One thing I find fascinating about ADHD is the connection among various features of the disorder, and how that reality parallels the connectedness, or lack thereof, among parts of the ADHD brain. The seemingly separate features of ADHD are all part of one whole, just as separate musical instruments are coordinated as one symphony performance. The brain’s conductor (executive function) coordinates activity in a typical brain, like a symphony conductor coordinates activity of musicians. But an impaired conductor cannot coordinate a musical performance.
Features of ADHD include forgetfulness, disorganization, inattention, impulsivity, emotion disregulation, and difficulty activating and sustaining effort. These are parts of one disorder.
Memory and attention are interactive. You may forget what your partner told you and get accused of not caring, but that might not reflect a simple memory problem. You might not have been present enough to process what your partner said. When your attention is pulled this way and that way, with no inhibition or regulation of input from many sources, you may hear the words without processing a message. The same outcome may occur when your attention is laser-focused on something that overrides your partner’s words. Then she asks you the dreaded question, “What did I just say?” If you have a sense of humor, you might improvise a creative answer to make her laugh. If you have no sense of humor, you might get angry that she is quizzing you like an attorney in court.
If you are not mindfully present enough to process and file a message in your memory, there will be nothing in the memory bank to pull up later.
Activation (opposite of procrastination) and attention are interactive. If you cannot effectively inhibit attention to all that is vying for it in the moment, you may become immobilized and appear indecisive. If all tasks are equally important, choosing where to start is complicated, and prioritizing is inconceivable. Either way, you fail to start, or you jump impulsively into whatever grabs your unmanaged attention with no regard for priorities.
Impulsivity and emotional reactivity are interactive. You may get hooked into believing that something external to you caused your emotional reaction. So the fix is external, with no regard for the internal problem (reasoning hijacked by emotion). The meaning you make is not recognized as problematic, as thoughts have become facts. Being impulsive, you react aggressively or defensively to the person or situation that you believe caused your arousal.
I’m often asked, “Isn’t everyone like this?” Most people have some of the parts some of the time. Adults with ADHD are the sum of the parts. They have been like this much of their lives, and are like this in different settings, to the extent that the sum of these features impairs their daily lives. Learning may be affected, or relationships may suffer. Adults with ADHD may underperform at work or become workaholics who neglect their families. Impulsivity may lead to financial or legal problems, or injuries from accidents.
We are like cats. All cats are alike in some ways, but I’ve never had one cat who was just like another. Observe a group of adults with ADHD, and you will see individuals who might share little in common except for the features that affect them. Effects can vary widely. ADHD grows up in different homes with different parents, different siblings or no siblings, different levels of support or rejection. It marries different people, some who are understanding and supportive, some who are inflexible and critical.
I can say with confidence, after 13 years of leading an ADHD support group, that group members recognize each other as being in the same “family” despite our differences. We accept our differences because we are different and wish to be accepted. When people tell me, “You don’t look like you have ADHD,” I still don’t know what to say…but I never thank them.
Do you make to-do lists and then ignore them, lose them, or get derailed after the first task? I’m most productive when I start my day meditating first, and then writing my task list. I prefer pen and paper, using one sacred notepad that I keep nearby…except when I lose it. If you prefer using your mobile device, be mindful of risking the out-of-sight-out-of-mind problem. How often do you scan your entire list, or your calendar, on an electronic device?
There is more to prioritizing than creating a task list. The time you protect for making the list should be on your calendar. It may be your most important, non-urgent task. Non-urgent tasks are easy to neglect. Brains like mine are drawn like a magnet to urgency. God only knows what I’m forgetting in this moment, while pushed to meet my blogging deadline.
Starting your day by jumping into a task with a microscopic state of awareness interferes with open awareness. Start your day in an open state before engaging in selective attention. Prioritizing requires both states of awareness. Going from an open state to focused attention is easier than shifting from one object of focus to another. Doing is more stimulating than planning. Prioritizing tasks requires patience and inhibition of impulsivity. If you neglect to prioritize the task of prioritizing, you may remember a critically important priority after it is too late to begin the task. Feeling horrible about having used your time unwisely, you may distract yourself unwisely with negative self-talk. That’s where a meditation mantra can help: let it be…move on.
