PDF Summary:Is It You, Me, or Adult A.D.D., by Gina Pera

If you're in a relationship with someone who has ADHD, you may feel confused, frustrated, or blamed for problems that seem to stem from nowhere. In Is It You, Me, or Adult A.D.D., Gina Pera explains how undiagnosed or untreated ADHD affects relationships and offers guidance for partners navigating these challenges.

Pera explains the neurological basis of ADHD, including how it affects attention, motivation, and emotional regulation. She discusses why ADHD is often misunderstood or misdiagnosed in adults, particularly in women, and explores treatment options including medication, therapy, and coaching. Throughout, she provides strategies for partners to validate their own experiences, communicate effectively, and support their loved ones in seeking treatment—all while maintaining healthy boundaries and avoiding codependency.

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(Shortform note: Many researchers interpret Pera’s description of difficulty “aiming for goals that are further away” and “inconsistent performance” through the lens of delay-aversion models of ADHD. These models propose that for some people, the act of waiting for a payoff is so unpleasant that it disrupts otherwise capable task execution. Sonuga-Barke, a leading proponent of this view, argues that ADHD can develop through a motivational pathway characterized by what he calls “delay aversion.” He explains that people with ADHD often choose smaller, sooner rewards over larger, later ones and engage in behavior aimed at escaping or reducing waiting, even when this leads to less efficient goal attainment.)

They struggle with insatiability, rigidity, and being empathic. They're hard to satisfy, uncooperative, and neglectful of others' perspectives. They tend to view every situation in a negative light, feel a strong urge to be correct, view making concessions as a loss, lack self-awareness and struggle to connect cause and effect, and frequently fail to recall previous acts of kindness and assistance from others. They additionally struggle with rigidity, an unwillingness to make concessions, and achieving balanced self-regulation.

(Shortform note: While some adults with ADHD may exhibit the traits described above, others may not. In ADHD 2.0, the authors note that many adults with ADHD are highly empathetic, cooperative, and flexible. They argue that with the right support and understanding, adults with ADHD can thrive and use their unique strengths to contribute positively to their relationships and communities.)

Manifestations and Common Misconceptions

Pera highlights that the disorder is frequently misunderstood and misdiagnosed because its indicators can be subtle or mistaken for other issues. Many people, including healthcare professionals, expect hyperactive and impulsive behaviors to be present, so they overlook cases where these symptoms are absent. This leads to many adults, especially women, remaining undiagnosed or misdiagnosed. Additionally, ADHD often coexists with other disorders such as anxiety, depression, and conduct disorders, which can complicate diagnosing and treating it.

ADHD Is Often Misdiagnosed in Women

The claim that adults, especially women, are frequently undiagnosed or misdiagnosed with ADHD when hyperactivity is not obvious is supported by epidemiological studies and clinical observations. For example, researchers have found that when they screen entire populations for ADHD, they identify many more women with predominantly inattentive symptoms than those who actually seek clinical help. This suggests that many women with ADHD remain undiagnosed or are misdiagnosed with other conditions. Additionally, some clinicians have noted that women with ADHD often present with symptoms that overlap with other disorders, such as anxiety or depression, which can lead to misdiagnosis. One academic review article highlights that women with ADHD are more likely to be diagnosed with mood or anxiety disorders before their ADHD is recognized.

Next, we’ll discuss some challenges related to diagnosing ADHD and its consequences.

Presentation & Diagnostic Challenges

Pera notes that diagnosing ADHD in adults is challenging because the criteria were created with children in mind. These criteria require that signs manifest before age seven, but some signs of ADHD don’t show up until later in life. Additionally, children might have impairments masked by extensive parental support, or bright kids may compensate for a long time before their symptoms become apparent.

(Shortform note: The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard reference for diagnosing mental health conditions. The DSM-5, published in 2013, updated the criteria for diagnosing ADHD in adults. The new criteria acknowledge that some people may not have been diagnosed as children, and they allow for a diagnosis in adults who meet the criteria.)

