Adult ADHD

ADHD in Adults

Many adults with ADHD aren’t aware they have it — they just know that everyday tasks can be a challenge. Adults with ADHD may find it difficult to focus and prioritize, leading to missed deadlines and forgotten meetings or social plans. The inability to control impulses can range from impatience waiting in line or driving in traffic to mood swings and outbursts of anger.

Adult ADHD symptoms may include:

• Impulsiveness
• Disorganization and problems prioritizing
• Poor time management skills
• Problems focusing on a task or over-focusing on a task (tunnel vision)
• Trouble multitasking
• Excessive activity or restlessness
• Poor planning
• Low frustration tolerance
• Frequent mood swings
• Problems following through and completing tasks
• Hot temper
• Trouble coping with stress

(taken from Mayo Clinic website, http://www.mayoclinic.org)

 

Below are some ways to help combat these symptoms.

Manage Distractibility

Getting off track is a common way that ADHD folks wind up losing time and thereby don’t have enough time to do the things that they were supposed to get done. Some of this is big chunks of wasted time, but they can also leak away small bits of time that add up. To the extent possible, it’s generally best to set up these strategies beforehand, when they’re on your mind, rather than relying on doing the right thing in the moment. Once you’re distracted, it’s too late.

– Use reminders to keep you on task, whether small taped up notes or large white boards.

– Work to ingrain the habit of frequently asking yourself, “What should I be doing now?”. Cue yourself to do this by using a repeating alarm that forces a small break in the progression of time so that you can notice what you are doing and then make a conscious choice as to whether it’s the best use of your time.

– Work in a quieter and less visually stimulating place or use a sound machine or fan to provide white noise to screen our other sounds. Alternatively, if it won’t become distracting in itself, use the television or music. You can also buy noise canceling headphones relatively inexpensively these days. Foam ear plugs cost virtually nothing, but may block too much sound.

– Try to keep an orderly work space, but if your work space is currently messy, rather than jumping into organizing it, clear it to the side and schedule a time to come back later to deal with it.

– When you find yourself off on a tangent, go back to the original task and finish that before moving on to the next. A certain amount of this is to be expected, so there’s no point in beating yourself up about it. Just go back to the previous task.

– Use hyper-focus for good instead of evil by immersing yourself in a project and completing a big chunk of it.

– Break work sessions into smaller pieces with short breaks in between to reduce wandering attention or to prevent crashing and abandoning work all together. However, if you are going to give the devil his due, set an alarm to cue you to return so the breaks don’t become longer than the work sessions.

– Employ active learning or active processing techniques to stay involved in what you’re doing.

– Work with a partner or in a group if feasible and if there will not be an undue social price paid in resentment from your only partially willing teammates.

– Set aside specific, interruption-free periods of your day for tasks that require extra focus. Preserve the sanctity of this time by closing your web browser, turning off your phone, and turning off your new email alert. If necessary, explain to coworkers or family members that you would prefer that they came back later unless there’s an emergency and then put up sign to remind them.

– If a new idea for a project keeps popping up, take a small moment to write it down so that you can return to it later rather than pursuing it immediately.

– If you are simply too distracted at work, then maybe you need a new job.

 

Managing Hyperfocus

The trouble with hyperfocus is that it is very difficult to stop once it has begun. Therefore, the best point of intervention is usually ahead of time, when it is on your mind.

– Set an alarm before you get hyperfocused to serve as a reminder, since once the hyperfocus starts it’s too late.

– Enlist others to serve as your reminder, if they are willing to do it. For example, “I get really focused on my work, so do me a favor and swing by my cubicle to pick me up on the way to the meeting.”

– Sometimes you just need to give the devil his due, so allow yourself times to do it. Intentionally picking when and how to do this is very different from unintentionally finding yourself off on a tangent.

– If you notice that you hyperfocused on something for too long, then take a moment to re-assess and see what the best course of action is, rather than getting down on yourself or impulsively jumping into something else that may not be the best use of your time under the new circumstances.