Beginning your day with a wide angle lens is important for living well with ADHD. You have an attention management problem, not an attention deficit. Broadening your awareness is no less important than focusing it. I have a harder time with open awareness. I can focus too well at times and lose awareness of time, other priorities, and other people. Poor attention management not only contributes to inefficiency, it can make you appear unconcerned about others.
Modern television studios use a small mounted camera for a director to employ for scanning and directing multiple robotic cameras. One robotic camera may show a wide angle view of the entire set, and another may focus on the face of a show’s host. We direct our visual attention in a similar fashion, first determining where to direct it, and then shifting from a broad view to a focused one. Scanning for where to direct your visual attention determines what you see. Scanning is like prioritizing.
Give your task list the time and attention it deserves. Expect occasional setbacks, but don’t waste time criticizing yourself for wasting time. Just return the wheels to the tracks in that moment of recognition, before the self-criticism engine starts. It takes seconds to get back on track and far more time to lecture yourself. The moment you have completed a task, direct your attention back to the task list, immediately, before your brain gets hooked by something urgent and less important. Just note what grabbed your attention and add it to your list if it is important. Then keep moving forward.
Now, back to my task list…
Do you have trouble deciding what to do first when you have many things to do? No one task seems more or less important than another. So you mentally spin like a roulette wheel, as if the ball is going to land on a number for you. You feel overwhelmed and immobilized. Adults with ADHD often feel like there is way too much to do, even when our workload is not that different from the workload of others and should be manageable.
If you have ADHD, you prioritize horizontally; each task is as important as all the others. What that means, in reality, is that we don’t prioritize. Prioritizing requires attention management, and your attention manager goes to sleep on the job. That is what ADHD is at the core, an impaired attention manager. It works inconsistently because of your neurological difference. If you take medication for ADHD, you may have an idea what it is like to organize and prioritize your work.
Whether you take medication or not, recognizing this problem points to an adaptive solution. Take Stephen Covey’s advice and schedule time for something important but not urgent. Instead of jumping indiscriminately into the first task that grabbed your attention, only to jump to another before finishing the first, you can schedule time for prioritizing. Of all people, you
need to pause before starting any task and consider your tasks for the day. You cannot do that when your awareness is locked up in a selective attention state.
We call it attention deficit, unfortunately in my opinion, because we have an attention management problem. In fact, it may be an attention surplus. The problem seems to lie in our limited ability to inhibit attention. Since you don’t have the attention manager of a neurotypical, prioritizing should be your first task of the day. Remember that you are impulsive and likely to jump into a task randomly, without regard to its importance. But I believe you can be impulsive and still know when your impulsivity can cause a problem. Scheduling prioritizing time is a way to prevent your ADHD from sending you into spinning.
I’m at my best when I have a task list. I keep a spiral notepad for my daily task list. Spiral notepads come in many colors. You can choose a particular color for your task lists so it is distinguishable to you and your family. The only problem I have had with this strategy is that I tend to grab the first notepad I find, often using a new one when I already have one in use. I’m still a rule violator at heart!
I plan to label and date a current one, always returning it immediately to my briefcase after updating it, and avoid using a fresh one when my current one is missing. I vow not to use a black for anything else when I cannot find a colored one. Colored notepads will be reserved for other purposes, like ideas and drafts for writing projects. To use a colored notepad for a task
list, or a black one for drafts of my blog, should draw a penalty flag. My brain may need a referee, perhaps an ADHD coach, as much as it needs an attention manager.
If you don’t know about professional organizers and ADHD coaches, click on this link: https://www.nytimes.com/2019/01/16/smarter-living/professional-organizers-productivity-clutter.html
Great novelists are teachers of life lessons. Viet Thanh Nguyen is a master of metaphor and simile, and author of the Pulitzer Prize winning book, The Sympathizer. In an interrogation scene, he describes the problem of being too close to one’s experience to see it.
…for we are the ones most able to know ourselves and yet the ones most unable to know ourselves. It’s as if our noses are pressed up against the pages of a book, the words right in front of us but which we cannot read. Just as distance is needed for legibility, so is it that if we could only split ourselves in two and gain some distance from ourselves, we could see ourselves better than anyone else can.
