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ADHD, Anxiety, Depression, ODD, OCD: Free Downloads

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Does my child have ADHD? A learning disability? Something else? Download these free resources to better understand attention deficit and its related conditions in both children and adults.

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With knowledge comes power - over symptoms, over treatment, and over ignorant myths about ADHD. That's where these 10 books come in. This list contains the best resources to understand this complex diagnosis, keep up with ever-changing treatment methods, and learn what it's really like to live with ADHD (or love someone who has it).

This free downloadable guide includes longstanding classics - like Ned Hallowell and John Ratey's Driven to Distraction, and Sari Solden's Women with Attention Deficit Disorder - as well as new favorites, like The Mindfulness Prescription for Adult ADHD. Topics range widely, from succeeding at work to explaining your condition to loved ones.

Add these books to your reading list knowing you're bound to finish them with a better understanding of ADHD - and of yourself. Download now!
NOTE: This resource is for personal use only.

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Free Resource: The All-Time Best Books on ADHD

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Following the diagnosis, your head is swimming. What causes ADHD? How has it manifested in your life? What can you do about it? Will you ever get organized? Start answering these questions and many more with these 10 comprehensive, recommended books.

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Diagnosis and treatment of attention deficit are keys to moving forward. Accepting your diagnosis and having the courage to own your symptoms and to discover your strengths will push you across the finish line. These inspiring women did just that - and were able to meet their goals and achieve career dreams.

Read how each of these women with ADHD handled their diagnosis, developed workable treatment strategies, and had the resilience to get back up when life had her down.

Michelle Rodriguez
A self-described scatterbrain who forged ahead to become a top actress in Hollywood
Michelle Rodriguez is known for playing tough, sexy women in the TV series (#CommissionsEarned) and in the Fast & Furious (#CommissionsEarned) movies. In 2006, Rodriguez admitted she had ADHD in an interview with Cosmopolitan magazine. She said she decided against taking medication, but she was afraid that her attention deficit would thwart her career dreams. "I want to write and direct, but it's not easy with ADHD. I have a hard time focusing when I'm alone. I'm a scatterbrain." As it turns out, Rodriguez's concerns were unwarranted.

During her childhood, Rodriguez's family moved around a lot. She was born in 1978, in Texas, and she lived in Puerto Rico and the Dominican Republic before her family settled in New Jersey, when she was 11 years old. She dropped out of high school, but later went back to get her GED.

Any problems she had in school didn't keep her from a successful acting career. After several jobs as an extra in movies, Rodriguez saw a notice for an audition in Backstage and took a chance, even though she had never before auditioned for a speaking role. She landed the lead in (#CommissionsEarned), beating out 350 other women for the part. She received the 2001 Best Debut Performance Award at the Independent Spirit Awards.
[Self-Test: ADHD Symptoms in Women and Girls]
When Rodriguez went on her second audition, she walked away with a part in The Fast and the Furious. She hasn't stopped acting since, appearing in over 20 films and several TV series since 2000, as well as doing voice work for several video games. In 2005 she was in the cast that won the Screen Actors Guild Award for Outstanding Performance by an Ensemble in a Drama Series.

Rodriquez has had rough times in her life, like many people diagnosed with ADHD. In 2006 she was charged with a DUI and, in 2009, she attempted to attack a photographer who got too close to her. By her own admission, she "partied hard." Rodriguez discovered a pattern about herself: She rebels, realizes that she is hurting herself, and works to get her life back on track.

In 2013, Rodriguez told Cosmopolitan Latinas that she planned to take a break from acting to try her hand at writing and directing. "Sometimes you gotta believe," she said. "And sometimes you may be wrong. But until you try it and put it out there, you can't let anybody have an opinion about it. That's how you get it done."

Brookley Wofford
A shy, withdrawn ADHD student who turned into a beauty queen and advocate
Brookley Wofford builds brand awareness through social media, public awareness campaigns, and multimedia platforms. She has worked with small start-up firms, nonprofits, and Fortune 500 companies over her career. In addition, Wofford was the first columnist for Kaleidoscope Society, an online magazine created to empower women with ADHD.

Wofford was diagnosed with ADHD in second grade. Before the diagnosis, teachers had suggested that she be screened for autism. She was in the gifted program, read well above her grade level, but preferred spending recess in a quiet corner reading a book rather than playing with her classmates. Doing group projects made her so fearful that she sometimes had her mother pick her up from school rather than face them.

Wofford daydreamed when taking tests, doodling as if she "had no control over her pencil," even though she knew the answers. She did better on tests when taking them alone in a quiet room.

Wofford's mother wanted to know why her daughter struggled at school. When she found that her daughter had ADHD, many of her behaviors made sense. Wofford remembers feeling happy during the months after her diagnosis, and she blossomed socially and academically.

Wofford blossomed in other ways, as well. In 2012, she won the title of Miss Mississippi International, and, in 2015, she was crowned Miss Minnesota United States. Her program, "Unlocking Confidence Through the Arts," is an effort to bridge the educational gaps of students with ADHD, especially those in low-income schools and in schools without art programs. She is also involved with Art Buddies and is a national spokesperson for Children and Adults with ADHD ( CHADD).

Wofford believes now that her ADHD gives her "a roadmap for success." She uses medication, on a limited basis, and exercise and nutrition to curb symptoms. What helps her the most is art: being creative, helping others through Art Buddies, and being an advocate for the ADHD community. These activities relieve the stress that often accompanies her efforts to manage her own ADHD symptoms.

Wofford keeps a notebook of her success stories and photos of past moments that make her feel proud. When she doubts herself, she looks through the book to remember what she has achieved. This helps her look to the future with confidence.
[Read: Leading Ladies with ADHD]
Marta Bot
A makeup artist to the stars whose goal is to accept, not hide, her own ADHD
Modeling in New York City led Marta Bota down the path of makeup artistry. She is a freelance makeup artist whose career has spanned more than two decades. She has done makeup for the on-air talent and celebrity guests on CNN, FOX News Channel, CNBC, MSNBC, and HBO. Working with makeup uses Bota's creative gifts. "Artistic expression has always been therapeutic for me," says Bota.

Bota's diagnosis came about when her son was being evaluated for attention deficit. The doctor handed her a questionnaire about her son's behaviors. As she read over the questions, she recalled having the same challenges as a teen.

Several months later, after her mother's death, Bota found her old report cards stored in boxes. On the back of them, were comments such as "Trouble paying attention" and "Needs to learn to focus." She was in the gifted and talented program, but she struggled to keep up with the work and to stay on task. That was her Aha moment. She decided to get tested for ADHD and to find ways to cope with the condition.

Bota had developed coping strategies before her diagnosis. She knew that a 9-to-5 career wasn't for her, so she started her own makeup firm, MB Face Design. What she likes most about it is that there is no routine - every day is different. She taught herself how to get things done by moving among several projects to avoid being bored by one of them.

Bota focuses on the positives of ADHD. She has more energy and gets more done in a day than many neurotypical people do, she says. She is creative and resourceful. Most of all, she learned to forgive herself and accept her condition.

In 2014, Bota received the title of Mrs. DC DuPont Circle America. Her platform was ADHD Awareness, Diagnosis, and Treatment. She also runs the ADHD Help and Hope Network on Facebook, giving inspiration and information on managing symptoms to thousands of fellow people with ADHD.

Jenna Knight
An ADHD coach who guides other women to overcome their own ADHD
Jenna Knight is an ADHD coach who works with women diagnosed with the condition. Her own struggles help her understand what other women are going through.

Knight was diagnosed with a learning disability in early elementary school. Her teachers noticed that it was hard for her to focus, but they didn't suspect she had ADHD. During her school years, Knight struggled with organization. She remembers when her mother was asked to come in to look at her desk at school. Among many other items, there were half-eaten sandwiches stuffed inside the desk. The look of disappointment on her mother's face remains with Knight.

Her teen years weren't much better. She hung out with "the wrong crowd" and used alcohol and drugs. She was in frequent fights and, at 16, was placed in foster care. A year later, she returned home and graduated from high school. After graduation, Knight left home and drifted from job to job.

In 1995, Knight got sober. She enrolled in a community college, where she was diagnosed with ADHD. When she first took medication, she said, "Wow, I can finally focus, and I can sit still." It was a few years, however, before she made progress in her life.

Knight's epiphany came after going back to school, and receiving her bachelor's degree in urban studies. Knight got involved with an LD/ADHD Task Force in Massachusetts and learned more about ADHD and how to manage symptoms. She realized that medication alone wasn't enough.

In time, Knight became an advocate for adults with LD and ADHD, working with the Massachusetts Statewide Rehabilitation Council, in Boston. There she met an ADHD coach, pursued a coaching career, and started her own firm, Never Defeated Coaching, in Worcester, Massachusetts.

She struggles to keep track of the details of her business, but she can't imagine a line of work that would bring her more satisfaction.

Margaux Joffe
A consultant and producer who believes that ADHDers can help create a better world
Margaux Joffe is an award-winning producer, creative consultant, and advertising professional. Her goal is to use media to inspire and educate others. She has produced, among other projects, public health campaigns, a documentary to raise awareness of human trafficking in India, and a campaign for prevention of sexual assault.

Joffe spent years believing that her difficulties with organization and time management were personal flaws. She tried living like neurotypical people do and suffered periods of depression and anxiety when she couldn't pull it off.

One day, as Joffe strolled through IKEA with her mother, she found the noise, crowds, and lights overwhelming. She shut down emotionally. Her mother called her a few days later to discuss the possibility of ADHD. As her mother ticked off the symptoms, Joffe had a watershed moment. She made an appointment with a psychiatrist, who diagnosed her as having ADHD.

After her diagnosis, at the age of 29, Joffe had mixed feelings. The diagnosis explained many things about her life, but she didn't want to think of herself as "disordered" or having a "deficit." Understanding ADHD freed her to find a path to success.

Owning attention deficit. Joffe works with a psychotherapist and uses traditional treatment methods to manage ADHD symptoms. Self-care is essential for her overall wellbeing and daily functioning. She makes sure she gets enough sleep and she exercises regularly. Yoga improves her focus, memory, and mindfulness. Because Joffe's brain is always racing, she follows her "24-hour rule": She waits a day before committing to working on any new idea or project.

To help herself and other women with ADHD, Joffe started the Kaleidoscope Society, an online magazine that shares positive stories of women living with the condition, and offers resources to help them manage their lives, relationships, and careers.

"The key is to own your ADHD and to stop trying to please others," says Joffe. "Those of us with ADHD have a sensitive heart, a creative mind, and incredible energy. We have the power to lead our generation to do things in a better way."

Caitlin D'Aprano
An entrepreneur who empowers other women to believe in themselves and their ideas
Caitlin D'Aprano is a business consultant and the founder of WillPowered Woman, which gives support, encouragement, and opportunity to single women who are experiencing violence or abuse from partners in the San Francisco area. She also founded and runs a women's accessory company, WPW, which sells products made from fish leather.

D'Aprano was diagnosed with ADHD in 2015, and this gave her a new perspective on life. It helped explain why she impulsively decided to give up her life and job in London and move to San Francisco a year earlier. The diagnosis allowed her find the solutions and strategies to help her succeed.

D'Aprano went to high school in Australia. She struggled with the school's "narrow teaching methods." When giving tests, teachers preferred that students answer math problems in order - no skipping around. D'Aprano broke the rules one year by answering the questions she knew and circling back to tackle the tougher ones. She earned "top of the class" that year. When her teachers found out, they forced her to follow the rules, and D'Aprano didn't complete any math test after that.

D'Aprano attended the University of Melbourne, in a three-year program, but it took her five years to complete, because of her inability to focus and her impulsiveness.

ADHD helps D'Aprano think creatively as a business consultant. It allows her to see challenges from different angles and to offer creative solutions to clients. Having more than one business helps keep her focused. Says D'Aprano: "I get bored working on the same things, so I have several different projects I work on."

Living with ADHD is a challenge for D'Aprano. To get things done, she uses to-do lists, blocks out time on her calendar to focus on a particular task, and gives herself strict deadlines. With these strategies in place, she finds that ADHD hasn't gotten in the way of success or happiness.

D'Aprano's mission is to empower women. She thinks that many women who have been diagnosed with ADHD hold themselves back. Her advice? "Be kind to yourself, believe in yourself, surround yourself with people who believe in you, and quiet those negative voices that tell you that you are never going to get anywhere."
[Read: 75 Tricks By (and For!) Women with ADHD]
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Diagnosis and treatment of attention deficit are keys to moving forward. Accepting your diagnosis and having the courage to own your symptoms and to discover your strengths will push you across the finish line.

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Angie Nash
Radio personality, Fort Wayne, Indiana
Angie Nash, who works at Majic 95.1 (WAJI), spent much of her freshman year in high school polishing her nails during lectures, skipping class, and rearranging classroom desks in a "U" formation. "It was less confusing to me that way," says Nash. "My teacher did not appreciate it and made me call home."

That's when Nash's mom decided to have her tested for ADHD. Nash was diagnosed at 15, but didn't take ADHD medication. After high school, she attended Northwestern College, a small community college in Ohio. After struggling at school for six months, she was placed on academic probation. Nash blames her challenges there on too much freedom and not enough structure.

