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The Sandwich Generation and ADHD

ADHD often runs in families. So, if you’re among the nearly half of adults who are caring for a parent and also raising a child or financially supporting a young adult, you know that ADHD in the family can complicate your caregiving challenges. 

The “sandwich generation,” a term coined by Dorothy Miller in 1981, is the generation whose members are “sandwiched” between caring for their children and one or more parents at the same time. According to Ms. Miller, little attention had been paid to the high levels of stress affecting members of this generation until recently; the number of people caring for two generations at once is expected to grow as more baby boomers enter their 60s.

Awareness of and options for support have increased since the 1980s. But what happens when one or more members of a “sandwiched” family are affected by ADHD?  

Characteristics of the sandwich generation

“In all too many cases the work of family caregiving resembles the life of the proverbial mom and pop grocery store—open seven days a week—whose owners have never had a vacation,” says Ira Rosofsky, PhD, in Caregiver Stress: Would You Like Some Angst With That Sandwich Generation? for Psychology Today

A survey by A Place for Mom, a resource for senior care, found 81 percent of family caregivers were also caring for young children. Although many respondents found caregiving to be rewarding, they also reported high levels of stress associated with the time required to accomplish their many responsibilities, and the associated financial challenges from increased costs and impact on their careers. Constant multi-tasking can be physically and mentally exhausting, and requires a balancing act. If you as caregiver are affected by ADHD, such multi-tasking is further complicated by executive function deficits.

“Caregiver stress is the emotional and physical strain of caregiving. It can…lead to serious health problems,” Dr. Rosofsky says. “Research shows that people who take an active, problem-solving approach to caregiving issues are less likely to feel stressed than those who react by worrying or feeling helpless.”

Multiple generations with ADHD

Genetic studies show there is a strong hereditary component to a diagnosis for ADHD, with an up to 90 percent likelihood of passing the disorder to your children.

If you or your partner has been diagnosed with ADHD, your children have a high likelihood of being diagnosed with it, and the likelihood of one of your parents having ADHD, or displaying its symptoms, is also high. This means you could have three generations of your family all affected by ADHD and living in one household. A caregiver has to manage the treatment plan for children and teens, while helping a parent navigate treatment options, all while maintaining her own treatment plan and needs.

Co-occurring conditions in the mix

In addition to the challenges ADHD presents, many people affected by ADHD also have co-occurring conditions. In fact, more than two-thirds of individuals with ADHD have at least one other coexisting condition. Disruptive behavior disorders such as oppositional defiant disorder, mood disorders and anxiety, sleep disorders, and substance abuse are just a few that commonly co-occur. Each presents a certain set of symptoms for the people impacted, and treatment and management of the conditions are most effective when tailored to the patient’s and family needs. For more information, read Coexisting Conditions, and discuss options with your healthcare provider. 

Tips for managing the crunch more effectively

Studies reveal significant physical and emotional risks for caregivers, so self-care is essential for your well-being and that of your family. When you’re on an airplane and the flight attendant describes safety procedures, whose oxygen mask are you to put on first if the air pressure changes? Answer: Yours. Unless you take care of yourself, your ability to take care of others greatly diminishes. 

There is no one “right” approach for everyone. The most effective approach for you depends on how caregiving and ADHD are affecting you and your family, and the first priority is to make sure you as caregiver are keeping up with your prescribed treatment plan. Here are a few additional tools to consider:

  • Exercise. The value of exercise in reducing stress cannot be overstated. Physical exercise reduces the level of hormones released during stress, primarily cortisol, and increases the production of endorphins. Studies have shown that cortisol suppresses immune system function and chronic stress—sustained stress for a prolonged period of time, accompanied by a feeling of a lack of control—has been linked to global immunosuppression. You can become sick more easily when this happens.

    Exercise helps to counteract the effect of stress by reducing cortisol levels and elevating endorphins, the chemicals our brains produce that reduce pain and positively improve our feelings of well-being. Exercise in a natural setting may increase the benefits even more. A recent study found a correlation between being in a natural environment and reduction in cortisol levels. 

  • Mindfulness and quiet time. It has long been known that mindfulness is helpful in reducing stress and helping manage ADHD symptoms. Worry and anxiety are common when you are a caregiver, and neither is constructive. Mindfulness can be as simple as focusing on what we are feeling or thinking in a present moment, rather than focusing on what might happen in the future

    Lidia Zylowska, MD, a psychiatrist who led the nation’s first study in mindfulness training for ADHD, tells Attention magazine that mindfulness is  “about being less distracted and bringing our attention to aspects of the present moment. It is also about having an open, nonjudgmental attitude when mindfully observing what is." 

    You can read Dr. Zylowska’s Eight-Step Program in Mindfulness for ADHD, in Mindfulness and ADHD.

    Having uninterrupted time for yourself is equally important and necessary for self-care. Patricia O. Quinn, MD, discusses the benefits of quiet time for yourself in 100 Questions & Answers About ADHD in Women and Girls. Having uninterrupted time for planning, financial management, or completing paperwork related to health insurance, programs and schools, Dr. Quinn writes, can help you stay on top of key tasks while setting a good example for your children that quiet time is beneficial for them as well. 

  • Nurturing relationships. Increased demands on your time can lead to less time devoted to your relationships. But the quality of your relationships is an important part of your physical health. How can you focus on maintaining relationships when caregiving and ADHD present more challenges?

    Understanding what the challenges are likely to be is important. The first step is to recognize that focusing on your relationships is an important part of your self-care. The stronger your relationships, the more they can support you as you provide care. 

    When ADHD symptoms affect you and/or your family members, learning more about ADHD and how to separate the behaviors and symptoms of the disorder from the person is important. Your patience decreases when you feel stressed. At times when you need more support, you may be inadvertently pushing away or ignoring those who can help support you. To learn more about relationships, read ADHD Complicates Romance and Mastering Social Skills.

  • Practice resilience. Steven Southwick and Dennis Charney discuss how resilience is something that can be learned and developed in their book, Resilience. Essential elements to achieving resilience include a positive attitude, reframing situations or events, and a strong set of core beliefs. 

    Your ability to be more resilient relies on a high level of self-care. Without good sleep, your ability to build resiliency is greatly diminished. For more information, also see MindTools’ Resilience.

  • Ask for help. Many caregivers are used to seeing what needs to be done and stepping in to take care of it. They are frequently so good at doing this that they don’t think to ask for help. The downside is that they take on so much that they can become overloaded and burn out.  

    Asking for help accomplishes several things. It helps to reduce the burden on the caregiver, increases the opportunity for other family members to be involved in care, and allows friends and family to provide specific support when they may be unsure how they can help. For tips to improve your ability to reach out for help, see Harvard Business Review’s 5 Ways to Get Better at Asking for Help.
Making the most of the middle 

Caregiving is an essential part of life for millions of people, and those affected by ADHD have special considerations to take into account. Optimizing your ability to provide care for your family and loved ones is a high priority, not only to avoid burnout, but also to appreciate the benefits of caregiving. Take steps today to ensure your wellbeing for yourself, your children, partner and parents. 
Are you caring for both children and parents, while your family copes with ADHD symptoms? What are you suggestions for making the most of the middle?

This article appeared in ADHD Weekly on May 25, 2017.

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