Reading this passage reminds me of how we can be so unaware of the effects of ADHD symptoms on others. We may be too nearsighted. To see our experience as others might observe it requires mental flexibility. To learn from our missteps requires the courage to observe our missteps with an open mind and tolerate feelings of embarrassment without retreating.
We can be so single-mindedly focused that we lose awareness of what is on the periphery of our selective attention. We can seem inconsiderate, not because we don’t care, but because we lose awareness too easily. For example, we can be so focused on a story we are telling that we don’t notice that the listener has other things to do. I was speaking to the owner of a restaurant last week who had other customers besides me…imagine that! It was one occasion when my wife and part-time attention manager should have kicked me under the table. I was on a roll when my listener interrupted me to get back to work.
The mindful speaking deficit for adults with ADHD is this: following our own thoughts while speaking, and trying to be succinct, requires extra mental effort and selective attention. We lose the big picture when we are too focused at the wrong time. For sure, engaging with others is where life happens, but it is not all that is happening. To someone whose selective attention is locked in place, it is all that is happening.
Our attention needs a manager, the absence of which is central to the disorder. There is no deficit of attention, just a deficiency in attention management. That is why boosting dopamine with medicine can help. It wakes up the manager.
Maintaining some kind of daily practice of mindfulness can help us to be mindful of where we are directing our attention, and whether we are even directing it at all. But it does not cure ADHD. I’m at my best when I wake up in the morning and say to myself, “Today I have ADHD.”
I was sitting in my doctor’s waiting room yesterday morning, waiting for a routine checkup and making a list of medicines and supplements that I take routinely. I’m now taking only Celebrex, vitamin D, and one other supplement whose name I could not remember…the one I take for memory problems. I had forgotten to take it yesterday. Imagine that!
A few years ago while writing Living Well with ADHD, I was browsing books on my shelves, searching for information that might be pertinent for a chapter I was developing. I came upon a book I had not read. I wasn’t sure where it came from. After pondering the question and skimming a few pages, I vaguely remembered purchasing it, but I did not recall when. The book was useful, and I’m glad I searched and found it. The title: In Search of Memory. I’m not making this stuff up!
Tomorrow morning, as today, I will wake up with ADHD, and it will be Groundhog day again. I need to remember that I forget! Maybe I will write the following message on a post-it note and put it on my bathroom mirror: “Remember that you forget!” I should write a note to myself right now, reminding me to write the reminder on a post-it note tonight. First, I have to go buy some post-it notes. I will add that to my expanding to-do list, one that keeps growing faster with additions than shrinking with deletions.
I was seconds from posting this blog when my MacBook’s power went off. I had forgotten–only minutes after seeing a warning that the battery was low–that the battery was low. So it goes. It is charging now, and I am imagining how nice it would be if I could recharge my biological memory!
Pushing back against uncomfortable feelings is unwise for two reasons: (1) there is no switch that turns them off, and (2) trying and failing to squelch them makes them worse. Wisdom is knowing how to relate to them.
Being anxious about anxiety compounds anxiety. Being angry at yourself for getting angry obstructs learning to act skillfully when angry. Thinking you are worthless for having low self-esteem is practicing low self-esteem.
I think of emotions as the color of life, hence the title of chapter nine in my book, Living Well with ADHD. There is a certain beauty in the full range of emotion. Watching a sunset brings on what you may label as a “good feeling,” and it is no less fleeting than a “bad feeling.” Having a friendly relationship with an uncomfortable feeling allows you to learn from your experience; whereas, believing that it is a problem leads to unwise effort and more discomfort, not less. For example, revenge may bring temporary comfort, but vengeful thought and action feeds anger in the long run. Self-defeating action usually follows.
Realistic and non-judgmental appraisal in the face of momentary discomfort is wisdom. Labeling feelings as good or bad is just extra thinking. The labeling doesn’t change anything for the better. You can feel bad about a mistake or failure without questioning your worth. You can only start (or re-start) right where you are. Accepting the uncomfortable feeling allows you to put the wheels back on the tracks promptly without unnecessary suffering.
Judging performance is not the same as judging the self. If you cannot accept the discomfort of a disappointing performance, you will not learn anything from it. If the “self” is to blame, you will either criticize that self, or feel sorry for the poor thing…neither is productive.