"I got into radio about 12 years ago, by accident," she says. She'd been hired as a receptionist at a hip-hop radio station, where a friend worked on-air. "The boss saw something in us, and he teamed us up on a show. It's the most 'normal' I've ever felt in a job. My mind goes fast, and in many directions, and that's great in my line of work." It also helped that her friend and co-host understood and accepted her ADHD. Nash moved on to Majic 95.1, where she now co-hosts "Majic in the Morning."

At work, Nash struggles to stay on task and meet deadlines. "What's helpful to me is to do things immediately," she says. "If I complete tasks as soon as they hit my desk, distractions don't have a chance to get in the way."

Writing daily lists helps Nash stay on track, and jotting notes on the back of her hand helps her focus when talking with friends. "I don't interrupt people when they talk anymore, because the notes remind me of what I want to say."

Nash has learned to stop comparing herself to someone without ADHD. "They can handle tasks and manage simple, everyday things that, to us, seem insanely overwhelming."
[Self-Test: ADHD Symptoms in Women and Girls]
Nash works on simplifying her life. "I live in an apartment, and I don't have credit cards. The fewer things I have on my mind, the better. Since I don't use medication, the key for me is to slow down, regroup, focus, and get lots of sleep."

Mandy Prosser
Software and database developer, KwaZulu-Natal, South Africa
Mandy Prosser, 43, coasted through high school, then attended four colleges, all in South Africa, enrolling in a different program at each one. The only program she completed was secretarial training in Pietermaritzburg. Having failed many courses after high school, Prosser's self-confidence plummeted. "I couldn't concentrate long enough to do the assigned reading," she says. Twenty-two years later, she's taking correspondence courses to complete her Bachelor of Commerce degree at the University of South Africa.

In 2000, at age 30, Prosser was not diagnosed with ADHD. "The doctor wrote down instead that I had major depression, because ADHD was not considered an adult condition here in South Africa and wouldn't get insurance coverage." It wasn't until 2011, at age 40, that she started taking ADHD medication.

"It changed my world," she says. "I am so grateful to be able to get a day's work done."

Prosser dabbled in several careers before finally taking a six-month Web development course in London, England. "On returning to South Africa, I got my first job in Web development for a company in Cape Town. Within a week, I was building databases, which I loved! I did really well."

These days she works in database development. Prosser still struggles to complete tasks she doesn't enjoy, such as documentation and large projects that she can't break into smaller pieces. But she thrives in the software industry's fast-paced environment, where new projects pop up all the time.

Besides medication, counseling, and joining an online support group, Prosser treats her ADHD by practicing Buddhism, yoga, and meditation (sometimes all at once!). She finds yoga a real boon for her ADHD brain. It calms her down.
[Why Women with ADHD Feel Disempowered - And What We Can Do About It]
Although it's hard for many ADHDers to meditate, Prosser insists that they can - and should - learn to do it. "Meditation helps quiet the chattering monkeys," she says. "Emptying the mind of thought for a few minutes can calm one down to the point where things no longer seem insurmountable."

Kathryn Goetzke
Entrepreneur and CEO, Oak Park, Illinois
Kathryn Goetzke, 41, has an MBA in international marketing, as well as an undergraduate degree in psychology. As founder, CEO, and president of Mood-factory, Goetzke develops products aimed at improving the mood of her customers. Diagnosed with depression and PTSD in her 20s, Goetzke's personal struggles led to her passion for helping customers with mood disorders.

Says Goetzke: "I managed my undiagnosed ADHD by keeping myself moving and engaged, and taking on difficult projects that required hyperfocus." She overindulged in alcohol and food, and occasionally went to therapy.

In her 30s, Goetzke contracted Lyme disease, and her life changed. "It forced me to slow down," she says. She saw a counselor, worked to end her alcoholism, took mood medications, and started exercising and eating well.

Her depression was well managed, but she couldn't stay organized or focused without self-medicating. "I had major responsibilities running a business and a nonprofit, and I could not figure out what to start or do," says Goetzke. Then, at 37, she was diagnosed with ADHD. Taking a stimulant medication enabled her to curb her impulsivity, stay on task, and finish projects. She finds daily prayer and meditation helpful, as well.

"It is critical for me to focus on my goals and to write them down," she says. Otherwise, she's easily distracted by the requests of others, and risks losing sight of her priorities. "Treating my ADHD allows me to use my creativity in a focused and structured way," says Goetzke.

Treatment has allowed her to foster new relationships and repair damaged ones. She talks openly to her brother about her ADHD, and he is understanding and helpful. She keeps tabs on family and friends' birthdays, so she can send a card. Her willingness to explain her challenges to friends and family has brought unexpected benefits: They help her say "no" to activities and responsibilities, so she can manage her time effectively.

"Now that I understand my ADHD, I consider it a gift."
["That Explains Everything!" Discovering My ADHD in Adulthood]
Eva Pettinato
Entrepreneur, Calgary, Alberta
ADHD may be no laughing matter, but it doesn't keep Eva Pettinato from making others laugh at comedy clubs, corporate events, and open mics. After taking a stand-up comedy course, in 2000, Pettinato started teaching comedy workshops and founded ZEDS Comic Communications.

Before launching her business, Pettinato had more than 50 jobs. "I was hired, promoted, and then fired, or I quit out of frustration or boredom," she says. In 2009, Pettinato enrolled in a Business Administration program at the Southern Alberta Institute of Technology (SAIT). She found the work difficult, and met with a learning strategist at SAIT to get help. He suggested she speak with the school's disability services. This led to her ADHD diagnosis, in 2010.

Pettinato says her diagnosis explains the difficulties she'd had in maintaining personal relationships and staying in jobs, and why she was drawn to comedy. "I love using humor to connect, disconnect, or get out of sticky situations," she says. Learning about ADHD gave her a new perspective. "I understand now that I am easily bored, and I stopped blaming everyone else for being boring. I learned to stay engaged in conversations by pretending it's a first date."

Along with medication, Pettinato gets counseling and has joined the Calgary branch of CHADD. She learned to advocate for herself without mentioning her ADHD. "Many people have distraction problems, so if I ask for noise to be reduced in a meeting at work, no one thinks it's a big deal," she says. "Getting diagnosed helped me to accept assistance from others," she adds, "and to admit that there are some aspects of business and life that can be more successfully done by others."
After decades of feeling bad about herself, and spending thousands of dollars on personal development courses, Pettinato says, "I've given up the great race to perfection based on others' standards."

Lisa Livezey Comingore
Human resources and community relations professional, La Porte, Indiana
In law school, Lisa Livezey Comingore, 42, daydreamed in class and had trouble studying for tests. While some of her classmates pulled all-nighters to study for finals, Livezey Comingore had to balance sleep and study to succeed. To stay focused, she took nonstop notes in class and frequent breaks while preparing for tests.

After graduating, Livezey Comingore ran her own home-based business, Owlz Media Group. "Working at home is a minefield of distractions," she says. At 39, she underwent chemotherapy for breast cancer. That's when her wife noticed that Lisa was forgetting to rinse her hair in the shower and wandering around the house aimlessly. On her suggestion, Livezey Comingore sought and received an ADHD diagnosis and began taking medication.
"The first med I tried didn't work. When I found the right med, it was like turning on a light," she says. Livezey Comingore also used the ADD Crusher program, a series of videos and materials that teaches ADHD management skills, to develop routines to stay on task.

She appreciates the structure her human resources job at La Porte provides. She's forced to get up and out the door, but "there's still some flexibility." She's learned to give herself extra time in the morning to get to work, which has reduced stress. At work, she uses reminders on her computer and phone to stay on task. She's also learned to keep the project she's working on in the center of her desk. It helps her fend off distractions.

Livezey Comingore can be hard on herself when she forgets or loses something, but, she says, "It's important to realize that, like anything else, ADHD isn't all negative or all positive. It's important not to beat yourself up.
"I am at peace with the fact that the condition makes me the quirky person I am. I try to laugh at the silly stuff and call it what it is: 'There's my classic ADD acting up again....'"

Karen Taylor-Crawford
Adolescent and pediatric psychiatrist, Chicago, Illinois
Karen Taylor-Crawford was chairman of the department of psychiatry at Christ Hospital, in Chicago, when she was diagnosed with ADHD, in her early 30s. She supervised the department, saw patients, and reviewed piles of documents, all while raising two children, ages two and 14.

Until she started treating kids with ADHD, Taylor-Crawford was skeptical about the benefits of medication. The turning point came when she started consulting for a local CHADD group, and her patient load increased. That's when she realized, "This [ADHD treatment] works!" She also noticed that she was often late for social engagements. She concluded: "You know what? I have ADHD."

Once she recognized her ADHD symptoms, she began to see a psychoanalyst. Her analyst didn't believe she had the condition, because she was an accomplished psychiatrist. "People would say, 'But you're so accomplished.'" When she heard this, she thought, "Do you know what it takes for me to get stuff done and how many deadlines I miss?"

Without a formal diagnosis and treatment, she relied on her faith in God, the help of family members, and supportive coworkers to manage symptoms. After a year or so, her analyst said, "You know, Karen, I don't do a lot of medication management. I'm going to refer you to a colleague, because I think you have ADHD."

"I sat up on the couch and said, 'Really? Praise God.'" She was diagnosed with ADHD and depression and was prescribed a stimulant medication and an antidepressant. Taylor-Crawford supplements her medications with fish oil, vitamin E, and a multivitamin with B-complex.

While recognizing the challenges of ADHD, Taylor-Crawford also recognizes its benefits. She attributes her intuition, spontaneity, and her capacity to forgive to it.

Although semi-retired, she keeps busy with patients, her sorority, writing articles, and tackling projects. "[ADHD] makes me look for projects and things to contain my wandering mind."

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Radio personality, Fort Wayne, Indiana Angie Nash, who works at Majic 95.1 (WAJI), spent much of her freshman year in high school polishing her nails during lectures, skipping class, and rearranging classroom desks in a "U" formation. "It was less confusing to me that way," says Nash.

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Carolyn O’Neal cried when she was diagnosed with ADD at age 53 — until the news turned out good for her family.

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“My ADHD Was Misdiagnosed for Decades:” Stories of Misread Symptoms, Advocacy & Epiphany

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ADHD misdiagnosis stories are all too common. Particularly among adults, symptoms like rejection sensitivity, poor focus, and stress are diagnosed as depression, anxiety, and even bipolar disorder. Even when those comorbidities exist, they are rarely the full picture. Hear from adults who persisted…

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High-IQ adults with ADHD seem to function well, but it comes at a high emotional cost. They feel burdened and exhausted, blaming their struggles on themselves, not on their ADHD. Here is a game plan for healing and hope.

ADHD is distributed across individuals of all intellectual levels, and some of those individuals have high IQs. There is significant overlap of characteristics among people with ADHD, high IQ, and creativity - like curiosity, impatience, high energy, low tolerance for boredom, charisma, nonconformity, risk-taking, and resistance to authority.

High-IQ people with attention deficit often excel at tasks requiring divergent thinking, which is spontaneous and non-linear - "out of the box" thinking. They are usually less successful at tasks requiring convergent thinking, which requires accuracy, logic, and speed - the math-SAT thinking.

Many high-IQ adults who struggle with ADHD symptoms wonder why their condition is considered to be less than credible. Lori, 43, a TV producer, said, "I just saw the second doctor who told me I couldn't have ADHD - I'm too smart, I did well in school, I don't have behavioral problems, I'm a high-functioning professional. Looks are deceiving; it's a hot mess inside my head."

Intelligence and IQ Do Not Counteract ADHD

Many assume that a high IQ makes everything in life easier, including the management of ADHD. However, research tells us that a high IQ does not protect anyone from the executive dysfunction or emotional dysregulation typical of ADHD.

Despite their strengths and talents, high-IQ adults with ADHD demonstrate more cognitive difficulties, functional impairments, and comorbidities than do high-IQ adults without ADHD.

In fact, the severity of their executive function impairments, especially in working memory and processing speed, does not differ from that in average-IQ adults with ADHD. What these intriguing individuals do have is a unique set of challenges.

Unique Challenges That Accompany High Functioning ADHD

Those who grow up celebrated as "smart" internalize their intellect as a foundation of their identities and a source of self-esteem. They know that they carry the expectation of success. Thriving in school with little effort, they have been told that success will be theirs.
[Get this Free Resource: Yes! There Are People Like You]
But here's where the path begins to diverge for those with ADHD: Due to the developmental delays that characterize ADHD, children with the condition tend to lag three to five years behind their chronological peers in social/emotional functioning. At the same time, very bright children with the condition often function three to five years beyond their peers intellectually.

Such extreme discrepancies in functioning are baffling to those living with them, as well as to those observing them. Rob, 31, a cyber-security technician, recalls the awkwardness he felt in middle school: "I got 100 on everything, but was seriously geeky and never had friends in my grade. I was more comfortable with younger kids or adults. Being smart with ADHD is a mixed bag."

"Potential" Becomes a Four-Letter Word

Intellectual prowess falters in those with ADHD as academic demands grow in speed and complexity. Confused by their inconsistent achievement, they find themselves unable to realize their potential. Parents and teachers usually attribute their underachievement to boredom, carelessness, laziness, or lack of caring, and these bright, demoralized teens have no better explanations.

A consistent refrain I hear is, "How could I have been so stupid?" Even after diagnosis, they deny the impact that ADHD has on their performance. Rather than acknowledge the complexity that ADHD adds to any task, they attribute their struggles to their flaws.
[Written for You: An Open Letter from a Smart Kid With ADHD]
The High Functioning ADHD Identity Crisis

Academic achievement is highly susceptible to impairment by ADHD. Studies show that 42 percent of high-IQ ADHD adults have dropped out of college at least once. Nonetheless, they still believe that their intellect should enable them to triumph over their impairments.

