Mycah Katz, MSW, Registered Social Worker (#833992) is a Registered Social Worker at MyLife Counselling in Guelph. Mycah works with individuals and couples through LGBTQ2+ issues, ADHD and Neurodiversity. Learn more about Mycah here.

Emotion, Attachment, and ADHD

Since the beginning of the pandemic, I have worked with many people who have been diagnosed with ADHD (attention deficit hyperactivity disorder), or suspect they have it. When it comes to learning about ADHD, the research is still insufficient. Many authors state that the cause of ADHD is unknown.1 There is evidence to suggest that a lack of dopamine in the brain affects the ability to pay attention and regulate emotions.2 However, dopamine is just one part of the story.

Those of us who are neurodivergent live in a society that does not recognize our needs, and this often starts in childhood. Most of my clients tell a very mixed story about their upbringing. They may have had some of their needs met, including having a roof over their head and plenty of healthy food to eat, but their parents were not often in tune with them emotionally. This is not to blame parents, the majority of whom do their best and have a desire to raise well-adjusted children; however, stress, mental health issues, and unresolved issues of their own may interfere with parents being able to bond with their children in a secure way. This is outlined pretty clearly in the book Scattered Minds by Dr. Gabor Maté, who has ADHD himself.

As a student of attachment theory, I have read many times that emotion regulation and our earliest bonds, typically to our parents, are closely linked.3 Having parents who recognize the needs of their children and meet them most of the time leads to a secure attachment style, which means that children are more likely to feel safe in the world and have a coherent sense of self. For parents who are not attuned to their children and/or neglect and abuse them, anxious, avoidant, and disorganized attachment styles are the result. The majority of clients I see in therapy are anxiously attached, which means they have a desire for intimacy, but they are often scared of it.

The research on attachment and ADHD shows that just 18 percent of adults with ADHD are securely attached, compared with 59 percent of the general population.4

People with ADHD may spend a great deal of their childhood feeling and/or being told by parents, friends, and teachers that they are lazy, that they are just attention-seeking, and that their needs are generally unimportant. This certainly does not promote a secure attachment style.

Add in the fact that transgender and gender non-conforming individuals are “3 to 7 times”5 more likely to have ADHD than cisgender folks; this may lead to a sense of insecurity in a society that still denies them the right to use the washroom that corresponds to their gender, and participate in sports.6

With all of this in mind, regulating one’s emotions is understandably difficult.

I like to say that ADHD is a very outward-facing condition. My experience with clients is that they often try to make others happy at their own expense. They feel guilt and shame when they try to assert their needs, and attempt to enjoy their free time. They have often experienced significant trauma at the hands of people they should have been able to trust, which can lead to depression, anxiety, and dissociation. Having the ability to set boundaries is highly compromised under these conditions, so they may be in relationships that do not meet their needs. This ensures that the cycle of insecure attachment continues.

ADHD is a complex condition that requires a nuanced approach. Some people require medication to focus and others may not tolerate it due to unwanted side effects. My experience is that stimulants are a positive experience for most people with ADHD.

There is also non-stimulant medication, such as Straterra, that many people take, which may have fewer side effects.7 People with ADHD may feel ashamed to talk to their family doctor about ADHD, so we need to have multiple avenues for diagnosis and treatment that are not exorbitantly expensive, especially for folks who are unemployed and under-employed, which occurs more often in the LGBTQ+ community.8

I have done training on ADHD and they often emphasize time management, task reminders, exercise and diet, and avoiding procrastination; however, we must ask why such things become a problem in the first place. People with ADHD thrive when they can focus on their own interests. If they have a job they don’t like and they are not supported by management, their quality of life will suffer. Society also has a long way to go in supporting neurodivergent folks. Unfortunately, people with ADHD may engage in a lot of self-care strategies that end up being eroded by misgendering or judgment by others. While many folks with ADHD have a drive toward perfectionism, I encourage them to cut themselves some slack when they are exhausted.

When I work with clients, I talk to them about how they get to know themselves. Many of them don’t know who they are and need some guidance, since they often didn’t receive that in childhood. Being able to slow down and focus internally, while often difficult, is important. When clients experience big emotions, I encourage them to try and sit with those feelings, rather than distracting themselves. Ironically, learning to listen to one’s own impulses is what people with ADHD did not often learn. Even breathing for a few seconds can bring us back to reality and in tune with the internal rhythms that folks with ADHD have been taught to ignore.

According to the Canadian Centre for ADHD Awareness, ADHD affects 5 to 9 percent of children and 3 to 5 percent of adults.9

Given how common the condition is, it should be no surprise when people with ADHD reach out for therapy, and they should be complimented for doing so. Building a secure relationship with clients should be the first priority, so that they can explore who they are and how to cope. This is particularly important for transgender and gender non-conforming clients, who may feel unsafe within their families and in society. We also need to remember that ADHD is not just a mental health condition; it can also be a gift. The clients I have worked with are resourceful, creative, and emotionally sensitive individuals. ADHD lends itself to a unique perspective and strengths that should be listened to, not ignored. As clinicians, we can help clients harness their gifts and to promote a world where people with ADHD can thrive.

1 https://www.healthline.com/health/adhd/adhd-dopamine

2 Same as above

3 https://pubmed.ncbi.nlm.nih.gov/7984163/

4 Koemans, R. G., van Vroenhoven, S., Karreman, A., & Bekker, M. H. (2015). Attachment and autonomy problems in adults with ADHD. Journal of attention disorders, 19(5), 435-446.

5 https://www.technologynetworks.com/neuroscience/news/adhd-and-depressive-disorders-more-frequently-diagnosed-in-transgender-youth-299702#:~:text=The%20most%20common%20diagnoses%20for,the%20matched%20cisgender%20reference%20group

6 https://slate.com/news-and-politics/2021/04/transgender-rights-bathrooms-sports-alliance-defending-freedom.html

7 https://www.webmd.com/add-adhd/adhd-nonstimulant-drugs-therapy

8 https://www.rutgers.edu/news/lgbtq-people-experience-higher-unemployment-result-covid-19-impacting-health

9 https://caddac.ca/understanding-adhd/in-general/

Mycah Katz, MSW, Registered Social Worker (#833992) is a Registered Social Worker at MyLife Counselling in Guelph. Mycah works with individuals and couples through LGBTQ2+ issues, ADHD and Neurodiversity. Learn more about Mycah here.

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