Inattention and Hyperactivity-Impulsivity: Their Detrimental Effect on Romantic Relationship Maintenance

Abstract

Objective: The aim of this study is to understand how ADHD symptoms correlate with romantic relationship maintenance and test theoretical pathways by which symptoms of ADHD lead to relationship difficulties. Method: This study involved two phases of data collection, which were identical except for the population. Phase 1 (n = 172) was a nonclinical sample of romantically involved young adults. Phase 2 (n = 39) was a clinical sample of romantically involved young adults with ADHD. Participants in both phases reported on their levels of inattention and hyperactivity-impulsivity, their relationship maintenance activities, and their relationship quality. Results: ADHD symptoms were associated with greater relationship difficulties. In both samples, inattentive symptoms were associated with greater interest in relational alternatives and less constructive responses to partner’s bad behaviors, whereas hyperactive-impulsive symptoms were associated with negative responses to bad behavior. Conclusion: The results of this study have implications for developing cognitive-behavioral therapy interventions targeting relationship difficulties in young adults with ADHD.

Keywords

ADHD hyperactivity impulsivity inattention romantic relationships relationship maintenance

Previously considered a “Disorder of Childhood,” ADHD is now widely recognized and diagnosed in adults (Kessler et al., 2010). Known to impact many domains of functioning, ADHD is also associated with strained interpersonal relationships, including romantic, which ultimately translates into lower odds of marriage and greater odds of divorce (Biederman et al., 2006). Tracing the cause of these ultimate outcomes back, individuals with ADHD and their partners report lower romantic satisfaction in dating relationships, a greater likelihood of infidelity, and a greater likelihood of intimate partner violence, among other relationship difficulties (Canu, Tabor, Michael, Bazzini, & Elmore, 2014; Fang, Massetti, Ouyang, Grosse, & Mercy, 2010; Garcia et al., 2010).

Relationship difficulties have profound consequences: In the context of stressful life events, divorce and marital separation have been ranked as the second and third most stressful events an individual can undergo, respectively, higher than even death of a close family member or being in jail (Holmes & Rahe, 1967; McAndrew, Akande, Turner, & Sharma, 1998). As such, a greater understanding of the process by which ADHD impacts relationship maintenance is crucial for the development of interventions aimed at improving the quality of life of individuals with ADHD. In the current study, we examine how the individual clusters of ADHD symptoms are associated with relationship maintenance processes in young adults both with and without ADHD. By doing so, we aim to identify the specificity of these associations to ADHD and how the success of relationship maintenance can be bolstered among individuals with ADHD diagnoses.

Hyperactivity-Impulsivity and Inattention in Social Relationships

Individuals who have ADHD have impairments in many areas of daily life, but of note for the current project are the enduring impairments in social functioning (Babinski et al., 2011; Bagwell, Molina, Pelham, & Hoza, 2001; Glass, Flory, & Hankin, 2012; Nijmeijer et al., 2008). Given the social difficulties observed in individuals with ADHD, it follows that romantic relationship initiation and maintenance may be an area of weakness for these individuals. Indeed, both inattentive symptoms and hyperactive-impulsive symptoms are associated with romantic difficulties.

Relative to individuals with other presentations of ADHD, those young adults with an inattentive presentation reach dating milestones at a later age, have a lower number of steady dating relationships, and feel less comfortable or assertive in particular situations (Canu & Carlson, 2003; Overbey, Snell, & Callis, 2011). In addition, individuals who show more inattentive symptoms and less hyperactive-impulsive symptoms tend to use relational problem-solving techniques such as positive reinterpretation and active coping less, spend less time on their romantic relationships, and express love and affection less than individuals who show less inattentive symptoms (Overbey et al., 2011). Not surprisingly, then, romantic satisfaction is negatively correlated with the ADHD inattentive presentation (Overbey et al., 2011).

Hyperactive-impulsive symptoms of ADHD are also associated with relationship difficulties, although distinctly different difficulties from those found in individuals with greater inattentive symptoms. For example, young adult males diagnosed with childhood ADHD-Combined type have higher mean verbal aggression and violence scores than controls, and were 5 times more likely to report the use of violent behaviors with romantic partners (e.g., throwing items, hitting) than were men who did not have a childhood ADHD-Combined diagnosis (Wymbs et al., 2012). Other studies have corroborated this finding, indicating that the presence of hyperactive-impulsive symptoms is a “small but significant” predictor of the use of aggressive tactics during relationship conflict (Theriault & Holmberg, 2001).