Mark's story is typical: A stellar student back in the day - debate team captain, accepted at two Ivy League schools - he can't relate to that earlier self. Now a 38-year-old advertising executive, he zoned out in his last business meeting, and worried that he missed something relevant. After finishing his PowerPoint at 2:30 a.m., he overslept the next day and left home without coffee. He says, "Whoever I was, I'm not that guy anymore. Doesn't seem to matter how much I know. When I have to perform, I freeze up and feel incompetent."

A high IQ can make it easier to compensate for ADHD symptoms. High-IQ adults with ADHD appear to function well, but this comes at a high emotional cost. Investing much time and energy to present a flawless public persona, they rely on obsessive behaviors to guarantee organization and structure. However successfully they manage their cycles of procrastination and hyperfocus, they inevitably feel burdened and exhausted. Determined to keep anxiety, frustration, shame, and disappointment internalized, they relentlessly self-monitor. They are hypervigilant about hiding anything that might expose their internal chaos.

Susan, 51, a magazine editor, explains how perfectionism works for her: "It doesn't matter what I have to do, as long as I come across as smart and in control. I know I can get a little rigid, but, if the managing editors are impressed, it's all good. It's just that I'm always so anxious, dreading the day they find out I'm a fraud."

The Secret Struggle of High IQ Adults with ADHD

High-IQ adults with ADHD feel most successful when their performance doesn't reflect the challenges over which they triumph each day. If they are not overtly suffering, nor appear to be in need, it is unlikely that they will get the support they need. The combination of pride and shame deters them from revealing their inner experience, and, as a result, they are isolated with their burdens.

Without the history of difficulties required for diagnosis, and given their high functioning, they present with a form of ADHD unfamiliar to most clinicians. If they are ever diagnosed, their diagnoses will likely be delayed until comorbid issues complicate their difficulties. The result of coping well is that the struggle remains secret, but no less damaging.

Having High IQ Doesn't Mean You Feel Smart

The fall from grace, when it comes, often involves revisiting the glowing recognition earned in the past. They judge themselves harshly - ashamed that they can't process faster, remember more, follow through better, be less emotionally reactive. It is painful to accept that they're working twice as hard, for twice as long, to achieve half as much.

What makes this more demoralizing is that, like Mark, they feel compelled to redefine their identities. Isolated by her secret life, Lori grieves for her lost confidence: "Who am I kidding? If I were really smart, I could crush this." These despairing individuals face a shame-based identity crisis, in addition to the impact of a neurobiological disorder.

What's Ahead After Getting Help with High Achieving ADHD

Lori was finally diagnosed after finding the right clinician, and began to recognize how her job as a producer was a good fit for her because she works in a highly stimulating, fast-moving, ADHD-friendly environment. Rather than trying to stifle her constant stream of ideas, she took the risk and found that they were well-received, even if she occasionally interrupted.

Rob began to accept that the way his brain worked was an advantage in his job, and that the other techs were similarly wired. No longer viewing himself as a social pariah, he went out to lunch with a colleague for the first time. Mark began to use his artistic creativity to make his ad campaigns funnier, edgier, and more colorful; he felt proud when his colleagues said that he was walking around smiling too much.

Susan began to relax her perfectionist instincts and see that the details she obsessed about were apparently not as critical as she thought. She loved feeling less vigilant and anxious.

Those who dwell at that random intersection of the genes for high IQ and ADHD have abilities that, properly channeled, define our entrepreneurs and our leaders. There is no shortage of successful people with ADHD! What makes the difference is the lens through which you view yourself relative to the rest of your world. The good news is that you can reframe the ways in which you label yourself, once you recognize that you applied those labels in the first place-and only you can peel them off.

Six Steps to Accepting Yourself: ADHD, IQ, and All

Having someone bear witness to your experience is the first step toward self-acceptance. You can't change your brain wiring, but there are many ways to feel worthier in your own skin.

1. Learn everything you can about your ADHD brain. Read, watch webinars, join online groups, so you can understand why you can't always control your responses, regardless of how smart you are. There is relief in discovering that many share the journey that feels like yours alone.

2. Strip away labels. You are not your symptoms nor your diagnosis nor your IQ. Separate the essence of who you are from the labels that might limit you. As you rid yourself of those labels, you can begin to redefine your identity with more realistic aspects of who you are, not who you "should" be.

3. Break out of the prison of isolation. Take the risk-with a therapist, a best friend, a partner, or a support group. Imagine feeling safe enough to take off your mask without fear of rejection.

4. Remind yourself that most people juggle issues that make the world less predictable. None of us has that coveted sense of control all the time.

5. Optimize your functioning through better self-care: diet, sleep, exercise, stress management, hobbies, and relaxation. Investing in yourself sends the message that you are worth it.

6. Celebrate your gifts. You may feel that your capabilities don't exist because you can't reliably access them. We don't expect artists to create masterpieces every day; show the same compassion for yourself and don't hold yourself to unrealistically high standards. Nothing can steal your brilliant solutions from you; rather than lament that they don't occur often enough, celebrate them when they do.

[Read This Next: "What If My Intense Drive Is Because of - Not in Spite of - My ADHD?"]

Support our team as it pursues helpful and timely articles like this by subscribing to ADDitude magazine. Your readership and support help make this content possible. Thank you.

Updated on April 7, 2021

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"I'm Smart, So I Should Be Able to Overpower ADHD. Right?"

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High-IQ adults with ADHD seem to function well, but it comes at a high emotional cost. They feel burdened and exhausted, blaming their struggles on themselves, not on their ADHD. Here is a game plan for healing and hope. ADHD is distributed across individuals of all intellectual levels, and some of those individuals have high IQs.

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What Causes ADHD?

Most researchers point to genetics and heredity as deciding factors for who gets attention deficit disorder ( ADHD or ADD) and who doesn't. Scientists are investigating whether certain genes, especially ones linked to the neurotransmitter dopamine, may play a role in developing ADHD.

But Michael Ruff, M.D., a clinical associate professor of pediatrics at Indiana University, believes DNA is just part of the story. He is convinced that at least some cases of ADHD are a byproduct of our fast-paced, stressed-out, consumer-driven lifestyles. Let's compare other research and expert insights to Dr. Ruff's controversial theory on what causes ADHD - genetic vs. environmental triggers.
In an article in Clinical Pediatrics, Dr. Ruff called ADHD an 'epidemic of modernity.'1 What does that mean? Is it the only explanation for ADHD?
Dr. Ruff: "I'm talking about the cultural environment that prevails today - the modern way of life and its impact on the developing brain. Today's children are immersed in a world of instant messaging and rapid-fire video games and TV shows. Today's parents are rushing around and working so hard to earn money to buy more stuff that they have less time to spend with their kids."

"When kids get accustomed to such a rapid tempo, it's hard for them to adjust to the comparatively slow pace of the classroom. They transfer the sense of urgency they've seen at home to their academic endeavors."

"Researchers Daphne Bavelier and Shawn Green have demonstrated that playing action-based video games can improve processing speed. Torkel Klingberg has shown that consistent use of adaptive video games improves working memory skills and alters brain structure."
[Self-Test: Signs of Emotional Hyperarousal]
"Increases in grey matter in the right hippocampus, the cerebellum, and right prefrontal cortex were observed in a study of adults playing Super Mario Bros. Another study demonstrated that playing Tetris resulted in a larger cortex and increased brain efficiency."

"StarCraft, an action game, can lead to improved brain flexibility and problem solving. Playing Rayman Raving Rabbids can improve reading in children ages 7 to 13. Brain-training video games change brain functioning and slow the degree of mental decay in the elderly. All of these findings are well documented."

"However, just as with virtually anything else in the world, too much of a good thing is bad for you. If you drink too much juice, eat too much fruit, or spend too much of your time jogging, there will be negative effects. Helping your child to have a balance of physical, social, unstructured, creative, and digital play, is vital. With video games, playing between 60 to 90 minutes a day appears to benefit kids the most."

ADDitude editors: The effects of video games on children with ADHD are neutral, except in extreme cases of negative obsessive fixation . While many games are advertised to improve cognition, memory, or other skills, the benefits of brain training are not proven.
There's evidence that ADHD has a biological basis. Doesn't that mean it's hereditary?
Dr. Ruff: "Not entirely. The young brain is highly malleable. As it matures, some brain cells are continually making new connections with other brain cells, a process known as 'arborizing,' while others are being 'pruned' back. Arborizing and pruning determine how circuitry is wired in the prefrontal cortex, the region that is largely responsible for impulse control and the ability to concentrate. We've failed to acknowledge the extent to which environmental factors influence these processes."

ADDitude editors: Available evidence suggests that ADHD is genetic - passed down from parent to child. It seems to "run in families," at least in some families.

A child with ADHD is four times more likely to have a relative with ADHD.

At least one-third of all fathers who had ADHD in their youth have children who have ADHD.

The majority of identical twins share the ADHD trait.

A number of studies are now taking place to try to pinpoint the genes that lead to susceptibility for ADHD. Scientists are investigating many different genes that may play a role in developing ADHD, especially genes linked to the neurotransmitter dopamine. They believe it likely involves at least two genes, since ADHD is such a complex disorder.

There's also evidence that toxins and pollution contribute to the development of ADHD, though more research is needed on these environmental factors.
[ADHD Is More Than Just Genes] The role of environment in causing ADHD is an interesting theory, but is there evidence to support it?
Dr. Ruff: "There hasn't been much research on the role of the environment in ADHD, but some studies are suggestive. In 2004, University of Washington researchers found that toddlers who watch lots of TV are more likely to develop attentional problems. For every hour watched per day, the risk rose by 10 percent.

"My group practice, in Jasper, Indiana, cares for more than 800 Amish families, who forbid TV and video games. We haven't diagnosed a single child in this group with ADHD."

"On the other hand, we care for several Amish families who have left the church and adopted a modern lifestyle, and we do see ADHD...in their kids. Obviously, the genes in these two groups are the same. What's different is their environment."

"There's also some evidence to suggest that academic problems are rare in social and cultural groups that traditionally place a high value on education, hard work, and a tight-knit family structure. For example, a 1992 Scientific American study found that the children of Vietnamese refugees who settled in the U.S. did better in school and had fewer behavior problems than their native-born classmates. The researchers noted that the Vietnamese kids spent more time doing homework than did their peers, and that their parents emphasized obedience and celebrated learning as a pleasurable experience."

ADDitude editors: While some environmental factors almost certainly do influence the development of ADHD, more than 1,800 studies have been conducted on the role of genetics in ADHD, creating strong evidence that ADHD is mostly genetic.

The genetic evidence for ADHD can be ignored, but not argued away. Studies of twins and families make it clear that genetic factors are the major causes of ADHD, says Russell Barkley, Ph.D., author of Taking Charge of Adult ADHD. In fact, an estimated 75 to 80 percent of variation in the severity of ADHD traits is the result of genetic factors. Some studies place this figure at over 90 percent.
How can parents reduce the likelihood that their children will develop severe ADHD?
Dr. Ruff: "I counsel parents to limit the amount of TV their kids watch. I urge them to read to their kids every day, starting at age one, and to play board games and encourage other activities that promote reflection and patience. I also urge parents to do more slow-paced, step-by-step activities with their children, like cooking and gardening. Carve out more quiet time, when you're not so busy. Put down the cell phone, and stop multitasking."

Edward Hallowell, M.D., practicing psychiatrist and founder of the Hallowell Center for Cognitive and Emotional Health: "We know enough about ADHD to offer science-based suggestions that can help reduce the likelihood of someone developing this condition.

He advises expectant mothers not to "indulge in alcohol, cigarettes, or illicit drugs, or mistreat yourself or your unborn child in any other way. And get good prenatal care. Poor health care [while expecting a child] brings the risk of developing ADHD."

"Make sure you have excellent medical care during [your] delivery....Lack of oxygen at birth, trauma during birth, and infections acquired during delivery can cause ADHD."

"Once you give birth or bring home your adopted child, rejoice. The exciting and momentous journey of parenthood begins. That being said, your enchanting infant requires a lot of work. You may be sleep- and time-deprived, and tempted to plant your [child] in front of the TV to keep him occupied. But don't. Studies have shown that infants and toddlers who watch more than two hours of television a day are more likely to develop ADHD than other children."

"As you turn off the TV, turn on human interaction. Social connectedness bolsters the skills that minimize ADHD's impact. So have family meals often, read aloud together, play board games, go outside and shoot hoops or throw a Frisbee - play, play, play. Also make sure that your child's school is friendly and encourages social interaction."

"These are practical measures that can help reduce the likelihood of a child developing ADHD. Remember, too, that inheriting the genes that predispose toward this condition doesn't guarantee getting it. It is not ADHD that is inherited, but rather the predisposition toward developing it. Simply by reducing your child's electronic time while increasing interpersonal time, you reduce the likelihood that the genes for ADHD will be expressed as he grows older - even if they were inherited."

