The ADHD Effect on Marriage

Melissa Orlov published this book in 2010 with Specialty Press. The foreword was written by Edward Hallowell. In the same year it won the ForeWord Reviews book of the year award in psychology, and it is still one of the most often recommended books for relationships affected by ADHD.

Orlov is not a clinician. She does not write as a psychiatrist or a licensed therapist. She came to this field through the site adhdmarriage.com, which she founded in 2007, and through her seminars and counseling work for couples. The material of the book comes largely from there: what she lived through in her own marriage, what the many couples who wrote to her site described, the observations accumulated over the years.

It is necessary to know this from the start, because both the strength and the limit of the book come from this source.

I could not reach a verified Turkish edition; I am leaving the title in English.

Whose eyes it is written through

The book speaks to couples, but where the narrator stands is clear. In her own marriage Orlov stood on the side of the spouse without ADHD, and she does not hide it.

Reading as someone with ADHD, I felt this in the first pages. The tired, angry spouse who has to remember everything and in the end begins to doubt their own love, the one described, is the portrait of someone living with a person with ADHD. I am the person across from that portrait.

An uncomfortable experience. At the same time a very useful one.

The book has two parts. The first describes how ADHD looks in a marriage: symptoms, diagnosis, and the twelve patterns, Orlov's most lasting contribution to this field. The second is a six-step plan for rebuilding. At the end there are worksheets.

Twelve patterns

The real value of the book is in this list. Orlov shows that in a relationship ADHD does not stay as separate symptoms; it turns into cycles that run between two people.

A few deserve to be described separately.

Symptom-response-response. A forgotten appointment does not by itself end a relationship. The real damage starts with the angry reaction to the forgetfulness and the defensive or avoiding answer given to that anger. The symptom happens once; the reactions pile up.

This framework did me good. It takes the problem out of people's character and places it in the interaction between them. Nobody has to have bad intentions; the cycle pushes everyone into their own worst self.

Hyperfocused courtship. At the start of a relationship the partner with ADHD can focus intensely on the new and exciting person. As the novelty fades the attention drifts too, and the other side reads this as love ending.

I stayed on this part for a long time. The intensity at the beginning is recorded on the other side as a kind of promise, and then it counts as a promise not kept. The person with ADHD, meanwhile, has not noticed making any promise. Hyperfocus is, in this respect, one of the least discussed and most trace-leaving things in relationships.

The parent-child dynamic. The most cited concept in the book and, I think, the most important. As untreated ADHD makes one partner look unreliable, the other begins to fill the gaps: reminding, supervising, correcting, redoing. Over time one settles into the role of the responsible parent, the other into that of the inconsistent child.

Orlov explains that this dynamic wears out both sides. The spouse in the parent role is lonely, angry and exhausted. The spouse in the child role feels belittled, watched and as if they cannot do anything right. Living a romantic relationship inside these two roles becomes increasingly impossible.

The rest of the list contains misinterpreted intentions, chore wars, the blame game, living on eggshells, the chase-and-flee cycle where one side pursues change and the other runs, nagging now and paying the price later, loss of faith, the collapse of sex life, and believing that ADHD does not matter in the relationship.

The list is long and some items blur into each other. But it lets couples put a name on their own fights. This is probably the most useful thing the book can do.

Where the blame falls

This is the first question to ask of relationship books, and Orlov's answer is complicated.

The book officially refuses blame. ADHD is not counted as anybody's fault. Both sides are part of the cycle and both need to change. One of the six steps is even named treatment for two.

I have to concede that it does not leave this stance on paper. It tells the partner without ADHD openly how their own anger, constant reminding and need to control feed the cycle. Being able to do this without belittling that partner's exhaustion is no easy thing.

But when it comes to the concrete part, the load is not evenly distributed.

The first move is expected from the partner with ADHD almost every time: accept the symptoms, go to an assessment, start treatment, manage yourself. I understand the logic; without the symptoms being addressed it is hard for the cycle to stop. Even so, over long stretches while reading I felt as if I were sitting in the dock.

The place I got stuck on most was the last pattern. Believing that ADHD is unimportant is treated in the book largely as a form of denial. In some cases it truly is. But the assumption that everyone who objects to the diagnosis is in denial opens a dangerous door for relationships where one partner diagnoses the other on their own.

ADHD cannot be a label one spouse sticks on the other. It is diagnosed through an assessment by a specialist. I would have liked the book to say this louder.

Six steps

The second part moves through these steps: developing empathy for your spouse; facing the obstacle emotions of anger, fear, denial and hopelessness; treatment for two; improving communication; setting boundaries and finding your own voice; reviving romance and fun.

The order seemed wise to me. Emotions come before communication techniques. A technique applied without talking about years of accumulated anger is hard to hold; I read the order with this acceptance.