In addition to the core symptoms of ADHD, several associated cognitive vulnerabilities have been identified, including working memory and cognitive flexibility deficits (Frazier, Demaree, & Youngstrom, 2004; Hervey, Epstein, & Curry, 2004). Attention deficits affect cognitive capacity, increase cognitive load (Roberts, Milich, & Fillmore, 2012), and may help to also explain the relational difficulties experienced by this population, as relationship maintenance of all kinds is effortful, requiring motivation and ability.

Relationship Maintenance: Transformation of Motivation

Relationship maintenance is broadly defined as the cognitions and behaviors that involved individuals enact to remain in their romantic relationship (Agnew & VanderDrift, 2014). Encompassing a broad array of activities, relationship maintenance is what occurs when a threat the relationship is encountered (Rusbult & Agnew, 2010). The threat can come from within the relationship (e.g., a partner behaves badly) or outside of the relationship (e.g., a desirable alternative partner appears), but regardless of the origin, neutralizing the threat is done through an effortful process that entails individuals placing the broader interests of the relationship ahead of their own myopic, self-interested responses (Kelley et al., 2003; Rusbult & Van Lange, 2003). Because it is an effortful process, however, individuals fail to engage in ample maintenance when they are lacking either motivation or ability, both of which are required elements for any effortful behavior (Bargh, Gollwitzer, Lee-Chai, Barndollar, & Trotschel, 2001).

Accommodation is a behavioral relationship maintenance mechanism concerned with how individuals react when their partner has behaved badly (e.g., has been rude to them; Rusbult, Verette, Whitney, Slovik, & Lipkus, 1991). There are four classes of responses, two of which are negative (i.e., exit and neglect) and two of which are positive (i.e., voice and loyalty). Engaging in the positive responses is better for the relationship, yet people occasionally engage in negative responses. The prevailing theoretical belief is that the negative responses are a gut-level reaction when a partner behaves badly that must be overridden and replaced with the positive responses via effort (e.g., inhibition of a prepotent response). As such, an individual not engaging in positive accommodation or engaging in negative accommodation when his or her partner behaves badly is indicative of an individual who either (a) lacks commitment to the relationship (i.e., motivation) or (b) does not have the cognitive ability to transform motivation (e.g., due to cognitive load, high emotional arousal, lack of time).

Derogation of alternatives is a cognitive relationship maintenance mechanism concerned with how individuals cope with the presence of relationship alternatives. One of the greatest threats to an ongoing relationship is high-quality relationship alternatives, or the other people with whom the individual could be involved if they were not in their current relationship (VanderDrift, Lewandowski, & Agnew, 2011). Because alternatives pose such a threat to the continued success of a relationship, individuals exert effort to derogate their alternative partners, viewing them as worse than their current partner. Because individuals must actively derogate the alternatives that they see, it is susceptible to failure, especially when cognitive capacity is limited.

The Current Study

The current project aimed to examine the roles of inattention and hyperactivity-impulsivity in relationship maintenance. This study utilized undergraduate college students who were all involved in romantic relationships. In Phase 1 of the study, we recruited a large nonclinical sample to test the hypothesized pathways; then in Phase 2, we recruited a clinical ADHD sample to confirm our findings in the nonclinical sample. Participants in both phases of data collection began by answering questions regarding their current romantic relationship functioning, including how they handle conflict in their relationship, their interest in relationship alternatives, their commitment to the relationship, and their thoughts of leaving the relationship. Participants then responded to questions inquiring about their present level of ADHD symptoms and answered demographic questions about themselves and their relationship. In total, the data provided by the participants allowed us to examine whether ADHD symptoms are indeed associated with problems in relationship functioning, what relationship maintenance mechanisms are foregone that lead to these problems, and whether different symptoms produce different patterns of difficulty for the individuals. Specifically, in the current study, we sought to test the following:

Hypothesis 1: ADHD symptoms (both inattentive and hyperactive-impulsive) will be negatively associated with willingness to accommodate and positively associated with interest in relational alternatives.