"A final note: You may not be able to prevent your child from developing ADHD, and that's just fine. I have ADHD, and two of my three kids have it as well. With proper interventions, ADHD need not be a liability. In fact, it can be a tremendous asset. While a person can learn the skills to compensate for its downside, no one can learn the gifts that so often accompany ADHD: creativity, warmth, sharp intuitive skills, high energy, originality, and a 'special something' that defies description."
If a child already has ADHD, can a change in the environment help control symptoms?
Dr. Ruff: "The brain can relearn executive functions like planning and attention well into the fourth decade of life. Consistent discipline, less TV and video games, and an emphasis on exercise, seem to be key. Exercise promotes on-task behavior and helps relieve the 'desk fatigue' that makes it hard for kids to sit still in class."

Colin Guare, a 24-year-old freelance writer and co-author of Smart But Scattered Teens: "If playing video games for hours guaranteed future success, I would be President by now.

"This isn't the case, of course. Still, much of my mental dexterity and sharper executive function - brain-based skills required to execute tasks - can be chalked up to my hours spent in front of a screen. Gaming has helped me manage my ADHD-related shortcomings."

ADDitude editors: Though parents will argue that video games are distracting, and an obstacle to learning, research suggests otherwise. In his book, What Video Games Have to Teach Us About Learning and Literacy, James Paul Gee, Ph.D., notes that what makes a game compelling is its ability to provide a coherent learning environment for players. Not only are some video games a learning experience, says Gee, but they also facilitate metacognition (problem solving). In other words, good games teach players good learning habits.

Several video games offer individuals with ADHD the chance to have fun and to polish their executive skills at the same time. Four popular, entertaining, mentally rewarding, and cool games for teens are: Portal and Portal 2, Starcraft and Starcraft II: Wings of Liberty, The Zelda Franchise, and Guitar Hero."

Randy Kulman, Ph.D., founder and president of LearningWorks for Kids: "Watch your child play Minecraft or other skill building games for a few minutes, and you'll see that he plans, organizes, and problem-solves while engaged in a video game - skills we'd all like our ADHD kids to develop. Wouldn't it be great if he could transfer those game-playing skills to everyday tasks? He can, with a little help from you. Use the following three steps to tap into the skill-building potential of video games:

1. Help your child identify the thinking and problem-solving skills that are necessary to play the game.

2. Encourage metacognition and reflection by talking about how these skills are used in the real world.

3. Engage your child in activities that use these skills, and then talk with your child about how the skills connect to game play."

Kulman recommends the games Bad Piggies, Roblox, and Minecraft to build these skills.
How about medication?
Dr. Ruff: "There's no doubt that medication can help control symptoms of ADHD. However, it's problematic when doctors and parents believe ADHD to be simply the result of a 'chemical imbalance,' while failing to consider that a 'lifestyle imbalance' may also be involved. Even if medication is part of your child's treatment plan, you still need to get the TV out of his bedroom."

ADDitude editors: There's no disputing that a healthy lifestyle - nutrient-rich foods, lots of water, exercise, and less stress - is better for ADHD. However, according to a study published online in the Journal of Attention Disorders in 2016, just the opposite is happening - children with ADHD engage in fewer healthy lifestyle behaviors than do their peers without the condition. There's definitely room for improvement.
[When ADHD Is All In the Family]
¹ Michael E. Ruff, MD, FAAP. ADD and Stimulant Use: An Epidemic of Modernity. Medscape (Feb. 2007). https://www.medscape.com/viewarticle/550918
² Kühn, S., Gleich, T., Lorenz, R. C., Lindenberger, U., Gallinat, J. Playing Super Mario induces structural brain plasticity: Grey matter changes resulting from training with a commercial video game. Molecular Psychiatry (Oct. 2013). https://www.ncbi.nlm.nih.gov/pubmed/24166407
³ Richard J Haier, Sherif Karama, Leonard Leyba and Rex E Jung. MRI assessment of cortical thickness and functional activity changes in adolescent girls following three months of practice on a visual-spatial task. BMC Research Notes (2009). https://bmcresnotes.biomedcentral.com/articles/10.1186/1756-0500-2-174
⁴ Zhang, Liuyan et al. "ADHDgene: a genetic database for attention deficit hyperactivity disorder." Nucleic acids research (Jan. 2012). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245028/
⁵ Christakis DA, Zimmerman FJ, DiGiuseppe DL, McCarty CA. "Early television exposure and subsequent attentional problems in children." Pediatrics (Apr. 2004). https://www.ncbi.nlm.nih.gov/pubmed/15060216?dopt=Abstract&holding=npg
⁶ Caplan, Nathan, Marcella H. Choy, and John K. Whitmore. "Indochinese Refugee Families and Academic Achievement." Scientific American (1992). http://www.jstor.org/stable/24938938
⁷ Franke, B et al. "The genetics of attention deficit/hyperactivity disorder in adults, a review." Molecular psychiatry (2012). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3449233/

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Most researchers point to genetics and heredity as causes of ADD or ADHD. Some scientists are investigating whether certain genes, especially ones linked to the neurotransmitter dopamine, may play a role in developing attention deficit disorder. Other experts contend that our fast-paced, stressed-out, consumer-driven lives are also triggers for ADHD.

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You may have once thought that your loved one with ADHD either had a motivational problem, a behavioral problem, a moral failing that he or she could readily change, or was willfully making bad lifestyle choices.

Maybe you believed he could just change if he wanted to. Maybe you withheld your compassion for his plight because, somehow, he deserved what was happening to him since he "chose" to behave impulsively, emotionally, and inattentively. Maybe you even criticized your loved one for deciding to be "that way," viewing his actions as intentional misbehavior and irresponsibility.

Hopefully, you know now that none of those assumptions is true. That change of perspective usually brings with it a deeper understanding of what may be going wrong with your spouse or son or daughter. My hope is that it has led you to have greater compassion for your loved one's plight and a greater willingness to assist him in managing this chronic disability.

Here are some of the ways you can help your loved one with adult ADHD.

1. Be an acceptor and a good listener. In various follow-up studies (including my own) of children with ADHD into adulthood, researchers working independently of each other discovered something: Adults with ADHD who felt they were doing pretty well always had someone who accepted them for who and what they were. That someone never abandoned them in times of trouble, and listened to them when they needed to talk about their problems. This was the person they always trusted to be there for them. Even if it was just to listen and relate to them in nonjudgmental ways, it was a valuable role, nonetheless.
[Free Download: 25 Things to Love About ADHD]
Being nonjudgmental does not mean you deny or make excuses for your loved one's inappropriate behavior or its consequences. You can be a good listener and acceptor while still openly acknowledging the facts of a situation. You can be constructively critical without being morally judgmental.

2. Be a support team member. Adults with ADHD don't just need professionals to diagnose, treat, and support them through the difficulties they experience in trying to change themselves and their lives for the better. They also need people who understand they are struggling to cope with a neurodevelopmental disability and who show some compassion for their struggles. That compassion should be expressed even if your loved one's attempts to change are not always successful. This person encourages him and actively assists him throughout the change process. Like a birthing coach or midwife, the role involves assisting your loved one through a passage to a new and better life. If you are so inclined, you can help him with the changes he is trying to make. You don't just "get it" about adult ADHD, you help him to "fix it."

3. Become an advocate. Sometimes your loved one may need help in explaining what ADHD is to others in and outside of your family. Or he could use your assistance in defending against the callous or ignorant opinions of others. Your loved one could also use your help in encouraging others to accept and to make accommodations for her. At times, when relatives, friends, or social acquaintances make insensitive or critical statements about your loved one, you can help change their minds. They may not understand the nature of the disorder. If so, you can diplomatically correct their misunderstanding. You can even suggest resources they can pursue to learn more about adult ADHD.

Your job as an advocate is not to bite someone's head off in defense of your loved one when someone has spoken ill of him. Instead, your role here is that of a teacher, liaison, or diplomat who clarifies the true nature of your loved one's ADHD symptoms. Again, don't make excuses, deny, or cover up the wrongdoings of your loved one and the adverse consequences of his actions. But you can help others to understand what role ADHD may have played in such misconduct and mistakes.
["Is ADHD Real?" How to Respond to Doubters with Tact and Facts]
The role of advocate can be played with people at government agencies, schools, or other organizations your loved one must deal with. Just being with her when she is trying to negotiate these bureaucracies can be of great help.

4. Become a benefactor. This is not a role most relatives, partners, or close friends can play. It involves having the financial resources to be able to help pay for constructive things your loved one wishes to do. Assuming this role can mean paying for professional evaluations and treatments, school tuition and books, or hiring him in a summer or part-time capacity if you have your own business. Being a benefactor may mean that you help to get your loved one preventive medical and dental care checkups, or cover the copays if she has insurance but can't afford them. This was one way I chose to help out my brother and nephew, who both had ADHD.

Notice that all of these things support constructive activities that offer a chance for improving your loved one's life. Money won't fix everything; problems can still occur. But what your financial support can do it to open doors of opportunity for self-improvement. And that, as they say, is priceless.
["A Day in the Life of an ADHD Advocate"] Adapted with permission from BARKLEY, R.A. (2017). ROLES you can adopt to be of help. In R.A. Barkley, When an Adult You Love Has ADHD: Professional Advice for Parents, Partners, and Siblings (pp. 293-306). http://dx.doi.org/10.1037/15963-015. Copyright © 2017 American Psychological Association. Any further use requires written permission from the American Psychological Association.

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Accept Them. Support Them. Have Their Backs.

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You may have once thought that your loved one with ADHD either had a motivational problem, a behavioral problem, a moral failing that he or she could readily change, or was willfully making bad lifestyle choices. Maybe you believed he could just change if he wanted to.

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Why We Need U.S. Guidelines for Adults with ADHD

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Our understanding of adult ADHD is advancing, yet professional, authoritative guidelines for diagnosing and treating adult ADHD are currently unavailable in the U.S. To improve quality of care, APSARD, an organization for ADHD specialists, is developing the first-ever guidelines for the diagnosis an…

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Most clinicians today evaluate adult ADHD symptoms through one of two lenses: strictly adhering to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the view of the informed clinician or researcher who adjusts these criteria based on the relevant research literature.

More often than not, the latter considers the DSM-5 criteria on its own too narrow and confining - even problematic - for accurately assessing an adult's symptoms of attention deficit hyperactivity disorder ( ADHD or ADD). And they are right. The DSM-5 criteria for ADHD - from arbitrary age cut-offs to ambiguous symptom descriptions - is concerning because it does not accurately reflect the observed experiences of individuals in this specific population or applicable research. The informed ADHD clinician knows this and uses first-hand clinical and research knowledge to develop effective management and treatment strategies. Which raises the question: Is the DSM-5 helping or hurting the accurate diagnosis of ADHD in adults?

ADHD in Adults: Diagnostic Problems and Solutions

According to the DSM-5, an ADHD diagnosis in adults is warranted, in part, if:

the individual meets five out of nine listed symptoms of inattentiveness and/or five out of nine listed symptoms of hyperactivity/impulsivity

symptoms were present before age 12

symptoms are persistent and significantly interfere with major life activities and/or result in significant suffering

Problem: DSM Symptoms Do Not Reflect Adult ADHD

The ADHD symptoms listed in the DSM were developed for children. We can see this in the phrasing of certain symptoms, such as "can't play quietly" or "driven by a motor" in the hyperactive/impulsive items. These phrasings don't translate well to the adult experience. Few adults with ADHD would use these terms to describe their daily experience with the condition, leaving clinicians to extrapolate these items into clinical practice with adults.
[Read: Your Complete ADHD Diagnosis and Testing Guide]
Some DSM-5 symptoms do include parenthetical clarifications meant to capture adolescent and adult experiences. These changes may have led to a rise in ADHD diagnoses, because they count as additional symptoms even when the root symptom they modify is not endorsed. But the lingering issue is that these phrases were essentially invented by DSM-5 committees. Little to no effort was made to empirically test them for their relationship to ADHD, to the root symptom they clarify, and to the extent they facilitate accurate diagnosis. Additionally, no guidance was offered as to whether these phrases should clarify existing symptoms or be treated as "new" symptoms. This is a significant problem.

Our recent research found a very low correlation between many of these clarifications and their root symptoms in the DSM-5. In the parenthetical comment for the inattentiveness symptom of seeming absentmindedness when spoken to, for example, the symptom actually appears to be as much or more related to anxiety, making it a poor symptom for ADHD.

It may be best for clinicians to simply ignore these parenthetical comments for now, and work with the patient to get a better understanding of symptoms, which can certainly stand to be reworked in both domains.

Solution: Adjust the Adult ADHD DSM to Reflect Executive Dysfunction

The DSM-5's list of symptoms associated with ADHD - especially those reflecting inattention, should be renamed or broadened for adults. A better way to think about and detect these symptoms are as problems with executive functioning (EF). These metacognitive functions - self-awareness, working memory, self-motivation, and more - allow us to meet goals. With ADHD, persistence is deficient for a variety of reasons rooted executive dysfunction:

The individual is time-blind; there is a lack of attention to future events and preparing for them over time

The individual is less likely to resist goal-irrelevant distractions

The individual has trouble re-engaging with the task after their attention has been diverted (indicative of deficient working memory)

[Learn: The Adult ADHD Mind - Executive Function Connections]
Solution: Expand the Adult ADHD DSM to Include Disinhibition

The DSM-5 lists too many unspecific and inapplicable symptoms of hyperactivity for adults. Paying more attention to cross-modal presentations of impulsivity provides a better method of assessment:

Motor disinhibition (hyperactivity): This declines markedly with age so that by adulthood, it's reflected in seat restlessness and internal, subjective feelings of restlessness and needing to be busy. External motor function should factor less heavily into the adult assessment.

