An Interview with Ari Tuckman, PsyD, MBA, author of  Integrative Treatment for Adult ADHD

New Harbinger Publications:  Does someone need to be hyperactive to have ADHD?

Ari Tuckman: No. There are three subtypes of ADHD. People with the inattentive subtype have difficulties with concentration, time management, organization, and memory, but are not hyperactive at all. Those with the hyperactive/impulsive subtype have difficulty sitting still, interrupt others, and leap without looking. Then those with the combined subtype have difficulties with both. So ADHD can look quite different, depending on the person.

NHP: How is ADHD in adults different from ADHD in children?

AT: The biggest difference between children and adults is that the hyperactivity that was present in childhood tends to be less pronounced in adulthood. The adult with ADHD won’t be as obviously fidgety, but may still feel restless when forced to sit still for extended periods. The other big thing that changes is the expectations that we have for adults. Whereas kids have parents and teachers helping to keep them on track, adults are expected to manage all that themselves. So they wind up having more difficulty with keeping on top of life’s demands, especially as their lives get more complicated.

NHP: Since everyone has their “ADHD moments”, it’s easy to feel that it is a bogus diagnosis. What distinguishes those who truly have the disorder?

AT: People with ADHD don’t just lose their keys occasionally—they lose them often. And when they do, it causes big problems in their lives, like getting to work late. People with true ADHD will have had it from childhood and have trouble in all aspects of their lives, including school, work, home life, and relationships. They will have suffered.

NHP: Why is it important to use an integrative treatment approach to adult ADHD?

AT: Standard therapy techniques are of limited benefit for adults with ADHD because it’s hard to make someone feel better about himself when he keeps creating the same kinds of problems for himself. In my four-part integrative treatment model, clients are taught about ADHD so they can approach those problems more constructively. Medication is used to improve their basic functioning. Coaching is used to teach specific strategies to help clients better manage their lives. And finally, therapy is used to help them build a stronger self-esteem based on honoring their strengths while accepting their weaknesses. Each part of the model is important, but none is enough by itself.

NHP: It seems like more people have ADHD now than they used to. Are we just better at identifying it or is it truly more common?

AT: It’s hard to answer this question definitively. We are certainly better at correctly diagnosing adults with ADHD, so we’re catching more of those people who have it. However, only 10% of adults with ADHD are currently being treated, so we still have a long way to go. It’s possible that more people have ADHD now than they used to, but that would be difficult to prove. For the time being, I’m going to assume that we are just better at identifying what is already there.

NHP: Because there is such a strong genetic component to ADHD, many families with an ADHD child also have an ADHD parent, leading to a potential double whammy. How are the parents, particularly the non-ADHD parent, to handle this additional stress?

AT: Managing ADHD should be a family affair—especially because unmanaged ADHD affects the whole family. It’s important for the both the ADHD parent and child to seek professional help to work on their weaknesses and lead happier and more productive lives. As any parent knows, it’s hard to tell your child to do something that you’re not doing yourself. The non-ADHD parent should also be involved in that treatment so she can learn more effective ways of helping the person with ADHD, rather than feeling resentful and powerless. It’s also important for the non-ADHD parent to find some time to get away and not feel responsible for the survival of the family.

NHP: ADHD in particular brings up the debate over responsibility for our actions—are we always responsible for our actions, even when there are intervening biological factors? Or do biological factors absolve us of responsibility? Where is the balance point between these two extremes?

AT: I often tell my clients to use ADHD as an explanation, not an excuse. That is, to understand how their ADHD brain wiring causes them to do things or process information in certain ways. With this understanding, they are in a better position to come up with new ways of doing things that will work for them. By contrast, using ADHD as an excuse lowers the bar for what can be expected of that person. Unfortunately, most of the world is unlikely to be all that forgiving. As I sometimes say, even the shortest kid on the basketball court still needs to score some points.

NHP: Why do we need another book on ADHD?

There are very few books exclusively about adult ADHD for clinicians, leaving most of us to extrapolate from childhood ADHD and make it up on our own. In writing this book, I took the best of what the research tells us and combined it with ten years of clinical practice so that readers don’t need to rely on their own trial and error. This book gives clinicians everything they need to know to work most effectively with this interesting and sometimes challenging group of people.