Hypothesis 2: Accommodation and interest in alternatives will mediate the association between ADHD symptoms (both inattentive and hyperactive-impulsive) and relationship difficulties (i.e., dissolution consideration).

Together, these hypotheses will test as to whether the theoretical rationale introduced previously (e.g., ADHD will be associated with a reduced ability to transform motivation in relationships) might explain previous research findings that individuals with ADHD have greater difficulty maintaining close relationships and report higher relationship dissatisfaction (Bruner, Kuryluk, & Witton, 2015).

Method

Participants and Design

Phase 1

In Phase 1, we collected a general sample (i.e., nonclinical). Participants were 172 heterosexual undergraduate students (55 males and 117 females) at a moderately sized private university in the Northeastern United States. A priori power analyses suggested that to have sufficient power (80%) to detect a mediated effect using bias-corrected bootstrapping techniques in which both the predictor-to-mediator paths and the mediator-to-outcome paths are medium (explaining 30% of the variance) requires 162 participants (Fritz & MacKinnon, 2007). The only criterion for participation was that participants had to be currently involved in a romantic relationship that had lasted at least 6 months. The average duration of their relationship was 20.2 months (SD = 13.8). Most participants indicated that they were involved in an exclusive dating relationship (89%, with 11% describing themselves as casually dating). Participants’ ages ranged from 18 to 28 years (M = 18.8, SD = 1.3), and the majority indicated that they were White (71%, with 5% Asian, 4% Black, 12% Hispanic, and 8% Multiracial).

All participants completed the measures described below in partial fulfillment of an introductory psychology course requirement. Participants signed up for a particular time to complete the study through the university participant pool website. They completed the study individually, after which they were debriefed and thanked for their time.

Phase 2

In Phase 2, we collected a clinical sample in which all participants had been diagnosed with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) defined ADHD and had been in a romantic relationship for at least the past 6 months. Over 2 academic years, participants with ADHD were recruited from a university-based psychology clinic as well as the introductory psychology participant pool at the same moderately sized private university in the Northeastern United States. Participants with ADHD were 39 heterosexual undergraduate students (20 males, 18 females, and 1 who specified “other”). The average duration of their relationship was 16.2 months (SD = 11.8). Most participants indicated that they were involved in an exclusive dating relationship (92%, with 8% describing themselves as casually dating). Participants with ADHD’s ages ranged from 18 to 23 years (M = 18.9, SD = 1.3), and the majority indicated that they were White (85%, with 8% Asian, 3% Hispanic, and 5% Multiracial).

Our ADHD group demonstrated (a) evidence that the student experienced ADHD symptoms in early childhood (before age 12; operationalized as endorsing historically elevated symptoms of inattention or hyperactivity/impulsivity in the research interview); (b) there was evidence that, no later than middle school, these ADHD symptoms led to substantial and chronic impairments across settings; (c) there was evidence that the student was currently experiencing impairing ADHD symptoms; and (d) there were no other explanations (e.g., anxiety) that better accounted for the current symptoms.

All participants with ADHD completed the measures described below in partial fulfillment of an introductory psychology course requirement. Participants signed up for a particular time to complete the study through the university participant pool website. They completed the study individually, after which they were debriefed and thanked for their time.

Measures

Both groups of participants (i.e., Phase 1 and Phase 2) completed an identical battery of measures, with the exception of Phase 2 participants completing a supplemental set of items regarding their ADHD diagnosis. Specifically, Phase 2 participants reported the age at which they were first diagnosed with ADHD (M = 12.5, SD = 3.8), whether they are currently receiving treatment (69% yes), and, if so, what kind of treatment they are currently receiving (73% just medication, 7% medication and accommodations, and 4% each: just accommodations, just counseling, medication and counseling, counseling and accommodations, medication, counseling, and accommodations). They also reported whether they have any comorbid diagnoses (49% none; 13% anxiety; 10% anxiety and depression; 7% depression; 7% learning disability; 5% anxiety, depression, and learning disability; 3% anxiety and learning disability; 3% depression and learning disability).

Participants in both phases of data collection completed all of the subsequently described measures.