Verbal: Excessive speech and lack of inhibition around others. By adulthood, verbal impulsivity actually becomes a standout symptom.

The following symptoms of impulsivity are not stated outright in DSM-5 criteria, but they are significant facets of adult ADHD:

Cognitive impulsivity: Impulsive decision-making and poor contemplation

Motivational impulsivity: Greater discounting of future (delayed) rewards - the individual can't generate the motivation to complete a task if the reward is too distant. They may opt for an immediate reward instead because they more steeply devalue the delayed reward as a function of its delay than do typical adults.

Emotional impulsivity: Absolutely central to ADHD, this realm is defined as impulsive expression of raw emotions and poor self-regulation of strong emotions. There's an immaturity in the inhibition of emotion that characterizes ADHD and separates it from a mood disorder like disruptive mood dysregulation disorder (DMDD) or BPD.

Problem: ADHD Onset Age is Arbitrarily Fixed in DSM

The DSM-5 states that several symptoms of ADHD must present before age 12 to merit a diagnosis. But nature does not respect a number like "12" - the onset of ADHD symptoms in people's lives can actually occur at any point in time. In the vast majority of cases, ADHD symptoms do present before age 18 or 21. But there's still a small percentage (up to 10 percent) who fit outside these parameters, or who may even develop acquired ADHD. An extreme sports athlete, for example, who sustained lots of head traumas can theoretically develop a form of ADHD secondary to traumatic brain injury (TBI).

What's more, parents of children with ADHD tend to inaccurately recall the age of onset of symptoms. Most parents are actually off by about three to five years, far later than actually documented in charts, according to our research. Adults make the same mistake when assessing their own symptoms. Thus, the age of onset criterion is too unreliable for us in diagnosis.

Solution: Subtract Years and Differentiate by Sex

Clinicians should still ask the patient about age of onset, but age should not be a lynchpin for core diagnostic purposes. One rule of thumb is to subtract three to five years from the age provided as likely reflecting a more accurate onset. But in general the age of onset should be ignored as a diagnostic criterion.

It's also critical to note that the DSM's symptom threshold or cutoff for a diagnosis of ADHD was based on field trials that included more boys than girls. Clinicians should factor in these discrepancies by using rating scales that have norms that are unique to each sex. This is especially so when evaluating girls and women. As for the five-symptom threshold requirement for diagnosis, research has shown that four symptoms, at least for adults, is enough to indicate the presence of ADHD.

Problem: DSM Definition of 'Impairment' is Subjective

How much ineffective functioning is enough to prove the presence of ADHD? While vague in the DSM-5, true impairment may be determined by clinicians looking at the major domains - health, occupation, education, driving, relationships - and assessing whether adverse or negative consequences have occurred because of ADHD behaviors. These negative consequences can include but are not limited to:

Being held back a grade

Being kicked out of school

Losing your driver's license

Difficulties with work-related promotions

Marital/cohabiting problems and violence

Impaired parenting

Accidental injuries

Risky sexual behavior

Substance abuse

ADHD adversely affects self-awareness, which can cause individuals to under-report symptoms and levels of impairment. To counter this, self-reports must be corroborated by someone who knows the patient well. These accounts should also be checked against documented records.

ADHD in Adults: Treatment

Why does weak or incomplete DSM-5 criteria matter? ADHD is one of the most impairing outpatient disorders. If left undiagnosed and untreated (or improperly diagnosed and treated), ADHD can impact quality of life and pose significant health problems. ADHD, however, remains among the most treatable disorders in psychiatry.

The components of an optimal ADHD treatment program should include:

Awareness: The patient should understand that ADHD is a broader problem with executive functioning, and it can be highly impairing without treatment. The patient should "own" their disorder and feel like a committed stakeholder in the treatment plan.

Medication: Moderate to severe ADHD absolutely warrants medication; this is the most effective treatment available - bar none. Along with medication, clinicians should encourage patients to engage in preventive medical and dental care, given the known health risks, earlier mortality risk, and reduced life expectancy linked to ADHD.

Behavior modification: Cognitive behavior therapy (CBT) targeting the executive function deficits, coaching, and mindfulness training are just some ways to change behaviors to reduce impairment from ADHD in adults.

Accommodations: Changes to the workplace, home, and/or educational setting should hit at the weak points of performance and executive function. This means

externalizing time by using analog clocks and timers

offloading memory by putting information onto notes

increasing self-motivation by seeking external accountability

I also recommend that adults learn about and choose ADHD-friendly occupations. These professions typically allow for more physical movement, require fewer periods of sustained attention, are more flexible, provide for more immediate feedback and accountability, and play to the individual's strengths.

ADHD in Adults: Next Steps
The content for this article was derived from the ADDitude Expert Webinar "Navigating the Life Stages of ADHD: Key Concerns in Diagnosing and Treating Adults with ADHD" by Russell Barkley, Ph.D. (available as ADDitude ADHD Experts Podcast episode #323), which was broadcast live on September 8, 2020. Dr. Barkley is a Clinical Professor of Psychiatry at Virginia Commonwealth University Medical Center in Richmond, VA and is the author of Taking Charge of Adult ADHD (#CommissionsEarned) (Guilford Press), among many other books, clinical manuals, and rating scales.
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ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.

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ADHD in adults looks and acts different than ADHD in children, but clinicians' diagnostic criteria - from age cutoffs to symptom phrasing - is undifferentiated, which sacrifices the accuracy of assessments. Understanding the weak points in standard diagnostic criteria - and how to factor for them in evaluation and treatment - requires a nuanced understanding of how ADHD manifests in adults.

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Your spouse litters the home with half-finished projects and loses a cell phone or set of keys at least twice a week. Your sibling talks before thinking, and nearly missed your graduation. Your grown child still relies on your birthday reminders and just left another job. Your parent exhibits all of these symptoms and refuses to acknowledge that something is wrong.

If this sounds familiar, you understand how daunting and draining it sometimes feels to support and advocate for a loved one with adult attention deficit disorder ( ADHD or ADD).

You also understand that your loved one is capable of tremendous things - with a little support and positive reinforcement. The trick is learning how to provide that without overstepping boundaries or passing judgment. When my patients' loved ones appear to be struggling, I recommend the following 6 steps:

1. Learn the true symptoms of ADHD

2. Understand the potential impairments of ADHD

3. Acknowledge the impact ADHD has on you

4. Assess your loved one's readiness to change

5. Know the best treatments for ADHD

6. Decide what role you will play

Step 1: Learn the True Symptoms of ADHD

Until you understand what is really going on in the ADHD brain, your efforts to help can be half-baked, ineffective, or even harmful. To begin, ADHD is not just a deficit of attention. It is a pervasive, serious cognitive and psychological impairment.

The well-known signs of ADHD - inattention, hyperactivity, and impulsivity - fail to reflect the one complex and crippling symptom shared by the vast majority of people with ADD: deficient executive functioning.

There are seven executive functions that impact self-awareness, self-monitoring, inhibition, memory, planning/sense of time, emotional control and self-motivation. When they don't work properly, they can make people with ADHD appear insensitive, unprepared, disorganized, or overly emotional.
[Learn more about executive functions and ADHD here.]
Executive dysfunctions may look like intentional slights, but these are largely biological problems that originate in the brain.

Understanding that your loved one's mistakes are not a sign of disrespect or selfishness, but a brain chemistry imbalance makes it easier to extend to them the same compassion you show to people with mental health problems or developmental disabilities.

Step 2: Understand the Potential Impairments of ADHD

People with untreated ADHD may experience a number of long-term challenges, including the following:

Impairments Associated with Untreated ADHD in Children/Teens

Comorbid psychiatric disorders (ODD, CD, ASD, anxiety, etc.)

Peer relationship problems (50-70%)

LDs, low academic achievement, school maladjustment

Greater family conflict/stress

Developmental delays (motor, speech, adaptive skills, etc.)

Internet use dependency/overuse (5-25%)

Antisocial behavior (25-40%)

Risky sexual behavior (irregular contraceptive use, STDs, etc.)

Impaired driving performance

Impairments Associated with Untreated ADHD in Adults

Marital dissatisfaction/divorce

Occupational maladjustment, frequent changes

Antisocial behavior, arrests, jail time

Continuing peer relationship problems

Greater family of origin conflict/stress

Financial problems, poor credit

Impaired parenting behavior

Greater loneliness in old age

Increased risk for anxiety disorders

Intimate partner violence

Intimate relationship problems

Limited educational attainment

Understanding these elevated risks can help you realize the gravity of the condition your loved one grapples with, and be more sensitive to potential future problems.

Step 3: Acknowledge the Impact ADHD Has on You

Loving someone with ADHD can be a lot of fun. Many people with ADHD are remarkably creative, very caring, and have a great sense of humor. They may also demand a great deal of time and attention from loved ones.

The parents or spouse of a person with ADHD may put their own physical and mental health on the back burner as they work to keep him or task, remind her of that appointment, or pick up after both of you.

When a person with ADHD doesn't meet his responsibilities, it can make loved ones feel worn out, tired. When the irresponsible behavior is extreme, it can weigh heavily on those around her.

It's OK - even essential - to acknowledge the anger, frustration, impatience, hostility, guilt, and discouragement you may experience. Those feelings don't make you a bad person and they don't mean you will abandon your loved one.

What they do mean is that you need to take time for yourself. Ask for help. Seek support from professionals. And remember that ADHD is a rollercoaster. For each dip, there is a hope for extraordinary success - like that experienced by Michael Phelps, Simone Biles, Justin Timberlake, and Adam Levine. Many people are able to lead productive, effective, happy, and successful lives with ADHD. Practice self-care, and don't give up on your loved one.

Step 4: Assess Your Loved One's Readiness to Change

You can't help someone who isn't ready to accept help, or doesn't believe she has ADHD. Before trying to intervene, acknowledge your loved one's "readiness to change," and adjust accordingly.

For example, the things you might do to support a loved one who says to you, "I think I have ADHD. I'd like to make an appointment. Can you help me do that?" are very different than the things you might do for a person who does not accept that he might have ADHD.

1. Pre-Contemplation Stage

Your loved one denies she has ADHD, or fails to admit she has a problem.

In this stage, make ADHD information readily available - bookmark ADDitudeMag.com, CHADD, or ADD.org. Look for a window of opportunity - perhaps when something goes wrong, and your loved one is wondering what has happened.

Say, "You know, this isn't the first time you've had this problem. I know it's frustrating to you because you've come to me a few times. Do you think it might be ADHD creating a problem? I think we need more information. Let's start with these resources you might find useful."

2. Contemplation Stage

Your loved one is thinking - and even accepting - that ADHD might be a problem.

In this stage, provide a list of local experts or ADHD clinics where they can learn more and pursue an evaluation.
[Find local ADHD treatment professionals in the ADDitude directory]
3. Preparation State

Your loved one is getting ready to engage in the diagnostic and treatment process.

Help him start right and follow through. Offer to drive him to the clinic, or call with reminders of her appointment. Take any steps you can to get the diagnosis underway.

4. Action Stage

Your loved one is getting help. She has a list of treatments and is working on self-change.

Help her get the prescription filled. Make an appointment with the recommended cognitive behavioral therapist. Call the ADHD coach, and set up a session.

60% of adults with ADHD are not compliant with their treatment within six months of getting a prescription. Help them overcome difficulties with executive functions and working memory that may stand in the way.

5. Maintenance Stage

Your loved one is improving and doing fine - maybe so fine that he doesn't think he needs treatment anymore.

Your role is to check in periodically, and offer help if he needs it. Be ready to encourage him to stick with the treatment process.

Step 5: Know the Best Treatments for ADHD

ADHD is a medical condition, not unlike diabetes, that you need to fully understand before you can treat it effectively. Your loved one may benefit from sessions with a counselor or medical professional designed to teach her about the condition and its chronic symptoms in order to drive home the importance of treatment.

An effective treatment plan comprises two parts: medication and behavioral therapy to target executive function deficits. Even with that, your loved one may need additional, complementary therapies including:

ADHD coaching

Regular exercise

Mindfulness training

Treatment for a comorbid condition

The first medication might not work. Your loved one may need to introduce additional therapies or medications to address remaining symptoms, or symptoms of another, related condition. Stand with her while she finds the right combination.

Step 6: Decide What Role You Will Play
[Learn more about these roles here.]
You can adopt one of four main roles for your loved one with ADHD:

Acceptor and listener: The trusted person your loved one can always go to in times of trouble who will listen without judgement or walking away.

Support team member: The person who actively helps with matters related to ADHD - you don't just "get it," you help "fix it."

Advocate: The person who helps explain ADHD to people outside of the immediate family, and who asks them to make accommodations for her.

Benefactor: This is not a role everyone can play. It is a person who can offer financial help when a person with ADHD needs it to pay for a constructive or effective intervention. For instance, life coaching or books at college.

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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Are You Ready to Change? A Support Plan for Each Stage of ADHD Acceptance

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Not all adults with ADHD need the same kind of support. To determine how best to assist and support your loved one, engage in this 6-part process truthfully - and with realistic expectations. The more honestly you answer these questions, the more likely you'll make a positive difference, and strengthen your relationship.

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There are no ADHD-friendly jobs.

Sorry to be so blunt, but people send email all the time asking "What is a good job for an ADHD person?", as if all people with ADHD have the same interests and abilities. Sorry. Now that we have cleared that up, let's move on.

