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One aspect of ADD folks that parents, spouses, teachers, therapists and other professionals fail to appreciate is that many of the behaviors that interfere with classroom functioning and interpersonal relationships are driven by the ADHD individual’s need to create stimulation and, thus, “turn on” their brains. Dr. Daniel Amen makes the distinction that these behaviors are brain-driven, not will-driven. He has a chapter in his book, Healing ADD, entitled “The Games ADD People Play,” which gives a tantalizing synopsis of behaviors that family members, friends and professionals take personally, but which are simply unconscious strategies to get certain-parts of the brain to “fire.” Dr. Amen has given me permission to reprint excerpts from this chapter here, and I strongly urge ANYONE dealing with ADD within themselves, within a family member or professionally to read his book! If you regularly deal with ADD individuals, or are ADD yourself, PLEASE read the following sections!

One thing to keep in mind as you read is that many ADD individuals suffer from self-esteem issues, so many of these “games” are also useful defense mechanisms ADD folks use to avoid having to feel ashamed and defective.

Games ADD People Play

“LET’S HAVE A PROBLEM”

Without enough stimulation, the brain looks for ways to increase its own activity. Being mad, upset, angry or negative has an immediate stimulating effect on the brain. Whenever you get upset, your body produces increasing amounts of adrenaline, which stimulates heart rate, blood pressure, muscle tension, and, yes, brain activity. Many people with ADD pick on others to get a rise out of them, to get them upset and to make them crazy. All too often, family members of my patients tell me they are tired of the problems in their families. They say, “I’m so tired of fighting with my brother [sister, mother, son, father, daughter, etc.]. Why does there have to be this turmoil? Can’t he [she] be happy with peaceful coexistence? Does he [she] have to fight? He [she] always has to have a problem. Joshua and Betsy were married for three years before they entered marital counseling. Betsy forced Joshua to get help. He didn’t see any problems and initially refused to see the therapist, but Betsy was beside herself. It seemed to her that they fought nearly all the time. She never felt at peace, never felt that they could have an evening or weekend during which Joshua didn’t complain about something. Even though Joshua was successful in his own business, he frequently complained about his employees. Betsy, who also worked with him, saw that he would regularly select an employee to pick on or engage in some kind of a battle. After an extensive intake interview, the therapist saw Joshua’s conflict seeking behavior as only one of his many ADD symptoms, including disorganization, distractibility, and impulsivity. She referred Joshua for a psychiatric evaluation and worked with the couple on strategies to recognize and stop this destructive game. Rosemary and Chrissy, mother and sixteen year old daughter, constantly fought. It didn’t seem to matter about what: It could be curfew, clothes, music, tone of voice-whatever. I met Chrissy when she was brought to our clinic for evaluation because of troubles at school. During the initial interview with Chrissy and her parents, I watched the two females go after each other. The tone between them was contentious, mutually irritating and on edge. The father wearily told me, “This is how they live at home. Everything is an issue. Everything is a problem. They both hold on to their own positions and cannot let go. It’s as if they have to irritate each other. II often don’t want to come home because I know I’ll have to listen to their battles.” In the evaluation process, Chrissy was diagnosed with ADD (school struggles, inattention, impulsivity, restlessness, and oppositional and argumentative behavior), as was her mother, who had grown up in an alcoholic home, struggles in school, and complained of low energy, disorganization, procrastination, and forgetfulness. After they were both treated for overfocused ADD, the tension diminished dramatically. The need for conflict diminished and everyone felt less stressed and more comfortable at home.

“I BET I CAN GET YOU TO YELL AT ME OR HIT ME”

Many people with ADD are masterful at getting others to scream, yell, spank, and basically fly out of control. They get others so upset that they cannot help but lose it. These negative behaviors provide quite an adrenaline rush but frequently lead to serious negative consequences, such as divorce, fights at school, unemployment, and even abuse. Again, the game is unconscious, not planned.

