about the day-to-day challenges associated
with living with an ADHD partner and about some coping
strategies used by their spouses. Unfortunately, the
interview questions were not administered to the spouses
of controls, and thus, it is not known how their responses
differ from those living with an ADHD partner. Along with
collecting similar data from normal controls and other clinical
groups, further work needs to utilize such data more
concretely. It should assess the actual ratio of support and
criticism given by each spouse, the reaction of the ADHD
partner to these responses, and the way marital adjustment
and family function can be assisted by outside
interventions. It would also be interesting to gain a better
understanding of personality factors, attitudes, and coping
styles that may contribute to the healthy functioning of
the marriages and families of ADHD adults. The data on
spousal compensation strategies also have to be seen
within a wider context. For example, Minde et al., 2003
reported that almost 60% of non-ADHD men had left their
ADHD spouses while only 10% of female spouses had left
their ADHD husbands. This suggests that the nature of
compensatory behavior and the impact of these behaviors
on marital relationships may differ for male and female
spouses.
Despite these limitations, our findings underscore the need
for comprehensive evaluations of ADHD adults to include
screenings for marital adjustment and family functioning
from the perspective of both the adults with ADHD and
their spouses, and for interventions to target these areas
of concern.
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Laurel Eakin is with Curry School of Education, University
of Virginia. Klaus Minde is with the Department of
Psychiatry, McGill University, Montreal; Lily Hechtman is
with the Department of Psychiatry, McGill University,
Montreal; Eric Ochs is with the Department of Psychology,
University of Victoria, Victoria, Canada. Erica Krane is in
private practice in Halifax, Canada; Rachelle Bouffard is
with Department of Psychiatry, McGill University, Montreal;
Brian Greenfield is with the Department of Psychiatry,
McGill University, Montreal; Karl Looper is with the Jewish
General Hospital, Montreal, Canada.
Correspondence concerning this article should be sent to
Laurel Eakin, Ph.D., Curry School Education, University of
Virginia, P.O. Box 400270, Charlottesville, VA 22904-4270,
Electronic Mail: laurel.eakin@cholmsky.com