There are no jobs that ADHD would prevent someone from doing. Just as there is no one "perfect" job that fits all ADHD people, there is also no limit to the things that an ADHD person can accomplish. For example, the idea that someone with ADHD should avoid detail work such as accounting simply is not true. There are accountants who have ADHD. There may be other reasons why you can't bean accountant, or a salesman, or a respiratory therapist, but being ADHD is not one of them.

"Everyone has personal challenges of one sort or another that may interfere with job performance," says Wilma Fellman, a career counselor and author of the book Finding a Career That Works for You. "Instead of tossing aside an otherwise great idea for a career because of the threat of challenges, work with someone who can help develop strategies, modifications, and accommodations that might make it a good match for you."

In other words, don't give up.
[Time Wasters and Productivity Killers at Work]
Find Out What You Want To Do

Much has been written about job accommodations for people who have ADHD. In fact, ADHD is included in the American's with Disabilities Act, which means that employers are required to provide "reasonable accommodations" for those who have been diagnosed. Of course, getting accommodations from your employer means that you have to tell them about your ADHD, which may create more problems than it solves. Some people who disclose their ADHD find that their employers perception of them changes almost immediately, and not always for the better.

Rather than depending on someone else to provide accommodations for you, Fellman recommends being more proactive and choosing a career that works for you. "Understanding your career interests and finding a job that matches these interests will improve your chances of being happy and successful in the career you select," she says.

A lot of the problems that ADHD people have as students comes about because we are forced to sit in classes that either don't hold our interest or don't match up well with our abilities. Why force yourself into a career that is just more of the same? Adults have more freedom than children. You don't have to feel like a square peg being hammered into a round hole.

How many careers can you name? A dozen? Maybe 100, if you really try? The Dictionary of Occupational Titles, published by the U.S.Department of Labor, lists over 27,000 occupations, covering nearly all job descriptions available in the United States. Many of these are jobs you probably never heard of and certainly haven't considered as a possible career. But they exist, and you would probably be interested in several of them, if you knew you had those options.
[How to Align Your Career with Your Passions]
Turning Things Around

If you have AD/HD, then you know that it affects your behavior and your abilities to do certain things. On the job, ADHD can show up as clowning around, not appearing to take things seriously, missed deadlines or in other ways that could cause potential problems between you and your employer.

Lynn Weiss, Ph.D., author of A.D.D. On The Job, believes that many of these behaviors can be used to work in your favor in the workplace. "Remember," she says, "although your ADD-related behaviors can cause problems in a work environment, they can also be used in a constructive way to your advantage."

As an example, Dr. Weiss talks about being extra sensitive to criticism, a trait that is very common among people who have ADHD. "Being hypersensitive is difficult and sometimes painful. But it does have a flip side that can serve as a tremendous asset for you in the workplace: a keen sense of intuition." She continues: "Most of the business world's top salespeople have good intuition, often called a gut-level feeling. For example, successful salespeople seem to just know with whom to spend their time, when to close a deal, and what the other person needs in order to be satisfied. Believing in and depending on this sense of intuition pays rich dividends."

Again, successful ADHD people are those who have learned to maximize their strengths and minimize their weaknesses. These people don't force themselves into a positions that don't fit. Instead, they find or create situations that allow them to make the most of their abilities.

Jeffrey Mayer, author of Success is a Journey, Time Management for Dummies, and other books about succeeding in business, writes that all successful people share five characteristics:

They have a dream.
They have a plan.
They have specific knowledge or training.
They're willing to work hard.
They don't take no for an answer.

You can find a career that works for you. Now, just go do it!
[Free Download: 8 Dream Jobs for Adults with ADHD]

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There are no ADHD-friendly jobs. Sorry to be so blunt, but people send email all the time asking "What is a good job for an ADHD person?", as if all people with ADHD have the same interests and abilities. Sorry. Now that we have cleared that up, let's move on.

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Many experts today argue that attention deficit/hyperactivity disorder is not, at its core, an attention problem, but rather a self-regulation problem exacerbated by weak working memory.

Our brains comprise two systems: the automatic and the executive. The automatic system guides 80 to 90% of our activities every single day; the executive system guides the remaining 10 to 20% and requires purposeful, regulatory effort. As many with ADHD know, this system of executive functioning can be exhausting; it requires frequent mental pauses and ceaseless self-regulation.

Executive function is so taxing, in part, because it comprises seven distinct brain activities — two of which are verbal working memory and non-verbal working memory (which hinges on visual and spatial acumen). Both types of working memory influence the amount of effort and type of actions required to modify what our brains would do automatically. The stronger your working memory, the less work your brain must take on with each new challenge.

The importance of working memory is growing within the study ADHD, according to Dr. Russell Barkley, author and clinical professor of psychiatry at Virginia Commonwealth University Medical Center. He calls working memory your brain’s GPS — an essential system that guides and directs actions, and which is commonly weak in people with ADHD. Dr. Barkley explained this GPS theory in depth in a joint presentation with ADHD coach Jeff Copper during an Attention Talk Radio podcast earlier this year. During their talk, Barkley and Copper shared strategies for offloading working memory stresses in the ADHD brain.

How Working Memory Powers Executive Function

Like a GPS booting up for a new voyage, the brain begins any new task by referring to its maps — those sensory images logged and stored in non-verbal working memory, Barkley says. It next tunes in to its instructions, the verbal commands and “inner voice” stored in verbal working memory. The visual images of the non-verbal working memory help the brain to act, and the verbal working memory becomes its guidance system.

[Take This Test: Do You Have a Working Memory Deficit?]

When a brain is storing and synthesizing both types of working memory effectively, it begins to work a lot like Waze or Google Maps — determining the relevance of new information as it arrives and altering the plan in real time to get us to our destination better or faster. It becomes a more powerful tool for self-regulation, for goal-setting and for working around obstacles in our paths. But to an already overwhelmed brain, all of this working memory can be a lot to process. Because of that, Barkley suggests a strategy called “externalizing” that gets the information out of the brain and into an external environment by transforming both the sensory and the verbal working memory into a physical manifestation. This helps the brain to become less taxed.

Below, Barkley and Copper offer five strategies for strengthening your working memory and externalizing information so that your brain can effectively plan and coordinate tasks without expending the extra effort.

Digital isn’t always the best solution.

To lessen the burden on your working memory, begin by simply writing things down with pen and paper. Yes, your phone is often nearby, but using technology for all such memory tasks is “… misguided for ADHD in many ways,” Barkley says. Smart phones, tablets, and smart watches – which may be lost, drained of battery life, and not synced – may lead to more stress than they relieve. Instead, Barkley says, “Let’s go low tech. Let’s go back to paper and pencil.” Use an ADHD-friendly notebook as the external storage device for your working memory. Use imagery, not just language; make to-do lists; keep your schedule; make goals – but do it on paper.

When you do use tech, use it wisely.

For example, Copper suggests snapping a photo of the outfit you’ve laid out for an upcoming trip so that you can recall it quickly from your offloaded, externalized working memory – now in the form of a photo – while balancing other priorities during your trip.

[Click to Read: Is Your Disorganization Out of Control?]

Map it out.

Returning to the GPS metaphor, Barkley suggests creating a work (or mind) map. This works well for those who achieve better results with visual cues – particularly when working on longer written projects or reports. Creating an image of something can be easier and faster to retrieve because it can be instantly imagined. For example, sticky notes can make great low-tech systems, because they can be moved around as we think through an assignment, allowing for quick categorization, scheduling, detailing, and rearranging without expending more mental energy. Sometimes, a picture really is worth a thousand words.

Simplify your workspace.

When it comes to controlling distractibility and impulses, working memory is often fragile. Barkley recommends limiting your workspace to only what’s involved in the project at hand. He even suggests that some students and professionals benefit from using two computers – one with games, social media and the web, and one that is stripped down, for work only. A software application that blocks browsing is another tactic that can limit online distractions and keep projects – and working memory – on track.

Take time to discover what’s right for you.

We can’t all commit to the same systems and expect powerful, individualized results – one size does not fit all. According to Barkley, research shows that, in the average ADHD brain, verbal working memory is twice as strong as visual working memory. For some, however, this isn’t the case. Artists, architects, and others who are visually inclined generally find that the opposite is true. (Some even find that their tactile, auditory, and olfactory senses may be harnessed to lighten the load on working memory.)

[Free Expert Download Available: Unraveling the Mysteries of Your ADHD Brain]

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Your Brain’s GPS Is Glitchy: Why Working Memory Fails and How to Bolster It

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Verbal and non-verbal working memory are two of your seven executive functions. They are also the essential batteries powering what Dr. Russell Barkley calls your brain’s GPS system — the one that keeps you on track, on time, and in control. Here, learn why ADHD brains so frequently struggle in thes…

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“It’s Not About Social Cues. It’s About Social Learning.”

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Social learning challenges are common in teens with ADHD, who struggle with perspective taking and situational awareness. Talk therapy and social skills groups rarely help.

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Misdiagnosed ADHD in adults can create a lifetime of emotional turmoil. Why can't I keep up? Why is this so hard? Dr. Dodson explains how to spot the signs and (finally!) understand what's holding you back.

Doctor's laptop and stethoscope, important tools for accurate diagnoses.

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A doctor consults with a patient about the possibility of adult ADHD.

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An adult with ADHD has a bag over his head, symbolizing the shame that often accompanies ADHD.

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Adult ADHD is often misdiagnosed due to overlapping symptoms with other conditions.

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Woman with ADHD is sleepless touching alarm clock while eyes open.

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Woman with ADHD drawing a lightbulb because People with ADHD nervous systems are usually much brighter and more creative than the average neurotypical person

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Pill box for ADHD medication

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A person with ADHD runs on a treadmill and it helps their ADHD symptoms.

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Doctor writing prescription for ADHD

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Late Diagnosis: Was ADHD to Blame All Along?

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Misdiagnosed ADHD in adults can create a lifetime of emotional turmoil. Why can't I keep up? Why is this so hard? Dr. Dodson explains how to spot the signs and (finally!) understand what's holding you back.

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Friendship groups can work wonders for kids with ADHD, but pragmatic social skills problems require a different approach. Here's how to get the specialized help your child may need.

Girl with ADHD sitting on stone steps outside folding arms over knees

Most parents know that ADHD symptoms can be a problem in the classroom. Not being able to sit still, pay attention, or complete work has its consequences, none of them good. Those same symptoms - hyperactivity, inattention, problems with organization and time planning, and impulsivity - also prevent kids from making and keeping friends. The good news is that using appropriate ADHD medications, attending social skills classes, and using cognitive behavioral therapy can help a child improve socially.

This is not the case for the challenges called pragmatic social skills problems. These are neurologically based, and are related to the brain's ability to receive and process visual and auditory social cues. These problems are a major obstacle to a child trying to make and hold on to friends.

Missing the Cues

Some children, adolescents, and adults with ADHD can't read others' social cues, and don't perceive how their body language and tone of voice are read by others.

Communicating with friends involves more than words. We communicate with facial expressions, gestures, eye contact, posture, and tone of voice. These make up nonverbal communication. Current studies suggest that nonverbal communication is a fully developed language, different from verbal communication (words) and processed in different areas of the brain than visual or auditory communication. Nonverbal communication is not taught. It is learned through observation, interactions, and feedback from others.

Nonverbal communication problems generally take one of two forms. In one scenario, the child or adult is unable to correctly read the nonverbal social cues of others. For example, the teacher stands in front of Billy's desk, looking directly at him, her face taut. But it's not until she says, "Stop that right now!" that Billy looks up, surprised. Billy did not pick up on the earlier cues that indicated his behavior was upsetting the teacher.

In other cases, a child or adult is unable to recognize how others perceive her nonverbal cues. Ellen talks to a friend but is standing so close that she is almost in her face. Ellen's voice is loud, and she is jumping up and down. Her friend pushes her away and says, "Leave me alone." Ellen is hurt because her friend rejected her.

Listening and Seeing Incorrectly

Nonverbal communication problems can be auditory or visual. Auditory problems involve using the wrong tone of voice, rate of speech, and variations in volume and word emphasis. For instance, a child might speak too loudly or his tone might not match the emotional message he wants to convey.

Visual communication problems involve everything from not being able to recognize the emotions expressed by others' facial expressions to violating another's personal space. For instance, a child may not be able to recognize a happy or fearful face. He may stand too close to someone while talking, or hug and kiss a stranger. His posture may indicate anger when he intends to express friendliness.

Social Smarts

Nonverbal communication challenges rarely respond to the typical social skills training groups that help many ADHD kids. Children with this challenge need specialized training.

In specialized social skills groups, the child is made aware of and sensitive to his social problems. This step is critical. Some children have little awareness of their difficulties and may deny their problems or blame others for them. Once the individual begins to accept the problem, the second step is to help the child develop new strategies for interacting with others. The third step requires the child to practice these new strategies outside of the group and to report back on how they worked.

The children in a specialized group are taught to recognize social cues. The leader might say, "Kids, let's look at these pictures. This one is a happy face. What makes it look like a happy face? This one is an angry face. What makes it look angry?" As children learn, the leader asks one of the children to show a happy face and another to show an angry face. As the class progresses, training may include asking a child to make or draw a face - a fearful one, say - and seeing if others in the group can guess the feeling that she is actually expressing.

If you suspect that your child has nonverbal communication problems, consult with a mental health professional. If he or she concurs, seek a referral to a pragmatic social skills group. It could make the difference between your child being lonely and being able to make and keep friends throughout life.

