Emergency first aid

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Family occasions can be an intense time for many people, and particularly challenging for people with ADHD. Why? ADHD often doesn’t provide that valuable space between a trigger and our response. The outcome can be explosions of emotion, or opinions shared without pause to rationally review the material for appropriateness and intended outcome.

Family engagement makes us particularly vulnerable because we meet with childhood history, and potential unresolved issues. Managing conflict is problematic, especially when we are filled with emotions difficult to control.

I was talking to a colleague about the intensity of seasonal celebrations with family, and why they can be so exhausting. I reflected on the effort required to maintain a congenial environment, and the personal guilt and self-recrimination when the façade of equanimity crumbles.

My colleague recounted a period in his life when he lived with relatives in Pakistan. He had no personal space or opportunity for solitude. He was in the company of others from the moment of waking, to falling asleep. I looked at him in bewilderment. “How did you survive?” I asked. He admitted initially it was very challenging, but eventually adjusted and found return to England created its own difficulties. He reflected how time on his own felt uncomfortable for a while, and created a sense of unease.

I thought about his experience. There is a growing body of evidence loneliness can be damaging to our health (Heinrich and Gullone, 2006; Klinenberg, 2016; Valtorta et al., 2018). I thought about my network of family and friends. I can’t remember the last time someone came to visit without planning and scheduling beforehand. Outside of work, I rarely see family or friends in person regularly or predictably.

I struggle with planning, and work on impulse. I have experienced the bitter reality of scrolling through my list of contacts during a dark hour of the soul to find no-one available for a shared cup of restorative tea. I have been left humiliated to reach-out for help and fail at the endeavour, ashamed I have given the message to others I could not cope, and angry with myself for my lack of self-sufficiency. These situations put vulnerable people at risk of turning to more responsive addictive activities to manage uncomfortable feelings and self-soothe, sometimes with regrettable consequences.

In situations where people are in regular company, (although I find the concept unpleasant and anxiety inducing) will eventually release the effort to create a false, but potentially less noxious presentation of themselves. If conflict and arguments arise, opportunities to reconcile and repair will present often. There would be an imperative to manage different opinions and perspectives so life in constant contact becomes bearable.

I have witnessed occasions where anger has been expressed in the presence of family. An emergency escape plan is rapidly deployed (it would surpass a building evacuation in terms of coordination and response). This is often followed by a period of quarantine by way of communicative silence, and the opening of backroom channels to make sense of the event and create endless hypotheses. Sometimes, a negotiator may be nominated to broker some form of resolution but an elephant will often be present in the room for weeks to follow.

Social media and the temptation to hide behind the written word of a text message, is all too alluring. However, hurt is easy to achieve by accusatory typing, but seeking sincere repair through apology is less certain when you are not physically with the person involved. Even a video call feels detached, and shrouded by an anxiety the conversation may be terminated at any moment by a press of a button.

The solution to the issue of reduced inter-personal contact is the intensification of amicability and social niceties. The challenge for someone on the Hyperactivity Attention Deficit Disorder spectrum is the sheer effort required to manage the requirement. I find myself oscillating between resentment against falsehood and dishonesty, versus an animalistic need for escape and time to recover.

Where does this leave us? Well, the wonderful saying, “Give me the strength to change what can be changed, the grace to accept what can’t, and the wisdom to know the difference” rings true here. We need to choose our battles, and plan our coping strategies.

I have accepted the need for time-out of social situations, and recovery time. I still feel selfish and anti-social, but the consequences of denying my needs is much more damaging. I would like to practise and learn the skills of expressing my feelings safely and without judgement. An excellent book by Rosenberg and Chopra (2015) provides a toolkit of language to navigate the thorny issues of expressing our wants and needs. However, as with all new skills, it takes practice and perseverance; but perhaps more importantly, requires opportunity to work with patient, understanding and willing participants.


Heinrich, L.M. and Gullone, E., 2006. The clinical significance of loneliness: A literature review. Clinical psychology review26(6), pp.695–718.

Klinenberg, E., 2016. Social isolation, loneliness, and living alone: Identifying the risks for public health. American journal of public health106(5), p.786.

Rosenberg, M. and Chopra, D., 2015. Nonviolent Communication: A Language of Life: Life-Changing Tools for Healthy Relationships. PuddleDancer Press.

Valtorta, N.K., Kanaan, M., Gilbody, S. and Hanratty, B., 2018. Loneliness, social isolation and risk of cardiovascular disease in the English Longitudinal Study of Ageing. European journal of preventive cardiology25(13), pp.1387–1396.

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