Predictor

To measure ADHD symptoms, we used the World Health Organization’s Adult ADHD Self-Report Scale (ASRS; Kessler et al., 2005). This measure has two subscales, one that measures Inattention symptoms (e.g., “How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?”) and one that measures Hyperactive-Impulsive symptoms (e.g., “How often do you interrupt others when they are busy?”). Both scales are rated on a scale from 0 (never) to 4 (very often). For analyses, the sum of each of the two scales was taken, and each evidenced acceptable reliability (inattentiveness: α = .81; hyperactivity-impulsivity: α = .83). See Table 1 for mean levels of each symptom endorsed by the sample. As shown, the overall level of ADHD symptoms endorsed suggests that participants in Phase 1 experience each of the symptoms within each cluster between “rarely” and “sometimes,” whereas participants in the clinical sample (Phase 2) experienced each of the symptoms between “sometimes” and “often.”

Table 1.

ADHD Symptom Endorsement.

Subscale	Item	Phase 1 (nonclinical)		Phase 2 (ADHD)		Range
Subscale	Item	M ^a	SD	M	SD	Range
Inattention	How often do you make careless mistakes when you have to work on a boring or difficult project?	1.85	0.89	2.59	0.91	0-4
	How often do you have difficulty keeping your attention when you are doing boring or repetitive work?	2.68	0.98	3.05	0.83	0-4
	How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?	1.66	0.98	2.21	0.95	0-4
	How often do you have trouble wrapping up the fine details of a project, once the challenging parts have been done?	1.63	1.09	2.33	1.08	0-4
	How often do you have difficulty getting things in order when you have to do a task that requires organization?	1.36	1.04	2.05	1.10	0-4
	When you have a task that requires a lot of thought, how often do you avoid or delay getting started?	2.33	1.13	2.82	1.12	0-4
	How often do you misplace or have difficulty finding things at home or at work?	1.63	1.14	2.31	1.20	0-4
	How often are you distracted by activity or noise around you?	2.34	1.14	2.79	0.83	0-4
	How often do you have problems remembering appointments or other obligations?	1.45	1.08	2.10	1.19	0-4
Hyperactivity-Impulsivity	How often do you fidget or squirm with your hands or feed when you have to sit down for a long time?	2.20	1.27	2.31	1.20	0-4
	How often do you leave your seat in meetings or other situations in which you are expected to remain seated?	1.00	1.02	1.41	0.99	0-4
	How often do you feel restless or fidgety?	1.94	1.12	2.26	1.22	0-4
	How often do you have difficulty unwinding and relaxing when you have time to yourself?	1.49	1.15	2.03	1.25	0-4
	How often do you feel overly active and compelled to do things, like you were driven by a motor?	2.00	1.07	2.15	1.29	0-4
	How often do you find yourself talking too much when you are in a social situation?	1.76	1.06	1.97	1.18	0-4
	When you are in a conversation, how often do you find yourself finishing the sentences of the people that you are talking to, before they can finish them?	1.47	1.14	1.87	1.08	0-4
	How often do you have difficulty waiting your turn in situations where turn-taking is required?	1.33	1.09	2.08	1.06	0-4
	How often do you interrupt others when they are busy?	1.42	1.13	1.89	1.02	0-4

Scale is 0 = never, 1 = rarely, 2 = sometimes, 3 = often, and 4 = very often.

Outcome

As an outcome indicative of relationship problems, we examined dissolution consideration. Research has shown that dissolution consideration is a mediating step between relationship commitment and relationship dissolution that reliably predicts individuals ending their relationship. This measure taps people’s thoughts, feelings, and actions toward dissolution and is the most proximal precursor to ending the relationship that currently exists in the literature (VanderDrift, Agnew, & Wilson, 2009). This construct is measured with five items (e.g., “I have been thinking about ending our romantic relationship”) rated on a scale from 1 (never) to 9 (always). The mean of these items was used for analyses (α = .95).