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Friendship groups can work wonders for kids with ADHD, but pragmatic social skills problems require a different approach. Here's how to get the specialized help your child may need. Most parents know that ADHD symptoms can be a problem in the classroom.

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Dominating conversations. Not showing interest in others. Telling cringey jokes. Struggling in unstructured social situations. Children and teens with ADHD know these social struggles and misunderstandings too well. For many kids, friendship foibles like these become a source of shame over time; they question why they can't grasp what comes intuitively to their peers and may retreat socially, often into the world of "virtual friendships."

Why do kids with ADHD struggle with friendships? Navigating social interactions requires various mental processes, or executive function skills. Deficits and delays in these skills - which I refer to as social executive function skills - are common in ADHD, and they explain many of our kids' problems in the social realm.

Lagging social executive function skills represent a learning challenge; they prevent children from intuitively picking up on social information from a young age to the same extent as their peers. This should not be confused with struggles stemming from social anxiety or other conditions.

Better social skills begin to take root when we understand the foundational skills that cause the most trouble - from internal dialogue and cognitive flexibility to perspective-taking and understanding context - and the strategies that effectively build and support these skills in ADHD brains.

Social Skills for Kids: Understanding Underlying Deficits

Children and teens with ADHD, even if they are socially motivated, tend to have a hard time with the following skills that underlie social interactions:
[Get This Free Download: 14 Ways to Help Your Child With ADHD Make Friends]

Perspective-taking: Understanding others' thoughts and feelings, and how you are coming across in social settings

Situational awareness; reading the room and understanding what you should be doing, based on context

Responding appropriately to others' emotions; you may come off as rude or disinterested if you do not respond as expected after someone has shared their feelings or emotions

Initiation; difficulty with starting conversations, with asking for help, and with self-advocacy skills

Cognitive flexibility for the sake of being part of a peer group, accepting others' ideas, and being able to take direction from others

Using humor appropriately

Many children with ADHD have trouble with the above skills because they struggle to "hear" their internal dialogue (which I refer to as their "Brain Coach" to help children make sense of this skill).

Of course, ADHD symptoms like impulsivity and inattention may also impact social interactions. Impulsivity may cause an individual to interrupt someone who is speaking or say inappropriate things, while inattention may show up as spacing out during conversation or appearing disinterested.

What Social Skills Struggles Look Like in Children

Lagging social executive function skills become noticeable to same-aged peers around age 7 and well before parents start to notice. Early signs often include the following:
[Read: It's Not About Social Cues. It's About Social Learning.]

Acting bossy and controlling with peers, especially during play

One-sided conversations

Difficulty in unstructured social situations, like recess

Difficulty keeping friends (but can make friends)

"Smothering" a new friend

Difficulty relating to same-age peers, but does fine with younger children and adults

Not understanding how they're coming across to others (poor perspective-taking skills)

What Social Skills Struggles Look Like in Tweens and Teens

As social expectations increase over time, new difficulties may emerge, also rooted in weak social executive function skills. Signs that a tween or teen is struggling socially include the following:

Retreating into video games/social media/the online realm to escape the uncertainty and unpredictability of socializing

Inflexibility; unable to accommodate different viewpoints, activities, etc.

Criticizing peers; might call others "weird" or "annoying"

Only wanting to befriend "popular" peers who are not accepting of them; may overlook peers with lower social standing

Little to no interaction with peers outside of school; may say that they have "school friends" but not "outside-of-school friends," meaning they do not understand the work it takes to build and sustain friendships - and their role in that interplay

Social Skills for Kids: Strategies and Guidelines for Parents

Parents play the most important role in helping children improve their social executive function skills. Here is how to begin:

1. Share your internal dialogue to model perspective-taking. This will help your child understand what it sounds like to think about others, and thus help develop their own self-talk. Vocalizing your inner dialogue will help your child learn to pause and consider how they (and others) come across in social situations. Share thoughts like:

"It was nice of that guy to pick up the lady's umbrella. She's probably grateful for his gesture, too."

"I'm feeling a little bored right now because you're having a one-way conversation with me about Minecraft. I wish we could talk about something that both of us are into."

I'm having cringey thoughts right now because that person is speaking so loudly on their phone in a restaurant."

2. Teach your child about the importance of "fake-outs." A fake-out (a term I use with the children I help) is when you show interest in what others are saying, even though you're really not invested. All of us engage in this type of reciprocity. But children with ADHD don't often understand that "tolerating" someone else's interests, especially when that person is new to them, is an unspoken part of social interactions and crucial to building and sustaining friendships.

3. Praise your child's efforts. Recognize when your child displays resiliency, flexibility, grit, and the willingness to try something new with others. Use purposeful recognition and praise to help your child understand social behaviors that would help their peers feel comfortable around them. Examples:

Recognize your child every time they show interest in others, especially when they're going out of their comfort zone. Say things like, "It was great of you to agree to play basketball with your classmate, even though I know you don't really like the sport. It showed them that you like hanging out them."

Does your child have responsibilities at home? Household chores are a great way to teach reciprocity because it teaches them to think about the needs of others.

4. Help your child understand context. The cause and effect of our words and actions, and how we respond to what's happening around us, fluctuate based on setting. A child, for example, might feel more comfortable sharing a joke with a classmate than with the school principal.

To demonstrate that people have a range of thoughts based on situational context, I use what I've dubbed the "Cringe to Clutch o'Meter" - a visual tool that helps improve perspective-taking in children. On one end is cringe (thoughts and feelings of discomfort and awkwardness) and on the other is clutch (positive thoughts and feelings). To use the tool, have your child note the context of a situation first. Then, ask for their perspective: Based on their words and actions, what kind of response do they think they elicited from others? Where does it fall on the scale?

5. Practice "reading the field" together. Situational awareness requires putting pieces of information together to make sense of what's going on, no matter if we're indoors or outdoors. (That's why I use "reading the field" instead of "reading the room.") Situational awareness is as much about knowing what to do at a birthday party as it is about safety awareness while walking through a busy parking lot. Everyday life offers plenty of opportunities to work on these skills in varied contexts.

So the next time you're at the shopping center parking lot with your child, help them "read the field." Here's what that may sound like:

It's Saturday morning. This is when most people are out shopping, so the parking lot will be busy with cars pulling in or pulling out of spaces. Reading the field involves looking at the cars to see if they have their white lights on, which means they're backing out. We don't want to walk too close to the cars, either. We also have to read the field to make sure we're out of the way of drivers looking for a space. When we're in a parking lot we do not look at our phones, because if you're looking at your phone, then you're not reading the field. Learn more about reading the field here.

6. Extracurriculars are essential. Whether sports, music, dance, or another interest, extracurriculars give your child a chance to spend time with their similar-age peers. Require them to participate in an after-school activity; they likely will not take the leap on their own.

7. Help your child remember past social successes. ADHD minds struggle with episodic memory, or recalling the emotions associated with past experiences. That means your child may struggle to recall social experiences they found enjoyable. (It's why they may remember last year's summer camp as "boring" even though they raved about it at the time.) Without the aid of memory, your child may be reluctant to engage in similar social opportunities as they arise. Tap into your child's episodic memory by asking questions about their past social experiences, scrolling through photos, and reminding them of all the ways they had fun and excelled.

8. Don't measure your child's social competency by how they interact with family. Children will often act differently at home than they do in school or with peers. Many children often do not feel the need to use "good social skills" with immediate family. They feel safest with family, and they know there are no social ramifications if they use poor social skills with Mom, Dad, or siblings.
As you help build your child's social skills, here are some important reminders:

Expect defensiveness and resistance. Teenagers may not be eager to engage in self-reflection or listen to what parents have to say. That's because social difficulties are a source of shame (for anyone). You might worry about hurting your child's feelings by broaching the subject. But remember : Your child's peers won't be as interested in protecting their feelings. It's better for your child to hear it from someone who loves them unconditionally, at the expense of temporary discomfort. Avoid falling into the argument vortex or trying to reason with your child about how they're coming across to others. (Remember that because they struggle with perspective-taking, they won't understand how others perceive them.)

Expect inconsistency. ADHD is a condition of inconsistent performance. Your child may make a social breakthrough one day and appear to take several steps back the next - and that's perfectly normal. Be patient. Results will come slowly and with time - not overnight.

Social Skills for Kids with ADHD: Next Steps
The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, "Raising Socially Smart Tweens & Teens" [Video Replay and Podcast #390] with Ryan Wexelblatt, LCSW, ADHD-CCSP, which was broadcast live on March 2, 2022. Ryan Wexelblatt, LCSW, ADHD-CCSP is the Founder and Director of ADHD Dude. He creates videos for parents and kids at the ADHD Dude YouTube channel, provides Parent Training and social programs for boys.
SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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The Social Executive Function Skills That Elude Kids with ADHD

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Children and teens with ADHD may lose friends because of deficits in social executive function skills - the underlying processes that are involved in social skills ranging from perspective-taking to reciprocity and cognitive flexibility. Here, learn strategies that help them bolster these skills and strengthen their friendships.

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Metacognition is the executive function (EF) that helps us reflect on and manage our thoughts, attention, effort, organizational skills, and emotions. It is the internal dialogue that tells a student, "You've done work like this before; you can do it again."

When a child with ADHD says, "I can't do math" or "I hate writing," that is a sign of under-developed metacognition skills that require intervention strategies and supports - namely, structured, open-ended questioning. Guided questioning eventually leads children to develop their own self-talk and do their own thinking, direct their own attention, and recognize and regulate their emotions.

Paired with common daily struggles, the recommended questions below are the same for teachers and parents. That is intentional. Through repetition and experience, children begin to internalize these questions and develop a metacognitive strategy to guide their own self-talk through any struggle - academic, social, or emotional.

Metacognition: Self-Talk Strategies

EF Skill

Day-to-Day Challenges

Questions

Initiation and activation
Avoiding assignments, procrastinating on homework, studying, or chores

What is the task or assignment?

What is the question asking?

What are you supposed to be doing?

Planning and organizing
Getting stuck on a word or complex text, feeling unsure of next steps on a multi-step math problem, forgetting homework, missing deadlines

What do you think you could do first?

What do you think you could do second?

What do you think you could do next?

Sustain attention, effort and working memory
Feeling distracted or unmotivated, not completing assignments, falling off-task

What is important?

What is your goal?

When you get distracted, what strategies help redirect your focus?

Which strategy could help now?

Self-monitoring
Failing to calm down and/or complete work, handing in assignments filled with errors, interrupting, carelessness

How is it going?

Is your strategy working?

Do you need to go back and revise your strategy?

Is your plan working?

Do you need to revise the plan?

Adapted from The Metacognitive Student (Cohen, R., Savage, J., Opatosky, D., Darrah, E., & Stevens S., 2021)

ADHD Metacognition & Self-Talk: Next Steps

Schoolhouse Blocks: Foundational Executive Functions

Access more resources from ADDitude's Schoolhouse Blocks: Foundational Executive Functions series exploring common learning challenges and strategies to sharpen core EFs at school.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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A Daily Plan to Practice Empowering Self-Talk

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Metacognition is the executive function (EF) that helps us reflect on and manage our thoughts, attention, effort, organizational skills, and emotions. It is the internal dialogue that tells a student, "You've done work like this before; you can do it again."

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Social Skills Training for Kids with ADHD

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Social skills don’t always develop naturally. But even the most impulsive children with ADHD can learn to get along with the group and make friends on the playground. Learn how acknowledging bad feelings and celebrating success can help your child develop social skills.

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WATCH THE VIDEO BELOW FOR THE FULL ANSWER

DO YOU HAVE A QUESTION FOR RYAN WEXELBLATT?
Ask your question about ADHD in boys here!

What Is Self Talk?

Almost 10 out of 10 kids I meet have never had ADHD explained to them in a way that is relevant to their daily life. 100% of the kids with whom I've worked (and the majority of their parents) have never had self-directed talk explained to them.

Because I want to teach kids that ADHD is not a "mental problem," I explain the concept of self-directed talk as their Brain Coach. I explain that volume on their Brain Coach can be turned down too low, which can make it challenging for them to complete non-preferred tasks as well as figure out what they should or should not be doing in social situations.

This video, designed for kids, introduces the concept of their Brain Coach. You may find this video helpful in understanding how to talk to your child about ADHD. It has been amazing to hear from parents across the country that their sons are telling them when they used their Brain Coach. All videos for kids can be found in the Dude Talk playlists on the ADHD Dude YouTube channel.

More on Self Talk for the ADHD Brain

1. Read This: How to Get Your Talkative Child to Stop and Listen
2. Read This: My Son Keeps Calling Himself 'Stupid'
3. Watch This: The Social Lives of Boys with ADHD
Ryan Wexelblatt, LCSW is the facilitator of the ADHD Dude Facebook Group and YouTube channel. Submit your questions about ADHD in boys here!

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The Power of Self Talk in Controlling an ADHD Brain

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Self talk is a powerful way to regain control over run-away ADHD emotions, thoughts, and impulses. Here, learn how to talk with your child about his ADHD brain coach, how to harness its power, and how to take the stigma out of everyday ADD challenges.

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Q: "My son is a complete motor mouth. I'm worried that he's overwhelming his peers by flooding them with whatever thoughts come into his head. How do I help him realize that without hurting his feelings?"