One of the carrying ideas is trying differently in place of trying harder. The partner with ADHD has been told for years to make more effort and it has not worked, because what was missing was not effort but method.

The treatment step does not target only the partner with ADHD. The anger, anxiety and exhaustion of the spouse without ADHD are also put forward as things that need to be addressed. This is the most concrete counterpart of the book's effort to see both sides as human beings.

As for medication: the book should not be read as a medication guide. Every decision about medication is made with a physician.

I read the boundary-setting step as an exit door for the spouse stuck in the parent role. Giving up trying to save everything and really sharing responsibility for the relationship. For the side with ADHD this is frightening, because part of the safety net built over the years is removed. But there is no other way out of the child role either.

Obstacle emotions on both sides

The four emotions in the second step, anger, fear, denial and hopelessness, are, I think, where the book holds a mirror to both sides at once. While reading I thought about how each of them looks different in the two partners.

Anger is visible in the partner without ADHD: loud, accumulated, knowing it is right. In the partner with ADHD it often turns into defensiveness or withdrawal. But it is there too.

Fear feeds on failing again on the side with ADHD, and on hoping again and being disappointed again on the side without.

Denial can appear as not seeing the diagnosis on one side, and not seeing your own share in the cycle on the other.

And hopelessness finally brings both to the same place: the belief that this relationship will not change.

These pairings are my reading; Orlov does not line up the emotions with this symmetry. But opening the emotions to discussion regardless of who is right is the most mature side of the book.

The situation on the evidence side

The weakness of the book shows most here.

The twelve patterns are not a clinical classification; they are an observation-based, descriptive framework. I could not find information on how often these patterns are seen, in which couples they never appear, or whether the six-step plan has been tested in a controlled way. While reading it is hard to tell which idea rests on research and which on the letters that accumulated on the site.

This partly falls into the pattern of generalizing a single experience that I criticize on this site. Partly, because Orlov does not start from a single marriage; she gathers the accounts of many couples and says so openly.

Still, the sample itself carries a bias. Couples who write to an ADHD marriage site or come to a seminar are couples struggling enough to look for help. ADHD relationships that go well barely appear in this book, and the reader can conclude that their own relationship will inevitably head toward these patterns.

One of the things stated more clearly since the book was written is that ADHD is strongly hereditary. The review by Faraone and Larsson (2019) gives heritability as about 74 percent. This finding is a firmer basis than the book can offer for understanding that a partner's symptoms are not a matter of willpower or morality. It is also something to be considered separately for couples with children.

The fact that difficulty with emotional regulation in adult ADHD has been placed more at the center of the picture also gives what the book says about anger and reactivity a stronger footing today.

Where it has aged

It is a fifteen-year-old book, and its language shows it from time to time.

The assumed couple is married, of opposite sexes, and in a large part of the examples the one with ADHD is the man. Orlov also speaks of women with ADHD and their spouses, but the center of gravity of the narrative is the woman who fills the gaps left by her husband with ADHD.

As a woman with ADHD I cannot help seeing this balance. When the person who is socially expected to manage the home, the calendar and the emotional work has ADHD, the parent-child dynamic joins with another shame. These women are both pushed into the child role in the relationship and counted as failing as women. The book does not open up this side; the matter of mental load would deserve a chapter of its own here.

Relationships where both partners have ADHD, which are not rare at all, do not fit the book's framework. There the question of who will be the parent works in a completely different way.

Orlov's The Couple's Guide to Thriving with ADHD, published in 2014, carries this framework in a more practical direction. That book is not the subject of this review.

How to read it

It works best when two people read together. The chapters are of a length that couples can sit down and talk through one by one.

I have a suggestion about order. After finishing the patterns section, do not go straight to the six steps. Stop for a while and have each of the two mark separately which patterns they see in their own relationship. Then compare the lists. Two people choosing different items from the same list is where the real conversation starts.

My advice to the partner with ADHD reading alone: try to read the first part without going on the defensive, but also do not read yourself as the only guilty one in each pattern. The book describes both sides; noticing this sometimes requires a second reading.

My advice to the partner without ADHD reading alone: do not use the book to hold up to your spouse as evidence. This is the worst way to use this book, and its language lends itself to this a little too easily.

If the diagnosis has not been made yet, the assessment must come first. A list of patterns in a book does not diagnose.

Who it is for

I recommend it to couples who do not understand why their fights always end in the same place and suspect ADHD has a part in it. Especially those who sense they have fallen into the parent-child dynamic but have not been able to name it.

It works best when it accompanies couple therapy or individual treatment. On its own, it is best not to hold high expectations of it as a solution plan.

I would not recommend it to someone whose relationship involves physical or emotional abuse. The book's framework is built for two well-meaning but stuck people; it can open a door to reading abuse as an ADHD symptom.

It is around two hundred and forty pages. Because it moves in short chapters it suits reading in intervals.