Pera adds that ADHD signs can manifest differently in women, complicating diagnosis. Women with ADHD may face extra challenges managing their time, staying organized, raising children, performing life-maintenance activities, dealing with hormonal issues, and developing problem eating patterns.

(Shortform note: Since Pera’s book was published, researchers have continued to explore how ADHD manifests in women. A literature review published in 2020 found that women with ADHD are more likely to have eating disorders, and an academic paper published in 2022 found that women with ADHD are more likely to have premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS).)

Consequences & Comorbidities

According to Pera, if ADHD isn't treated, it can lead to significant impairments in self-regulation and maturity. Self-regulation means controlling your behavior, thoughts, and emotions, while maturity involves setting priorities and accomplishing them, and managing responsibilities like work, finances, and relationships. People with ADHD frequently struggle to begin tasks, controlling their behavior, and balancing their actions, making it difficult for them to act in mature ways.

(Shortform note: The idea that untreated ADHD can lead to significant impairments in self-regulation and maturity is supported by research. In a study, researchers followed a group of people diagnosed with ADHD in childhood for 20 years. They found that those who had limited or inconsistent treatment reached milestones like independent living, employment, and stable relationships much later than their peers.)

Dynamics of Therapeutics and Relationships

Partners of those with ADHD may need to help them seek treatment, Pera suggests. This is because people with ADHD may not recognize their symptoms or follow through on treatment. Therefore, partners may need to help them find a therapist, make appointments, and attend appointments. This is not codependent caretaking, as over time, those with ADHD will hopefully take more responsibility for their treatment.

(Shortform note: While Pera argues that organizing your partner’s treatment isn’t codependent caretaking, it can become codependent if you always take charge of your partner’s treatment. This is because you may become so focused on your partner’s needs that you neglect your own, which can lead to burnout.)

Next, we'll discuss some interventions and management strategies, the relational impact of this condition, and diagnostic considerations.

Interventions and Management Strategies

To handle ADHD, Pera recommends considering therapy, coaching, or workshops. Coaching centers on the client's objectives and creating successful plans, frameworks, and assistance, while cognitive behavioral therapy (CBT) addresses these issues and also focuses on thought processes and feelings. Coaching allows for more regular communication, which may lead to increased accountability. It capitalizes on clients' assets, so it's an extremely successful method for numerous emotionally stable individuals with the condition. However, coaching approaches that are too rigid tend to focus narrowly on particular ways to mitigate ADHD, ignoring significant cognitive and emotional matters that are crucial to people's well-being. The optimal combination of coaching and/or therapy depends on your unique challenges.

(Shortform note: If you’re unsure which of these options to pursue, try one for a short period of time and track a couple of metrics that are important to you, such as how many times you forget to take your medication or how many times you lose your keys. If you don’t see improvement, try another option or a combination of options. This approach will help you avoid wasting time and money on options that don’t work for you.)

Workshops for couples are most effective when they incorporate psychoeducation about ADHD and its effects on relationships, along with practical management strategies. Partners become aware that they’re not alone, and expressing and listening to their mutual irritations and approaches in this setting can be incredibly therapeutic for them.

(Shortform note: While workshops can be therapeutic, they can also backfire if they focus too much on rehearsing grievances. This can reinforce negative narratives about the relationship, making it harder to see the positive aspects. Effective workshops balance acknowledging challenges with building positive interactions, helping couples develop a more nuanced and hopeful view of their relationship.)

We’ll next discuss core interventions and supportive strategies.

Core Interventions

According to Pera, medication and CBT are core interventions for ADHD. CBT is a form of verbal therapy that targets the thinking patterns underlying emotions and aims to change them. The premise is that everyone holds basic assumptions.

Medication and CBT are the most effective ways to manage ADHD. Stimulant medications function by slowing dopamine and norepinephrine reuptake, raising the synaptic dopamine levels. They work fast, but their effects diminish in a few hours. Combining CBT with medication management significantly improves symptoms of ADHD, anxiety, mood, and general functioning.