 

Manage Hyperactivity/Motor Restlessness

Fortunately, the most obvious aspects of hyperactivity from childhood will have faded for most adults. However, we also expect adults to be much better able to sit still, so the bar has been raised. The trick is to find more productive, or at least less destructive, ways of managing that excess energy.

– Work in a job that provides or allows a lot of physical movement. When considering a job change, look for a job that allows you to be on your feet, that allows movement from room to room, that calls for frequent interaction with others, or that enables you to travel from one job site to another.

– If your job requires prolonged desk work, take frequent brief breaks that allow movement, like going to the water fountain, delivering mail, and so on.

– Bring your lunch so you can spend the lunch hour walking or exercising without taking the time to buy something. The more sedentary your job, the more important it is to exercise, so do it before or after work if you can’t do it during the day.

– Try to avoid jobs with lots of long meetings or sedentary, detailed desk work.

Manage Procrastination and Avoidance

Some of these difficulties may be based in the primary symptoms of ADHD, such as by getting distracted to other tasks or forgetting about a project. The avoided tasks may be too boring to inspire you into action. However, you may also avoid or put off tasks that you feel probably won’t work out well anyway or that get you too stressed just thinking about it. If this is the case, it may be worth seeing a therapist to work on developing a more active approach to tackling these kinds of demands with less interference from negative thoughts and feelings.

– Keep in mind the potentially high price paid for procrastinating—stress and disaster is you miss the deadline.

– If the problem is based in not knowing how to do something well, then learn the necessary skills so you can do the task more easily and quickly.

– Break big projects into smaller pieces so it feels less awful and overwhelming, then give yourself small rewards for meeting interim deadlines. If you have difficulty visualizing the whole project and how the pieces fit together, then recruit some help with it from a coach, therapist, romantic partner, friend, or coworker.

– Make a commitment to someone else to complete the task—use social pressure to your advantage.

 

– Intersperse boring and enjoyable activities. The more enjoyable activities may simply be less boring than

the primary activity, but at least it provides a break of sorts.

– If the thought of a long stretch of working on the dreaded activity is too much to bear, then make a commitment to only do ten minutes and see how it goes. If it’s going well, then agree to another ten minutes. Often these activities are not so awful once they are actually started. It’s getting over the initial hump that’s the hardest.

– Severe procrastination may be telling you that you are better off doing something else, having someone else do it for you, or finding a new way of doing something.

 

Learn New Things

In order to learn something, our attention has to hold onto it long enough to process the new information and put it into long term memory. This working memory, as it is called, is similar to the RAM in a computer—when the RAM gets over- loaded, programs start crashing and information gets lost. These techniques help you to make the most of your RAM.

– Use flashcards and repetition

.

– Repeat someone else’s actions rather than relying on remembering written instructions. This will be especially helpful if you learn better by doing than by hearing or reading.

– Reduce external distractions in order to make the relevant information stand out more. However, some people find that music or television can help to quiet internal distractions and keep them focused.

– Break the work into several shorter sessions based on mental sharpness or time the most intense learning for the parts of the day when you have the best alertness or medication coverage.

– Use active learning techniques: repeat the information either out loud or mentally; relate the new information to old; think about how the information will be retrieved later; and process the information further, thereby increasing the odds that the information will be remembered.

Remember to Remember

A lot of success in adulthood depends on our ability to remember to do the right things at the right times. This is also where a lot of ADHD people run into trouble. For example, remembering while you’re at work that you need to buy milk on the way home doesn’t really help all that much. Nor does remembering it when you’re pulling up to the house. The time that it really counts is when you’re approaching the turn off to the supermarket. It’s all about the timing. Therefore, if you have trouble reliably remembering the right thing at the right time, the trick is to keep it on the top of your mind or to create external reminders at a moment that it is on your mind.

– Place objects where they will serve as their own cues—for example, put DVDs to be returned to the rental store right in front of the door so you can’t help but see them. The corollary to “out of sight, out of mind” is “in sight, in mind”.

– When setting a reminder alarm, respond to it immediately to prevent quickly forgetting it again. A variation of, “Speak now or forever hold your peace” is “Do it now or forget it forever.” At a minimum, if you can’t do the task immediately, then snooze or reset the alarm to go off again so you don’t forget.