Potential mediators

To measure accommodation, participants completed the Exit Voice Loyalty Neglect (EVLN) Accommodation scale (Rusbult et al., 1991). This measure assesses individuals’ willingness to inhibit impulses to react destructively and act constructively when a partner has engaged in a potentially destructive act. This measure contains 16 items, four items tapping each of four options for responding to a partner’s behavior: (a) exit (e.g., “When my partner is rude to me, I feel so angry I want to walk right out the door”), (b) voice (e.g., “When my partner is rude to me, I try to resolve the situation and improve conditions”), (c) loyalty (e.g., “When my partner behaves in an unpleasant manner, I forgive my partner and forget about it”), and (d) neglect (e.g., “When my partner does something thoughtless, I avoid dealing with the situation”). As is commonly done, we created two scales out of these items, Destructive Responses (i.e., exit and neglect; α = .79) and Constructive Responses (i.e., voice and loyalty; α = .76), to use in analyses.

To measure interest to alternatives, we collected two measures. First, participants completed the Attentiveness to Alternatives Index (Miller, 1997), which consists of six items intended to tap how much individuals notice their alternatives (e.g., “I’m very aware that there are plenty more ‘fish in the sea’”). Each item was rated on a scale from 1 (never) to 6 (always). This self-reported attention to alternatives scale evidenced acceptable reliability (α = .77). Second, all participants completed a measure of susceptibility to infidelity (Buss & Shackelford, 1997). This measure asks participants to report how likely they believed they currently were to engage in six forms of infidelity: flirt, passionately kiss, go on a romantic date, have a one-night stand, have a brief affair, have a serious affair. Participants responded by placing an “x” on a scale from 0% to 100%. As in past research, the mean of the responses to the six forms of infidelity was used as the measure of susceptibility to infidelity. This composite measure evidenced acceptable reliability (α = .90).

Demographics and controls

Finally, participants answered demographic questions about themselves, their current partner, and their relationship. These questions included ones about age (in years), gender (coded male = 1, female = 2), cohabitation status (coded cohabitating = 1, not = 2), and whether the partners live greater than 50 miles apart (coded yes = 1, no = 2). To serve as a control for relationship motivation in some analyses, participants completed the eight-item commitment scale from the Investment Model Scale (Rusbult, Martz, & Agnew, 1998; α = .91).

Results

Initial Analyses—Phase 1

We began by examining whether ADHD symptoms are significantly associated with dissolution consideration (i.e., the most proximal precursor to ending the relationship; VanderDrift et al., 2009) and relationship maintenance. See Table 2 for descriptive statistics and bivariate correlations among all study variables.

Table 2.

Descriptive Statistics and Bivariate Associations Among all Study Variables.

	M (SD)	1	2	3	4	5	6	7	8	9	10	11
M (SD)		18.9 (1.3)	0.5 (0.5)	16.2 (11.8)	22.3 (6.4)	17.9 (6.3)	3.6 (1.5)	5.5 (1.4)	4.7 (1.8)	25.2 (26.3)	6.5 (1.8)	3.3 (2.6)
Demographics
1. Age	18.8 (1.3)		−.12	.12	−.08	−.19	−.09	−.19	.10	−.11	−.09	.04
2. Sex^a	0.7 (0.5)	−.07		.09	−.09	.06	.02	−.18	−.50*	−.38*	.24	.04
3. Relationship duration (months)	20.2 (13.8)	.24**	−.03		−.06	−.10	.05	.08	.13	.26	.02	.01
ADHD symptoms
4. Inattentive	16.9 (5.9)	−.01	−.03	.01		.43**	.39*	−.11	.30	.23	−.09	−.04
5. Hyperactive-impulsive	14.5 (6.5)	−.06	−.04	−.02	.47***		.23	.18	.04	.05	−.09	−.03
Relationship qualities
6. Destructive accommodation	3.3 (1.4)	−.05	−.06	.07	.10	.27***		−.25	.49**	.40*	−.28	.39*
7. Constructive accommodation	5.6 (1.2)	.08	−.20**	−.03	−.16*	−.02	−.04		−.09	.05	.01	.02
8. Interest in alternatives	4.1 (1.4)	−.09	−.19*	−.01	.31***	.30***	.30***	−.12		.64***	−.53***	.43**
9. Susceptibility to infidelity	24.7 (25.3)	.08	−.04	.06	.16*	.11	.20**	−.10	.46***		.43**	.48**
10. Commitment	7.0 (1.8)	.01	.15*	−.06	−.17*	−.30***	−.31***	.19*	−.59***	−.44***		−.63***
11. Dissolution consideration	2.9 (2.2)	.13	−.11	.11	.20**	.26***	.42***	−.18*	.56***	.52***	−.71***

Note. Values below the diagonal are from Phase 1 (nonclinical), whereas values above the diagonal are from Phase 2 (ADHD).

