Adult ADHD and Anger


Adult ADHD and Anger

When ADHD and anger are combined, the destruction to a person’s life is multiplied many times.

At least 40% and as many as 60% of children with ADHD will still have symptoms of ADHD well into adult life. Of these Adults with ADHD, probably at least 50% will have problems with anger. ADHD experts feel that anger issues in ADHD adults often take two forms- problems controlling anger toward others or anger directed inwards-toward themselves.

As many of us now realize, just being ADHD causes frustration and the doom of impending failure. Teachers often tell me of how ADHD kids just seem to give up when they appear overwhelmed and frustrated.  It’s often this frustration that causes ADHD children to fail at whatever they are doing. These failures just help perpetuate a cycle of frustration-failure-loss of confidence that further damages already fragile egos and self-esteem.

Adults with ADHD suffer many of the very same behavior problems they had as children-poor concentration to detail, impulsivity, inattentiveness, but rarely show all of the elements of hyperactivity. Usually by age 25 to 30 most will have learned coping mechanisms that help control or suppress their outright hyperactivity.

It’s often anger that gets the adult with ADHD in trouble. Anger usually clouds a person’s judgment and impulsivity is then quick to follow. Let me tell you about one of my 29 year-old patients and you’ll get a clearer picture of how anger makes adult ADHD worse.

Robert had a pretty good job as a machine operator in a local plastics manufacturing plant. He had been ADHD since his was able to walk according to his mother and had taken multiple ADHD medications all the way through technical college. Unfortunately, at age 24, Robert decided he had outgrown his ADHD, because he was able to date and get married, had a steady job and wasn’t hyperactive.

As a result of Robert’s self-evaluation, he didn’t return for follow-up and wasn’t seen in my office for four years. During that time, he had two speeding tickets; had not been arrested, but came close while arguing with an officer about speeding; was passed over for promotion and raises three times; and was experiencing problems in his marriage.

When he finally showed back up in my office, he had just been placed on 30-day probation at work and was told he would be fired if he had any more outbursts. Robert had blamed others at work every time he experienced a failure and had become angry with those he thought caused his problems.

When he and I finally got deep into his social and work relationships, it was very obvious he still had a “flaming case of ADHD”. He eventually admitted he just got tired of taking medications and was “hiding his ADHD” from everyone else.

What had “set him off” in his latest meltdown was a co-worker getting away with something Robert thought wasn’t fair. Apparently, another machine operator took an extra 15 minute smoke break and got away without a reprimand. When Robert complained to his shift foreman, his complaint fell on deaf ears because as Robert put it: “They are best friends anyhow and smoke together all the time.”

The foreman’s indifference “set Robert off” and he started fussing and hollering at both his co-worker and boss. The whole fiasco ended with Robert in the “big boss’s” office getting a reprimand for causing such a commotion. After cooling off, Robert admitted he should have avoided losing his temper and now realized he had significant anger issues.

How did we help Robert deal with his anger issues?

First of all, I started him back on the very ADHD drug he had used and had worked so well for over ten years-Focalin. Why? Since Robert was about to lose his job we didn’t have time to try counseling, behavior training, relaxation techniques, or lifestyle changes. All of these interventions take 60 to 90 days or even more to implement. We needed to make a dramatic change in his behavior-one that would save his job.

Don’t get me wrong, we did make changes in his diet, sleeping habits, and schedule behavior counseling as soon as possible. Once again-even though diagnosed as ADHD in the past-I put Robert through another head to toe evaluation to make sure he was not the victim of ADHD misdiagnosis.

In Robert’s age group the common things that can look just like and mimic ADHD causing misdiagnosis of ADHD include:

  • Obstructive sleep apnea
  • Depression
  • Anxiety disorders
  • Thyroid disease
  • Alcohol and drug abuse
  • Caffeine and stimulant addiction.

After all was said and done, Robert’s tests came back normal and that essentially confirmed he had Adult persistent ADHD.  The good news? Robert has control of his emotions and behavior 98% of the time, still has his job, his marriage is no longer on the rocks and he’s going back to school to learn another trade. His life is no longer full of the ups and downs of petty jealousy, unreasonable rivalry and threats and of course he is a lot happier.

Obviously, ADHD and anger seem to go hand-in-hand with about 50% of teens who have ADHD persisting into adulthood. In these persons, the inability to control anger actually stems from problems in executive thought processing and not recognizing little social and interpersonal clues that allow a person to get along well with others.

As I pointed out to Robert, while it really isn’t fair for a coworker to be treated differently, an extra 15 minute break isn’t something worth fighting for or losing his job over.

Frank Barnhill, MD

P.S. I just finished reading one of the best books on dealing with adult anger I’ve read in the past three years. In “The Cow in the Parking Lot”,  Leonard Scheff and Susan Edmiston explore the emotions and behaviors related to anger and offer insights and training techniques that should allow any angry adult to deal with the largest part of their destructive behavior.  Their book should be required reading for all teens and adults with ADHD.

You might also want to take a look at these previous articles:

Helping ADHD teenagers and adults handle anger producing situations

Problems sleeping cause ADHD Behavior in Children and Adults

Anger issues can be part of ADHD 

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