– Post a family calendar in a visible place and meet occasionally to discuss it, especially if you have kids with lots of activities.

– Use post-its, white boards, and pads of paper as reminders. Sprinkle them liberally throughout the home and workplace.

– Leave yourself a voicemail or email to better remember at the place where you need to remember it, such as calling your home voicemail from work and leaving yourself a message to pay bills tonight.

– Reduce the amount of external distractors in your environment so that the relevant reminders stand out more. This may involve reducing the amount of overall clutter.

– Develop routines of doing the same things in the same order on the same schedule to prevent skipping steps.

Stay Focused on Long Term Goals

Long term goals are especially difficult for most ADHD folks since they do not loom as large in their consciousness as more immediate concerns and distractions do. It’s not that they are unaware of these goals or don’t want them, but rather that they are continually pushed from the present moment into some future moment—later, tomorrow, next week—and thereby potentially postponed into oblivion. So the trick is to find ways to keep these future goals in mind in the present.

– Post a picture of the desired goal to serve as a reminder.

– Put up a note to yourself as a reminder.

– Break long projects into smaller pieces and set deadlines for each part. This may also entail setting up more regular check-ins with your boss or romantic partner to ensure that you don’t get too far afield.

– Spend some time on a regular basis tracking your progress on long term projects to make your successes more tangible and to see where you need to do better. Make adjustments as necessary.

– If your job involves a lot of long term projects and you keep running into trouble with them, you may be better off in a job with shorter goals.

Stay Focused on Short Term Goals

Managing short term goals tends to be easier than longer term goals because it involves a smaller window of time in which you need to stay focused.

– Take the first or last fifteen minutes of the day to plan your activities and set priorities. This becomes easier once it becomes a habit—no exceptions.

– Build in small rewards for completing tasks.

 

– Learn to ask yourself about priorities before diving into a new task—“Is this what I should be doing

now?” no matter how tempting something is.

 

– Tie short term goals to larger goals, so there is a feeling of bigger progress with each small step.

 

Tackle Repetitive and Boring Tasks

Repetitive and boring tasks are the bane of most ADHD folks. It can feel like torture, yet is still an important part of managing our lives.

– Set deadlines to create structure and keep you on task.

 

– Use last minute pressure to get energized and stay focused, if there isn’t too much danger of disaster striking if you run over.

– Delegate it away, if possible.

– Do it in small bits that feel less taxing.

– Work with someone else if the company will make it more enjoyable and keep you on task.

– Create variety by rotating through several activities. The variety is more enjoyable and the time is still being spent productively.

– Set up rituals to create consistency, like always paying bills on Sunday nights.

 

– Set up a timer with a specific amount of time that you will do the task before taking a break. s Keep in mind the cost of not following through.

Use Time More Efficiently

Folks with ADHD often feel like they just don’t get enough done in a given stretch of time, despite their best intentions. Sometimes it’s big things that suck away the time, sometimes it’s just a bunch of small detours. These techniques will help you get more done.

– Inefficient use of time is often related to disorganization of objects because lots of time is wasted looking for things, so it may help to invest the time to get your stuff organized.

– Reduce distractions when trying to get things done, such as by turning off the phone and email alerts or going to a quieter environment.

– Use daily goal setting to keep priorities at the front of your mind.

 

– Limit the number of balls you have in the air at one time. Tempting as it can be, don’t start something before finishing something else. This provides an incentive to finish the first tasks.

– Use a beeping or vibrating alarm to alert you regularly to the passage of time and also to remind you to consider whether what you’re currently doing is what you should be.

– Make hard choices ahead of time to limit the number of activities you’re involved in so you don’t get stretched too thin and accomplish little.

– Use social pressure positively, by making a commitment to someone else to get a certain number of things done in a given time period.

– Work with someone else present—even if she is not directly involved in the process, her mere presence can serve as a reminder to stay on task.

 

Reprinted with permission from Integrative Treatment for Adult ADHD: A Practical, Easy-to-Use Guide for Clinicians. Ari Tuckman (2007). New Harbinger Publications.