Sex is coded 0 = male, 1 = female.

p < .05. **p < .01. ***p < .001.

Briefly, both inattentive symptoms (r = .20, p < .05) and hyperactive-impulsive symptoms (r = .26, p < .001) were positively associated with dissolution consideration in this nonclinical sample. Furthermore, both dimensions of ADHD symptoms were negatively associated with overall accommodation (inattentive: r = −.18, p < .05; hyperactive-impulsive: r = −.21, p < .01). The inattentive component of ADHD symptoms was associated with less constructive accommodation in bivariate correlation analyses (r = −.16, p < .05) but unrelated to engaging in greater destructive accommodation (r = .10, p = .20). The hyperactive-impulsive component, on the contrary, was associated with greater destructive accommodation (r = .27, p < .001) but unrelated to engaging in constructive responses (r = −.02, p = .84). Both the inattentive symptoms (r = .31, p < .001) and the hyperactive-impulsive symptoms (r = 30, p < .001) were associated with greater attention paid to alternative partners, but hyperactive-impulsive symptoms were unassociated with susceptibility to infidelity (r = .11, p = .16), but inattentive symptoms were a significant predictor (r = .16, p < .05).

Importantly, all of these significant associations were stable controlling for the effect of commitment in multiple regression analyses, except for the effects with regard to susceptibility to infidelity. Specifically, inattention was nearly significantly associated with constructive accommodation when added to a model already containing commitment, β = −.135, t(169) = −1.78, p = .08, and hyperactivity-impulsivity was significantly associated with destructive accommodation when added to a model already containing commitment, β = .196, t(169) = 2.61, p < .01. Attention to alternative effects also hold after controlling for the effect of commitment—inattentive: β = .218, t(169) = 3.61, p < .001; and hyperactive-impulsive: β = .140, t(169) = 2.19, p < .05.

Pathways to Relational Difficulties—Phase 1

We next tested mediation models in which the association between ADHD symptoms and dissolution consideration was explained by accommodation and interest in alternatives. The model constructed simultaneously tests multiple mediated paths and employs bootstrap resampling to create confidence intervals (CIs) around the estimated indirect effects (Preacher & Hayes, 2008). See the top half of Figure 1 for the visual depiction of the tested model. Upon the addition of the four mediators, the previously significant association between inattention and dissolution consideration, β = .18, t(170) = 2.49, p < .05, dropped to nonsignificance, β = .00, t(166) = 0.06, p = .95. Looking at the indirect effect, results from bias-corrected and accelerated 95% CIs suggest that the overall indirect effect was significantly different from zero (95% CI = [0.0402, 0.2990]). Specifically, the indirect effect between inattention and dissolution consideration through attention paid to alternatives was significantly different from 0 (95% CI = [0.0386, 0.1807]), whereas the indirect effects through constructive responses (95% CI = [−0.0001, 0.0600]), destructive responses (95% CI = [−0.0328, 0.0684]), and susceptibility to infidelity (95% CI = [−0.0107, 0.1209]) were not.

Figure 1.

Pathways to relationship difficulties among the nonclinical sample.

Next, we performed the same multiple mediator model analyses with hyperactivity-impulsivity as the predictor (see the bottom half of Figure 1 for this model). Upon addition of the four mediators, the previously significant association between hyperactivity-impulsivity and dissolution consideration, β = .25, t(170) = 3.47, p < .001, dropped to nonsignificance, β = .06, t(166) = 0.90, p = .37. Results from bias-corrected and accelerated 95% CIs suggest that the overall indirect effect between hyperactivity-impulsivity and dissolution consideration was significantly different from zero (95% CI = [0.0741, 0.3236]). Specifically, the indirect effect through destructive responses was significantly different from zero (95% CI = [0.0137, 0.01352]), as was the indirect effect through attention paid to alternatives (95% CI = [0.0370, 0.1821]), whereas the indirect effects through constructive responses (95% CI = [−0.0146, 0.0275]) and susceptibility to infidelity (95% CI = [−0.0107, 0.0902]) were not.