What is the self anyway? It helps me to think of “self” as my own construction, an image I’ve created, one that I sometimes color with certainty about what others are thinking. After all, I’m an expert on what other people are thinking about me at any given time…aren’t you? Embracing certainty about what others are thinking is an example of unwise effort.
Uncomfortable feelings have value and should be respected. If you can be curious about them, and get up close enough to notice what those sensations really are, you might discover that they that are actually tolerable. In a sense, they are empty of content except for your conjecture. The notion that they are intolerable is just something you say to yourself while tolerating them.
Try this: Next time you get a shot or have blood drawn, turn your attention toward the needle’s prick instead of away from it. Get up close and discover what the nature of your pain actually is when you allow it. You just might relate differently to it, even though that brief insertion of a needle is no different than before.
Feelings are just feelings. When you try not to have them, you will think and act unskillfully. “If you’re not willing to have them, you will,” says Steven Hayes, author of Get Out of Your Mind and Into Your Life. Willingness to experience life fully requires acceptance of your experience as it is…including your feelings as they are.
Can you recall times in your life when someone presumed to be an expert on your experience, or your intentions? You didn’t listen to me because you don’t care…you would have remembered if it had been important to you…you hurt me on purpose.
I recall a moment when I knew with certainty that no one in the universe shared my personal experience, only similar experiences. Standing beside my brother on a spring day in 2011, minutes after our father had taken his last breath, I awakened to the reality of a private experience that would never be repeated. I hadn’t just lost my dad; I had lost a relationship that no one else had. As close as the three of us were, I didn’t have my brother’s relationship with our father, and he didn’t have mine.
My brother and I spoke at our father’s memorial service, describing the same person from our different experiences. I felt a special connection to my brother that day, recalling precious moments in our shared history. It was the same history, but not the same experience. Furthermore, each person attending the funeral stood alone with a personal experience of my father. And as we stood together in respect for a life that we knew from the outside, not one of us was an expert on my father’s personal experiences.
Married for 62 years, Mom knew Dad better than anyone. She knew when he was worried about something. I could never tell…he tried not to show it…but her experience informed her of the signs. Still, her experience was not his. His efforts not to appear worried may have been his way of protecting her. I cannot be certain about his motives.
The next time someone shares their expertise about your intentions, you can try, if you wish, to comprehend why thy are so certain. You might even ask, “What makes you think that?” Confidence in your personal experience can help you avoid being defensive or angry in response. You can be curious instead, which may help the speaker suspend certainty, or make you aware of something useful. Practicing mindful awareness…of self and other…and keeping an open and flexible mind, are good for your relationships and your emotional wellbeing.
We don’t hear ourselves speak when our brains are on automatic pilot, which is most of the time. It happens to all of us. My morning meditation practice now includes observing a feeling of annoyance rising within me when I hear superfluous language.
Two presidents, the previous and the current, have influenced our speech in a subtle way that challenges my equanimity. One of them often said, “Look…” as he began to answer a question. The other has coined annoying verbs, like “hugely.”
Now, I’m hearing intelligent people on the entire tiny spectrum of political discourse using both. When someone begins an answer with “Look…” I find myself thinking, “Look at what?…I was listening until you said, ‘look’!” It makes me anticipate a lecture, and I want to tune out.
When I hear people using fake adverbs, I think, “Why not use a real word and demonstrate that you have a vocabulary?” Who needs adverbs anyway? Adverbs are just hyperbolic symbols, like exclamation marks! The current president is hugely hyperbolic! And so annoying!
I made the mistake this morning of believing that early voting meant early. All I could find online showing the time of day said early voting starts at 7 a.m. “in most locations.” The website for my local library, the early voting location for my district, showed the dates and not the times. This was my second trip to vote early. Last week, the line was too long…as long as my to-do list.
When I arrived at the library early this morning, coffee in hand, I read the times on a sign: “Early voting, 8 a.m. to 4:30 p.m. on weekdays.” I got back home at 7:15…in time to eat an early breakfast.
The Four Tops had a song in the 60’s titled, “I can’t Help Myself.” I Ioved that song when I was an adolescent…still do. But the adult version of me has developed an aversion to helplessness. I don’t want to hear myself saying, I have ADHD and I can’t help being impatient…I can’t help being late…I can’t help interrupting others…I can’t help tuning others out, or as Elvis sang, I can’t help falling in love with you. (Footnote: As a teenager, I “fell in love” with (1) pretty girls who didn’t like me, and (2) songs that made me feel sorry for myself!)