Bonnie had been diagnosed with inattentive ADD at age 12. The only treatment she received was medication, which she took sporadically. Now at age 15, she was struggling in school and had problems with her parents at home. She also fought with a number of her teachers. On top of all this, the parents were furious at the school because on one the teachers had yelled at her to shut up and sit down in class a number of months earlier. The teacher was disciplined by the school for the outbursts, but she said that she just couldn’t take Bonnie’s lack of respect and disruptive behavior. During Bonnie’s initial evaluation in our clinic, her father cried, saying, “I never thought I would have such negative feelings and behaviors toward my own child. I just start screaming at her, because she says terrible things. She knows every hot button I have, and I feel like she intentionally pushes them on a regular basis. Sometimes I understand why parents abandon their children. They just can’t take the negative feelings, the lack of respect and the constant fighting.”

Jesse, age 6, had parents who did not believe in spanking. They were well educated people who had discussed how they would raise their children even before he was born. Yet, even they didn’t want to use spanking, they often found themselves on the edge of losing control. They yelled more than they wanted to, and they found themselves using physical punishment on impulse because they would get so frustrated at Jess’s misbehavior. Jess was impulsive and seemed driven to turmoil. Ironically, the parents found out that when they yelled or spanked him, his behavior would be better for a while. The mother told me, “If we have a bad morning at home, he has a good day at school. If we have a kind loving morning at home, then he seems to have a bad day at school.” I diagnosed Jesse with classic ADD: He had the full cluster of symptoms. Besides treating him medically, I worked with his parents on effective parenting strategies. I warned them that as soon as they stopped yelling at Jesse, he would get worse for several weeks. It was as if he were going through adrenaline withdrawal. The parents? yelling, screaming and hitting were stimulating to him, and he, unknowingly, used their anger to feel more alert, which is why he did better at school when he had a bad morning at home.

Evan and Alexa, ages 15 and 12, were a brother and a sister at war. Evan was diagnosed with Classic ADD when he was ten years old and Alexa had only recently been diagnosed with Overfocused ADD. The parents brought them to our clinic for medication and family therapy evaluations. The siblings seemed to be masterful at upsetting each other. They had been at odds for as long as anyone could remember. On one occasion- the one that precipitated the referral- Evan came into Alexa’s bedroom to borrow a CD. Alexa screamed at him to get out. When Evan refused, she threw a speaker at him. Evan attacked her, leaving bruises all over her body.

It is essential to stop playing both “Let’s Have a Problem” and “I Bet I Can Get You to Yell at me or Hit Me” if an ADD person is to live happily with others. When I teach parents, siblings and spouses to become less reactive and to feed their need for adrenaline with anger, the ADD person may initially get worse. It seems that the ADD person goes through withdrawal when others become more understanding or more tolerant, at least initially. When the ADD person can no longer get the adrenaline anger rush, he’ll go after it full force, escalating the outrageous behavior. But if a parent, sibling or spouse can remain non-reactive for a long enough period of time, the conflict-driven behavior usually diminishes significantly. Nevertheless, they will periodically test the “non-reactive skill” of the people in their environments by seeking intense emotional reactions. Others have to remain on guard to keep these negative behaviors away.

“MY THOUGHTS ARE MORE TERRIBLE THAN YOUR THOUGHTS”

Psychiatrist and brain-imaging specialist Mark George at the National Institutes of Health demonstrated, in a landmark study, that negative thoughts have a stimulating effect on the brain. Using functional brain-imaging studies, he looked at brain activity while people were thinking about something neutral, something positive and something awful. The neutral thoughts did not change brain activity. The positive thoughts cooled overall brain activity, especially in the limbic area of the brain-certainly not good for ADD folks, who have poor brain activity to begin with. The negative thoughts, however, brought brain activation, especially in the limbic areas (making them more depressed) and in the prefrontal cortex (helping them focus).

Clinically, I have seen that many ADD people seem to be experts at picking out the most negative thoughts possible and staying focused on them for prolonged periods of time. It is almost as if they need the negativity to have the mental energy to function. When I started to talk about this idea to colleagues at my clinic, Jonathan, a marriage, family, and child therapist who has ADD said, “I think I do that myself. I wake up thinking about the most horrific things that could happen during the day. I feel anxious but it motivates me to get up and get moving.”

You have probably noticed the people who play this game at work: If ten good things happen and one bad thing happens, most of their thoughts are focused on the bad thing. There are the people who complain, gossip, find fault, undermine, and pit people against each other. In meeting they disagree and find fault. As managers, they are often the ones who notice the negative much more than the positive.