Comparisons to a Clinical Sample—Phase 2

Examining mean levels of symptoms experienced, as expected, the nonclinical sample (Phase 1) had lower levels of both inattentiveness, t(209) = −5.04, p < .001, and hyperactivity-impulsivity, t(209) = −2.99, p < .01, than did the clinical sample (Phase 2). Next, we examined bivariate associations among ADHD symptoms and relationship maintenance constructs within the ADHD sample. Full results can be seen in Table 2, above the diagonal. Briefly, among the ADHD sample, the only statistically significant association is between inattentive symptoms and destructive accommodation (r = .39, p < .01). However, despite the lack of significance, descriptively the patterns of associations mirror the pattern among the general sample. Specifically, inattentive symptoms are positively associated with interest in alternatives (r = .30 among clinical; r = .31 among general) and susceptibility to infidelity (r = .23 among clinical; r = .16 among general), and negatively associated with constructive accommodation (r = −.11 among clinical; r = −.16 among general) and commitment (r = −.09 among clinical; r = −.17 among general). The association between inattentiveness and dissolution consideration was the only bivariate that differed substantially between the two samples (r = .04 among clinical; r = .20 among clinical).

Likewise, hyperactive-impulsive symptoms are positively associated with destructive accommodation (r = .23 among clinical; r = .27 among general) and susceptibility to infidelity (r = .05 among clinical; r = .11 among general), and negatively associated with commitment (r = −.09 among clinical; r = −.30 among general). The associations between hyperactivity-impulsivity and constructive accommodation (r = .18 among clinical; r = −.02 among general) and between hyperactivity-impulsivity and dissolution consideration (r = −.03 among clinical; r = .26 among general) differed substantially between the two samples. All analyses were recomputed covarying for pharmacotherapy presence or absence. The overall pattern of results did not change.

Discussion

Relationship maintenance is an effortful process requiring both motivation and ability (Rusbult & Van Lange, 2003). Because ADHD symptoms may limit cognitive resources available for the relationship (Roberts et al., 2012), we expected that ADHD symptoms would lead to greater relationship difficulties through their impact on individuals’ ability to engage in relationship maintenance. In line with previous research that has suggested that inattentive and hyperactive-impulsive symptoms pose a risk to romantic relationships (Bruner et al., 2015; Overbey et al., 2011; Theriault & Holmberg, 2001; Wymbs et al., 2012), our research suggests that these relations exist regardless of whether or not the individual meets criteria for ADHD. The comparisons between the clinical and general samples suggest more similarities than differences, issues of statistical power aside, suggesting that the patterns found in the general, nonclinical sample hold when examining a clinical sample of individuals who have been diagnosed with ADHD.

The major and most novel contribution of this work, above and beyond adding to the romantic relational correlates of ADHD symptomatology, is that these data add a theoretical pathway explaining how the symptoms of ADHD may lead to relationship difficulties. Indeed, mediation models confirmed that both clusters of ADHD symptoms were associated with greater dissolution consideration through their impact on relationship maintenance. To rule out the idea that it may be motivation to maintain the relationship that differs as a function of symptoms, rather than ability to do so, we ran all pertinent analyses controlling for commitment (a motivated state indicative of wanting the relationship to persist; Arriaga & Agnew, 2001), and the patterns did not change. Thus, our hypothesis that reduced relationship maintenance occurs in the context of elevated levels of inattentive and hyperactive-impulsive symptoms was supported.

The two clusters of ADHD symptoms did not exert their influence through identical maintenance failure pathways, however. Inattentive symptoms led to relationship difficulties through their impact on the individual’s interest in relationship alternatives, whereas hyperactive-impulsive symptoms exerted their influence on relationship difficulties through destructive responding and attention paid to alternatives. If replicated, these patterns suggest that high levels of inattention may result in individuals paying more attention to alternative partners which in turn leads to more relationship dissolution consideration during relationship problems, whereas individuals with higher levels of hyperactivity-impulsivity may fail to suppress their negative responses to their partner during relationship problems and may also fail to suppress their desire to search for an alternative partner.

