ADD and Sex

How does ADD impact sexual behavior and functioning?

Over the years, behind the closed door of my office, I have heard hundreds of unusual stories regarding my patients’ sexual activities. I have come to appreciate that, while the topic is often emotionally loaded, the behaviors are generally completely understandable when put into the context of ADD.

ertterdownloadsA certain amount of body exploration and sexual experimentation is normal for all children; in young children with ADD this exploration and experimentation can seem extreme because we see it. Young ADD children often lack that inner voice that says, “Keep your hands out of your pants when others are around” or “Do not touch other kids’ private body parts” or “Don’t draw that in school.”  While other children may have the same impulses, they usually have enough self-control and social monitoring to think first and, in this way, stay out of trouble with their sexual thoughts and feelings.

As children get older it is normal for them to be sexually curious. Oftentimes, older children and adolescents with ADD impulsively act on their curiosity. Then, as a consequence of their poor monitoring and decision-making, they get caught doing something that seems bizarre or perverted to others. The number of older children and adolescents in our practice who have been caught looking at, taking, or even wearing mom’s lingerie, exploring pornographic websites on the computer, using (and running up huge bills) on phone sex hotlines, or sending pornographic photos of themselves to someone they met on the Internet is astonishing. In my experience, upon taking the time to debrief the events with my patients, clearly these behaviors are not signs of perversion or serious mental health problems but rather normal sexual interest in the absence of good self-control.

We all know that in adolescence, sexual exploration continues, and that its consequences can be very serious. Premature experimentation or early sexual involvement can lead to unplanned pregnancy, sexually transmitted diseases, and serious legal trouble. Adolescents with ADD who are struggling with a low self-esteem and lack of acceptance by peers can too easily become involved in sexual relationships to feel good and be accepted never thinking about the potential consequences. In my experience, impulsive kids who struggle in reading the social signals often finds themselves caught up in the heat of the moment and have no idea how to get out.   Many of my ADD adults share with me their scary versions of this story still feeling the regret and guilt.

Dr. Craig Liden | ADD and SexI have found that adults with ADD often struggle with relationships and sexual activities as much as the adolescents do. Impulsivity frequently leads the adult with ADD to jump into relationships and sexual intimacy too quickly. At first, this intimacy feel good; it blots out the pain of loneliness that often accompanies adult ADD. But this quick, feel-good approach to sexuality commonly contributes to promiscuity, addictive involvement in pornography, and risky sexual behavior in the ADD population. In fact, individuals with ADD have been found to have a four times greater risk of acquiring a sexually transmitted disease than the general population.

ADD can also have a significant impact on sexual functioning in “normal” adult relationships as well. It is easy to imagine how the ADD adult with low arousal who finds himself particularly exhausted at the end of the day often has no interest or energy for sex. Many of my patients who have experienced chronic stress as a result managing their weak attention day in and day out struggle with the spectrum of sexual dysfunctions that occur in people who are depressed and anxious — decreased libido, difficulty with arousal, and an inability to reach an orgasm.

Apart from these sexual difficulties, it is not uncommon for the ADD individual’s poor communication and listening skills to interfere with intimacy and, in turn interfere with the quality of his sexual relationships. In my discussions with spouses of ADD individuals, complaints about self-centeredness in the bedroom are the norm.

We’re talking tricky topics this week on the Being Well Center blog.  Check in for discussions about ADD and drug abuse and ADD and chronic health problems.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

first photo credit: Patricia Mellin via photopin cc

second photo credit:.Andi. via photopin cc


ADHD – An All Day, All Life Problem

In the overwhelming majority of cases, ADHD appears to have a genetic basis.  The attentional weaknesses and executive dysfunctions that characterize ADHD appear to be the result of genetically based differences in the parts of the brain that control paying attention and regulating behavior.

This means that the core characteristics of ADHD including low arousal, impulsivity, distractibility, short attention span, and inefficient executive functions (i.e. poor working memory, time/task management, problem solving, response generation, emotional regulation, and self-monitoring), are there from the moment an ADHD individual wakes up in the morning until the time he/she goes to bed at night.

As a result, any life task that requires some degree of focused attention or executive self monitoring can be adversely affected by untreated ADHD.  As it turns out, this is a pretty profound statement!  Reflect back on your day today…try to think of one thing you did that did not require efficient attention or executive functioning skills.

Getting up?  Sorry.  Doing your morning routines?  No way.  Arriving at work on time?  Really?  Doing your job?  C’mon.  Taking to co-workers?  Hardly.  Making the right choices at lunch?  Think about it!  Driving home safely?  Huh?  Preparing dinner?  You’re kidding me, right?  Supervising homework?  Get real.  Getting to bed on time?  I doubt it!

When you think about it, its pretty unbelievable, isn’t it?  This is what makes ADHD such a serious and complicated problem.  And as life goes on, there are more and more demands placed on our attention and executive functions.  ADHD is clearly an all day, all life problem!

I have included with this post a set of Daily Activities Checklist that I use at The Being Well Center to establish the fact that a person’s ADHD is pervasive, impacting daily tasks in all areas of life.  This in one of the key criteria that needs to be met to establish the diagnosis of ADHD.  There’s one for kids and one for adults.  Try it and examine the impact ADHD has on your or your child’s life!

ADD Daily Activities Checklist – Child

ADHD Daily Activities Checklist – Adult