The negativity often associated with ADD frequently ruins lives. Few people are drawn closer to people who are negative, complaining, or filled with anxious thoughts. Many ADD people who unknowingly play this game end up isolated, lonely, depressed, and even more negative. People who are isolated form others have a higher incidence of both physical and emotional problems.

Some time ago, on of the physicians who worked in my office went through a period during which he was one of the most negative human beings I had ever met. He always had a sour look on his face. Every time I saw him he complained nonstop about office procedures and personnel. He was negative with patients. He hadn’t exhibited this behavior when I hired him. I found myself avoiding him in the hallway feeling frustrated by his behavior. After several weeks of this behavior I told him to come into my office. He started the meeting by complaining about a front-office issue without first wanting to know why I asked to see him. Immediately, I stopped him, saying, “I don’t know what is going on with you but something is different. People are avoiding you and the patients don’t want to see you anymore.” The doctor then told me that he had ADD and that he had decided to stop taking his medication a month ago. He didn’t know why he had stopped it, but when he started taking it again, the negativity problem subsided.

Many people with ADD who play the game “My Thoughts Are More Terrible Than Your Thoughts” end up isolated. Be careful with negativity. This is s damaging and dangerous game.

“IT’S YOUR FAULT”

Another common game played by people with ADD is “It’s Your Fault.” This may be the most dangerous ADD game of all. In it, the ADD person reasons that he or she has little, if anything, to do with the problems in his or her own life. Any problem is someone else’s fault. Frequently I hear that these people do not perform properly at school, at work or within their families because of “the lousy boss,” “the ineffective teacher,” or “the mean brother [or sister].” This game can completely ruin a life. Whenever you blame someone else for the problems in your own life, you become a victim of that other person and you have no power to change anything. Without a sense of personal power, people often feel overwhelmed and hopeless.

Billie Jean came into my office blaming nearly everyone in her life. Her husband mistreated her, her children neglected her, her boss was mean to her, and her doctor (not me, thankfully) did not take her seriously. When she was late to an appointment, it was because of traffic; when she missed a payment, it was because she hadn’t gotten her mail. There was an excuse for everything. Gently, I started to ask her what she could do to make the situations better- with her husband, children, job and everyone else in her life. This process was critical for her emotional health. Unless she took responsibility for her emotions and actions, she would always be at the mercy of others. Her tendency to blame was a way to feel angry and entitled so that she could use that anger as a stimulant. Eliminating blame and asking herself, “What can I do to make the situation better?” was one of the most important parts of her healing process.

Watch out for the “It’s Your Fault” game. It may ruin your life.

“NO, NO WAY, NEVER, YOU CAN’T MAKE ME DO IT”

Opposition also increases adrenaline in the ADD brain. Many people with ADD, especially Type 3 [overfocused ADD] tend to be argumentative and oppositional with people in their lives. These negative behaviors often cause tension and turmoil in families, in relationships, or at work. Many parents tell me they are tired of arguing with their children. This game has one simple rule: I ask you to do something and you say no. I frequently ask my patients: “How many times out of ten when your mother [father, teacher, boss] asks you to do something, will you do it the first time without arguing or fighting?” Many of my patients tend to look down at the floor when I ask this question. They quietly say, “Not many times, maybe two or three times out of ten.” I then ask them why. They tell me they have no idea why they do it, that it is not their goal to be oppositional.

I had a very interesting session recently. I saw a 10-year old boy for the first time. He came into my office with his mother. He immediately sat down on my blue leather couch and put his shoes on it. (That doesn’t bother me: I figure I see difficult kids, you have to have an office that will stand up to them). The shoes on the couch bothered his mother, however. She told him to put them down. When he refused, she put them down on the floor. He immediately put them back up on the sofa. She looked at me in frustration and then moved her son’s feet back on the floor. He put them up. She put them down. She put them down again and slapped his leg. This went on and on. I watched to see the interaction between them. He wanted his way. She was determined not to give in, but she engaged in the same repetitive ineffective behavior. She would have done better by cutting the oppositional behavior right away and give an immediate and unemotional consequence. After about ten minutes of this behavior I asked the boy if it was his plan to upset his mother. He said no. Then I asked him why he had to do the opposite of what she wanted. He said, like so many of these kids do, “I don’t know.”