Clinical Implications

These results may have several clinical implications. In general, our data suggest that, whereas both inattention and hyperactivity-impulsivity are associated with limited transformation of motivation in the romantic context, the two symptom clusters may lead to different outcomes as a result of what types of maintenance are limited. Inattention is a likely cause of sustained relationship dissatisfaction, whereas hyperactivity-impulsivity is a cause of failure to persist in the relationship. Both inattention and hyperactivity-impulsivity are associated with increased attention to alternatives, implying that interventions for those with inattentive symptoms only may focus on teaching the individual with ADHD strategies to push aside one’s own interest in pursing something new and instead focus on their partner’s good qualities. Interventions for those with hyperactivity-impulsivity symptoms, however, may need to also focus on teaching skills to help the individuals forego their “gut-level” desire to act destructively when their partner behaves badly, or to not engage in destructive accommodation practices such as avoiding a discussion with the partner or impulsively exiting the relationship.

Most of the group cognitive-behavioral therapy (CBT) treatment programs (Safren et al., 2005) that are currently used for adults with ADHD do not include romantic relationship modules. To our knowledge, the only group CBT that targets romantic relationship directly is the integrative couples group treatment program developed by Wymbs and Molina (2015). Results from this study indicated that while the 6-week intervention did not have an impact on positive relationship quality, less relationship negativity was reported (especially by males).

Given the promising data published by Wymbs and Molina (2015) as well as the current results, it may be beneficial to investigate whether a CBT intervention which targets and teaches skills designed to help those with ADHD engage in less destructive accommodation practices and focus more on their partner’s good qualities is effective. For example, interpersonal effectiveness and distress tolerance skills that are taught in dialectical behavioral therapy (DBT) may be useful toward improving romantic relationships in adults with ADHD. However, at this point, there are no data that have been published on the efficacy of DBT interventions on romantic relationship outcomes in adult ADHD.

Limitations and Future Directions

Our findings need to be considered within the context of our methodological weaknesses. First and foremost, our clinical sample was smaller than our nonclinical sample. Whereas this is common in clinical research, our findings should be considered preliminary until replicated in a larger sample of individuals with ADHD. In addition, our data are cross-sectional. Our mediation models were constructed with theoretical considerations in mind, based on the literature suggesting that dissolution consideration is the most proximal precursor to dissolution (VanderDrift et al., 2009), and that relationship maintenance activities precede this construct temporally (Rusbult et al., 1998), but nevertheless, we cannot empirically rule out reverse causality or a third variable explanation for our findings. Future research would benefit from examining the time course of relationship difficulties among individuals with ADHD to ensure the causal order. Likewise, due to low statistical power as well as the great range of comorbid conditions, we were not able to consider the impact of psychiatric comorbidity. Future research should consider how psychiatric comorbidity may affect associations between ADHD symptoms and romantic relationship maintenance behaviors.

Finally, we did not consider psychosocial or pharmacological treatment status as a covariate in our analyses. It is possible that some of our participants may have participated in couples counseling which may have affected responses on the relationship questionnaires. Likewise, we did not control for stimulant medication use. It is possible that some participants reported lower levels of ADHD symptoms as a function of stimulant treatment. This latter limitation suggests that relationship impairment may be even greater for individuals with ADHD who do not receive pharmacological treatment, but because of our limited variability on that construct, this is an issue that requires future research to understand. Future research aimed at examining a broader range of maintenance mechanisms would contribute to the understanding of ADHD symptoms and relationship difficulties.

Conclusion

These data represent a first investigation of the pathway between experiencing ADHD symptoms and having romantic relationship difficulties. Our findings suggest that both inattention and hyperactivity-impulsivity play a role in romantic relationship dissolution consideration in both clinical and nonclinical populations. Given the importance of healthy romantic relationships to a variety of functional outcomes, interventions designed to support these relationships in the ADHD population may be important to consider. Our preliminary data suggest several avenues of possible intervention.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Laura E. VanderDrift is an assistant professor of psychology at Syracuse University. Her research interests include the predictors of outcomes within interdependent social relationships, including dissolution behaviors and health outcomes.

Kevin M. Antshel is an associate professor of psychology and director of the Clinical Psychology Doctoral Program at Syracuse University. His research focuses on better understanding the heterogeneity of ADHD with particular emphasis on mediators and moderators of treatment outcomes.

Amy K. Olszewski is an adjunct instructor of psychology at Syracuse University. Her research focuses on developmental neuropsychology.

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