ADHD and Bipolar Disorder

The claim that “Medication and CBT are the most effective ways to manage ADHD” doesn’t hold true for people with both ADHD and bipolar disorder. The National Institute for Health and Care Excellence (NICE) recommends that people with both ADHD and bipolar disorder should not start ADHD medication until their bipolar disorder is stabilized. This is because stimulant medications, which are commonly used to treat ADHD, can trigger manic episodes in people with bipolar disorder. Therefore, it’s important to stabilize the bipolar disorder first before starting ADHD medication.

Supportive Strategies & Relational Approaches

To address denial in your significant other, Pera suggests using the LEAP strategy, which stands for Listening, Empathizing, Agreeing, and Partnering. This approach helps you express your worries without causing your partner to feel defensive. It also helps you shift from emphasizing diagnoses to concentrating on behavior problems and shared solutions.

(Shortform note: In I Am Not Sick, I Don’t Need Help!, psychologist Xavier Amador offers practical advice for using the LEAP strategy in everyday conversations. He emphasizes the importance of staying with the other person’s point of view until they feel completely understood. He explains that you shouldn’t offer your own opinion or advice until your partner says, “Yes, that’s exactly how I see it.”)

Additionally, Pera advises confirming your viewpoints and seeking support. If your partner with ADHD is in denial, you may have learned to doubt your perceptions and judgment and may have trouble knowing when you're acting reasonably. Staying true to your emotions will help you stand on firmer ground. Seeing a therapist familiar with symptoms of ADHD can help anchor your perceptions, and participating in a group for support can validate your experience and strengthen your ability to hold your ground. Knowing your worries are legitimate in your own mind allows you to mentally feel more comfortable telling your partner, “It could just be me, but…” As you increase your knowledge of ADHD and its symptoms, your understanding will grow clearer.

(Shortform note: While confirming your viewpoints and seeking support can help you feel more confident in your perceptions, it can also backfire if you’re not careful. If you’re not open to the possibility that your partner’s perspective is valid, you may become entrenched in your own viewpoint and less willing to work toward repairing the relationship. For example, psychologists have found that when people engage in “co-rumination”—repeatedly discussing and dwelling on problems with others—it can lead to increased anxiety and depression. While co-rumination can strengthen friendships, it can also reinforce negative thinking patterns and make it harder to see solutions. If you’re only seeking validation for your own perspective, you may be less open to understanding your partner’s point of view.)

You'll develop a firm grasp of the subject, knowing your comprehension may not be flawless. Once you reach that stage, you’ll be almost immune to blame or guilt about your perceptions.

(Shortform note: As your understanding of ADHD solidifies, you’ll naturally start to interpret your conflicts through the lens of your “illness model” rather than through self-blaming explanations. This means that other people’s accusations will stop feeling like trustworthy evidence against you, so you’ll feel less guilt.)

Relational Impact and Diagnostic Considerations

ADHD can significantly affect relationships, Pera points out. This is due to the symptoms themselves, but also because of a lack of awareness of them. People often misattribute the traits to other causes, such as immaturity or selfishness. People who don't know they have ADHD frequently develop poor coping strategies, and their loved ones do too. This may lead to life together feeling chaotic.

(Shortform note: If you’re in a relationship with someone with ADHD, you may feel like your life together is chaotic. In Thinking in Systems, Donella H. Meadows suggests that you can make sense of chaos by drawing a simple diagram of the steps that lead to it. For example, you might diagram the steps that lead to a fight. Then, you can choose one step to change.)

Pera also notes that diagnosing adult ADHD often needs input from others. Adults with ADHD may not realize the impact their symptoms have on their own lives or the lives of others. Input from others helps the clinician get a more complete picture of the signs and their impact. It further aids the partner without ADHD in understanding the symptoms and how they affect the relationship.

(Shortform note: In some cases, asking for input from others can be dangerous. In Why Does He Do That?, Lundy Bancroft explains that abusive and controlling men often manipulate counselors, mediators, and other helping professionals. They present themselves as calm, reasonable, and concerned while portraying their partners as irrational, unstable, or mentally ill. Bringing an abusive partner into the diagnostic process can give them more power to misrepresent you and retaliate against you later.)