I can help myself. To become a responsible adult, I had to give up trying harder to be like the other 95%—the neurotypicals—and incorporate a new mindset, “Try another way.”
I once asked a high school pitcher, a star on his baseball team, this question: “If you didn’t have a right arm, would you try to use it?” He was relying on his unreliable memory, misplacing appointment cards and telling himself that he would remember the appointment. I told him that the memory in his phone was more reliable than the appointment cards, and more trustworthy than the differently-wired brain beneath his baseball cap. He agreed. He couldn’t deny it.
I learned a valuable lesson from a clerical worker at my first mental health clinic job. I was about 22 years old then and complaining on a rainy day that there was no place to park near the building. She said, “Who do you think you are? We all have to park where we can.”
I’m not entitled for any reason. Relinquishing responsibility because I have ADHD will not prevent consequences for my negligence. I get stopped for speeding when I deserve to be stopped. I get a penalty for late payments on bills when I postpone paying them. I experience effects of my wife’s hurt feelings when I am inattentive, or when I forget an important event.
I can help myself. It is no one else’s obligation to do my work or clean up my messes.
Helping yourself starts with acknowledging your brain difference and accepting yourself, as you are, with the compassion you would grant to a close friend. Billy Joel sang, I love you just the way you are. He didn’t add…and now change yourself. Instead, he said, Don’t go changing to try and please me. Changing behavior and habits is not the same as changing the self. Embrace yourself, and it will be much easier to change habits and patterns of behavior.
It is okay to be different. Fly your freak flag proudly, but don’t embrace “can’t help myself.”
For years I thought ADHD Awareness Month was November. Imagine that…I was only one month late! And I used to think of it as an oxymoron, as “inattention” and “awareness” are incompatible concepts.
In all seriousness, too many people don’t understand what ADHD is, and some people still doubt that it is a thing…despite the science. Some people still believe that it is only a childhood disorder and that kids grow out of it. There is some reason for that misunderstanding. There is nothing in pediatric mental health that has been researched more than ADHD, but research in adult ADHD is relatively new. For nearly thirty years, we have used mostly children’s criteria for diganosing adults. There are important differences.
Researchers continue to debate whether we should have an age-of-onset criterion for diagnosing ADHD. Until recently, the symptoms had to be present before age seven. Increasing the age of onset still doesn’t capture every adult with the disorder. The sypmtoms sometimes are not evident until well into adulthood. Symptoms must impair daily functioning in some way, but they might not have impairing effects until the features intersect with increasing complexities in life. For example, entering college may be the first time symptoms become evident. Entering a career, a marriage, or parenthood may be the first time symptoms impair functioning.
When the symptoms arrive at that intersection…that life transition…adults with undiagnosed ADHD wonder what happened…or their spouses wonder what happened. How does one lose competence suddenly? The onset of symptoms wasn’t sudden…the life transition was…and they met at the intersection.
Sometimes we are just too defensive about having these features, even after a professional diagnosis, to adapt effectively in life transitions. Those who are less defensive do better. That is why my mission has been to help adults with ADHD accept their different brains in order to live well with them. There is much to gain, and nothing to lose, by being open to a fresh perspective on what we call an attention deficit disorder.
We would be better served calling it an attention management disorder. Effective attention management requires inhibiting a surplus of attention. Lacking an effecive attention manager, our brains are trying to attend to too much. No one can do that well enough to attend effectively to one thing at a time. That is why we can feel overwhelmed by tasks that we think should be manageable.
I have been embarrased when my symptoms have caused problems for me, or for others around me. That is why I believe we must learn to tolerate the discomfort of embarrassment. If we can to that, we are better able to develop new skills, incorporate new strategies, use new tools, and work more skillfully with others. The alterntive is to deny the disorder and underachieve, or harm our relationships.
Let’s continue to educate others about the reality of ADHD in adults. If you want to arm yourself with facts, read ADHD in Adults: What the Science Says, by Barkley, Murphy, and Fischer. I would suggest reading the results and summaries, as the chapters are structured like professional journal articles…boring in style and important in content.