The unconscious game of “No, No Way, Never, You Can’t Make Me Do it” can isolate a person. This level of opposition drives others away, causing them to make negative judgments about you. While writing this book, I went to Israel to speak at an international ADD conference. At the conference I had the pleasure to spend time with a family that had come to see me in California. The 11-year old boy had been depressed when he came to my clinic. Through his history and our scans we were able to diagnose him properly, put him on the right medication, and help the family with the right behavioral strategies. He made a wonderful improvement. The child and his mother joined my daughter and me on a trip to Jerusalem. The souvenir shops caught the boy’s attention. He wanted a chessboard. The mother said no. He asked again. She said no again. This went on for thirty minutes. I watched. Finally the boy asked me how he could get his mother to get him a chessboard. I said, “You don’t want to hear my answer.” He said he really wanted my help. I told him (with his mother listening), “If your mom gets you what you want after she has already told you no fifteen times, then she is teaching you to get your own way by irritating other people. You’ll be difficult and no one will want to be with you, because you will have to have your own way.” He put his hand over his mother’s ears so she wouldn’t hear any more of my advice. Later he said, “Dr. Amen, you are right. I don’t like people who are pests. I’ll try not to be one.”

You cannot let people badger or irritate you into getting their own way. If you allow this game to work, it sets up serious social problems. No one likes someone who argues with everything they say or opposes them most of the time.

“I SAY THE OPPOSITE OF WHAT YOU SAY”

Here’s another destructive ADD game. Let’s call it “I Say the Opposite of What You Say.” This game is similar to “NO, No Way, Never, You Can’t Make Me Do It,” but involves speech more than behavior. The people that play this game take a position opposite to that of the other person in the conversation. For example, if your spouse complains that you do not listen to him or her, you deny it and then say that he or she does not listen to you. If a parent tells a child to clean his messy room, he or she is likely to say that the room isn’t messy. If a person takes a view on a political position, you will take the opposite position (even if it is against what you really believe). The need for opposition seems to be more important than the truth. The back-and-forth disagreement brings more adrenaline, stress, and irritation to the table. Watch out for this game. It pushes people away from you.

It seems to me that politicians in the United States and abroad are masters of this game. I have often thought that many politicians have ADD. If a Democrat has a good idea, the Republican will automatically put it down; and if a Republican offers a helpful plan, the Democrats will automatically look for ways to shoot holes in it. Cooperation is so foreign to the political process it is a wonder anything gets done. Unfortunately, this same dynamic happens in ADD homes.

“I SAY THE FIRST THING THAT COMES TO MIND”

Many of my patients struggle with the game of “I Say the First Thing That Comes to Mind.” I have heard a number of my patients say, “I am brutally honest.” They wear this trait as if it were a badge of courage. I usually reply to them that brutal honesty is often not helpful. Relationships require tact.

Recently, I walked into my waiting room to greet an eight-year old patient. I was about ten minutes late for the appointment. When she saw me she said, “Well it’s about damn time.” Her mother looked horrified and apologized for the little girl’s comment. Living in an ADD household, I knew comments like that were just part of the terrain. This game causes many, many problems. When you just say the first thing that comes to mind, you can hurt someone’s feelings, infuriate a customer, or give away secrets that were entrusted to you. One of my patients was charged with bringing a friend to a surprise party in the friend’s honor. On the way to the party my patient inadvertently started talking about how much fun the party would be. It was only when he saw the look on his friend’s face that he figured out he had ruined the surprise.”

“LET’S CALL IT EVEN”

Many people with ADD play a deflection game titled “Let’s Call It Even.” In this game, whenever someone else has a complaint or a criticism, the player also adopts the complaint as his or her own. For example, if a husband is unhappy that the house isn’t clean, his wife (the player) complains that he doesn’t help enough. If a wife complains that her husband doesn’t listen enough, the husband will complain about the same thing. If a sibling says that her sister goes into her room and takes things, the sister will say that she does that because her sister does it too.

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