Start by sharing your own internal dialogue. For instance, if your son is having a one-sided conversation with you about Pokémon or Fortnite, you have to say out loud, "You know, I'm feeling kind of bored with this conversation because you're just talking at me about your interests, and we're not really talking about things that we can both talk about, or that we both enjoy."

When I tell this to parents, a lot of them respond, "Oh, I don't want to do that. I don't want to hurt his feelings." If your main concern is protecting your son's feelings, then you cannot teach him how to navigate socially in the most effective way. Either he can hear the truth from somebody who he knows loves him conditionally (and it might hurt his feelings), or he can be told by other boys to "shut up" or "you're annoying." It's preferable that he learns from you because he knows that you have an emotional investment in him.

Try this: Instead of saying "You're giving me too many details," you could ask him, "If you were talking to one of your buddies right now, do you think he would be interested in this conversation?" This helps him develop self-directed talk around perspective taking, and allows you to reflect on his behavior without telling him directly that he's talking too much.

Teaching social skills is teaching accountability. We have to learn how to be accountable to others in order to interact with them. So please do not worry about hurting your son's feelings. And again, share your inner thought process with him so he understands your perspective. That's how you'll help him develop perspective-taking skills.
[Help Your Child's Peers 'Get' ADHD: A Free Guide for Parents] This content came from the ADDitude webinar by Ryan Wexelblatt titled "The Social Lives of Boys with ADHD: Why Traditional Therapy and Social Skills Groups Rarely Work" That webinar is available for free replay .

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Q: Should I Tell My Son That He Has A Motor Mouth?

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Boys with ADHD don't always have reliable social filters. If your son is prone to rambling with you, it's likely he does the same thing with his peers. You can help him the most by telling him honestly when his tangents become boring.

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Roughly one quarter of all adults with ADHD also experience symptoms of depression. Learn how to recognize signs of depression, assess treatment options, and reclaim your health.

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Some ADHD experts believe that a cluttered desk, closet, or house reflects a disorganized mind; others take it as a sign of genius. A lot of adults with ADHD, including me, agree with the latter opinion.

Either view can be true, depending on the individual and the degree of his disorganization. Those who are organizationally challenged spend hours - days, even - trying to get things neat. We lose quality time with our kids or a night on the town. "Controlled chaos" might be a better choice for ADHD adults. On the other hand, a mess that is ignored can grow larger, until we feel overwhelmed by it.

How do you distinguish a productive mess from a debilitating mess? Read on...

Messy and Organized

The guiding principle shouldn't be what others say, but how you feel about clutter and how you function with it. If you're an adult with ADHD who can perform well with clutter all around - at home or at work - who cares if someone calls you a slob (unless it's your boss).

Some of the messiest people I know can find the document they're looking for from a tall stack of papers without missing a beat. That's what I call organized, messy or not. Living up to your own expectations is more rewarding than forcing yourself to conform to standards set by those to whom sorting comes naturally.
[Self-Test: Is Your Clutter and Disorganization Out of Control?]
Family, friends, and co-workers may make judgments about our clutter and berate us for it. Neatniks assume that we are lazy or disorganized, when neither is necessarily true. If you are in control of your mess, and your mess isn't controlling you, let the criticism roll off your back.

How do you know whether you are in control? Ask yourself, "Am I wasting time looking for what I need?" and "Am I being pulled off task - and accomplishing little - because of clutter?" If you answer no, you have a mess you can live with.

When I wrote my thesis for my master's degree, my desk and floor reflected my "messy" mind. Spreading out my ideas and sources - papers and open books - allowed me to survey all of my ideas and put them in together in original ways. No one visiting my office could have seen the method in my mad array of papers, but the seeming chaos helped me develop a thesis that received rave reviews from my professor.

Messy and Dysfunctional

Chances are, ADHD adults may recognize the signs that their messes are controlling them. Here are seven obvious ones:

When you have to purchase items to replace those that you can no longer find.

When you spend time looking for things that you use routinely.

When your spouse or a disgruntled coworker complains about your mess creeping into his space.

When the mess on your desk becomes a distraction in itself.

When your boss tells you to clean up your cubicle. Most bosses will not intervene unless your disorganization is seriously affecting your performance.

When items are not in the right room - dishes in the bedroom, toothbrush in the living room, bedroom slippers in the garage, hairbrush in the kitchen, hiking equipment in the dining room.

When a stack of papers becomes so tall that it falls over, or when you find yourself stepping over things to move through a room.

[Free Download: Clean Up and Get Organized in One Weekend]
Don't Let Clutter Overwhelm You

One of my clients was clearly a slave to his mess. He piled stuff - papers, clothes, sports equipment, unpaid bills - all around the dining-room table, kitchen counters, coffee table, and other shared spaces in the house. His wife picked up, but didn't know where to put the homeless items. He suggested storing his clutter in his office, which was in the basement. They agreed it wasn't fair for her to have to run up and down the stairs to get his stuff out of the way.

The solution? They placed a large wicker basket - about the size of a milk crate - in every room. They refer to the baskets as their "designer dumpsters." Whenever she sees his stuff cluttering up shared space, she deposits it in the basket in that room. He always knows where to find the items that he's misplaced.

At one point, I sat on the trunk in my office - amid the disarray of books and papers - thinking about giving up on my thesis. My thoughts came so fast that I didn't think I could capture them in an outline. I took photos of the floor and desk - and of myself atop the trunk - to preserve the moment when I almost gave up. The photo reminds me that I am more than my mess. I am an ADHD coach whose contributions and academic achievements have made a difference in people's lives.

Look beyond your mess - assuming it's not messing up a colleague or spouse - and find something about yourself to applaud. I'm already clapping for you.

Clutter Control Tips for ADHD Adults

Use baskets/containers without lids for like items (e.g., boot box, gloves/hat/scarves box, kitchen spice box).

Place a wastebasket in every room.

Place a magazine rack in rooms where you read.

Spend 15 minutes a day de-cluttering (throwing and putting things away, filing, if necessary).

Designate at least one junk drawer in every room. If you don't know where an item should go, or if it doesn't have a home yet, put it in that drawer.

[Free Resource: 22 Strategies to Combat Clutter]

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Some ADHD experts believe that a cluttered desk, closet, or house reflects a disorganized mind; others take it as a sign of genius. A lot of adults with ADHD, including me, agree with the latter opinion. Either view can be true, depending on the individual and the degree of his disorganization.

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Tried-and-true organization tricks don't work for you. Why? You need a system designed for your ADHD mind. Efficiency is our battle cry in this room-by-room plan that nips common clutter magnets - like the kids' room or the hall closet - in the bud.

A to do list will show you how to organize your home.

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A woman sits on the floor of a room covered in mess. She needs tips on how to organize her home.

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A messy pile of Tupperware in a refrigerator belonging to an ADHD home

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Untidy stack of shoes whose owner need to learn how to organize her home.

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A paper shredder overflowing with paper in the disorganized office of a person with ADHD.

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An organized linen closet in the home of a person with ADHD

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A couple with ADHD sleeps on the couch in the middle of a messy living room.

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A kitchen timer, a valuable tool when you learn how to organize your home in bursts

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The Ultimate Room-by-Room Organization Guide

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Tried-and-true organization tricks don't work for you. Why? You need a system designed for your ADHD mind. Efficiency is our battle cry in this room-by-room plan that nips common clutter magnets - like the kids' room or the hall closet - in the bud.

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Q: "My daughter's room is an absolute disaster, and mine is not much better. Instead of hanging clothes up or putting them away, we both dump them wherever it's convenient. The disorganization is causing anxiety because we are overwhelmed wherever we look. How can we find a system that works for us?" -Kcalm

Q: "My two adult children and I are all diagnosed with ADHD. How can we keep on top of the clutter? We seem to let it get to the point of being overwhelming." -Frustrated Mom
Hi Kcalm and Frustrated Mom:
Your questions are among the most common - and commonly frustrating - for parents AND children with ADHD. It's not only difficult to find organizing systems that work for you; it's nearly impossible to maintain the ones you get going. Here a few guidelines to get you started - and consistent.

1. Everything Needs a Home! Barbara Hemphill once said that clutter is delayed decision-making. So if you don't know where something lives in your home, you're more apt to let it sit wherever it lands. Start by designating specific "homes" for all your belongings. And make sure your areas are clearly labeled. When you're tired after a long day, visual reminders make cleaning up that much easier.

2. Use My "Triple S" System - Short, Simple & Specific - to Set Daily Goals. Try to organize everything in one day, and you'll end up overwhelmed and frustrated. Try specific daily intentions instead. "Thursday night we're going to put away the clean folded laundry." "Saturday morning we'll tackle the weekly mail." In other words, break down your tasks into manageable parts to feel more in control.

3. Make It Fun! Crank your favorite music and throw yourself a dance party. Set a timer and play "Beat the Clock" by seeing how much you can get done before it goes off! Grab your favorite candy and "have a treat while you make it neat!" Infusing energy and play into your organization routine is a wonderful way to get your ADHD brain moving!

4. Pair Up to Pare Down! Grab your children and work together! Sometimes "body doubling" (being in an environment where others are doing what you're doing) helps us to initiate and stay on task. Plus hard work goes faster when we do it with someone else.

Our Editors Also Recommend:

Free Download: 10 Ways to Get Organized This Weekend
3 Games for Clearing Out Clutter
Nix Morning Chaos with This Two-Part Routine

Organization guru Leslie Josel, of Order Out of Chaos, will answer questions from ADDitude readers about everything from paper clutter to disaster-zone bedrooms and from mastering to-do lists to arriving on time every time.
Submit your questions here!

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Q: I Have an Overwhelming ADHD Clutter Problem

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Is ADHD-related disorganization causing you (and your children) frustration and anxiety? You need a system that makes sense to you - not the rest of the world. Here, learn how to find what works to help you and your kids stay on top of clutter, once and for all.

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I always know where my keys are. I don't generally lose things. I remember to lock the doors at night. I'm almost always early for appointments and meetings. I earned two college degrees.

I've written two books on women with attention deficit disorder ( ADHD or ADD), and I am considered an expert in the field.

And I have ADHD.

People say, "How can that be? You seem so together! Even your socks match."

I was diagnosed with inattentive ADD almost 25 years ago. And though I've dedicated my professional life to helping other women with ADD, I, too, struggle with the condition.

ADHD doesn't go away after you use the pretty polka dot planner or the calendar with the cute stickers and matching pen. It doesn't go away with medication, meditation, or magical gadgets to keep you on track. ADHD is generally a life-long condition that can affect anyone: a bus driver, teacher, surgeon, writer, or rock star. And it affects each of us in different ways.
[Could You Have Inattentive-Type ADHD? Take This Symptoms Test]
My ADHD: Anxiety Over Being Late, Lost, Left Behind

I'm never late because I'm so anxious about being late. I arrive with lots of time to spare to alleviate a sense of panic, a panic driven by ADHD. I keep my eyes on the clock so that I'm not embarrassed by lateness. The fear of being judged keeps me on my toes, but what a price I pay for that.

As I said, I never lose my keys. If I do lose something, though, I can recall where I misplaced it. I've learned to visualize where I last had the object in my hands.

I remember the name of the clerk who filled my script yesterday at CVS, but I don't remember the name of the woman who sat next to me for two hours, making fascinating conversation at a recent party. My word retrieval is worsening with age: "You know, that thing you boil water in? Oh, yes, a teapot. Thanks."

I did well in school until I hit sixth grade and moved to another district, where I could not keep up academically or socially. It got worse from there. With the help of a kind adult who cared about my future, I was provisionally accepted into college. That's when I took off. My secret (I did not know I had ADHD or even know what it was) was to take courses I had an interest in. I learned to sidestep classes I knew I'd struggle with or fail. I'm sure many of you have done that dance. Instead of going into psychology and earning a Ph.D., where I'd have to take statistics (my math skills are nil), I turned to social work. My love of people and wanting to help the less fortunate made me a good candidate for that kind of degree.

Not to say I didn't struggle. There was still a required statistics class that almost did me in. My husband got me through it. I'm not proud to admit how much he had to help me.
[Download This Free Resource: Get Control of Your Life and Schedule]
What Is Your Flavor of ADHD? Mine Is Inattentive

My flavor of ADHD means that I shut down easily. If someone asks me to bring food to an upcoming gathering, I nearly pass out. What does that mean? How much food? What kind of food? I've passed on many invitations, out of fear of not knowing what to bring.

This leads me to clothes, the other reason for declining many social activities. Deciding what to wear (unless I'm home and out of view of anyone besides my family) is excruciating. Many people might laugh at this, but it's true. Packing for a trip takes me a week. It involves making lists, trying on outfits, checking the weather daily to determine what to bring. Then I forget what I packed, only to have to start over.

Planning daily meals when my children were young made me feel like the worst parent in the world. I couldn't figure it out. A meal isn't typically one thing. It usually involves three things: a main dish and two sides. To me, that was like making three meals each night. My failure at meal prep took a toll on my self-esteem. I'd talk to my sister-in-law on the phone. She is also a mother of two, and she could talk me through cooking things. If that isn't a magic trick, I don't know what is.

To make matters worse, my kids were picky eaters and nothing was acceptable to both of them on any given night. Feeding involves nurturing and love, yet I fell short and felt like a terrible mother. I remember one child fussing because I had put butter on her pasta, while the other beamed over her butter-covered plate of penne.

My ADHD Doesn't Define Me

We each have our own ADHD profile. Some of us lose things. Some of us say things out of turn. Some of us are so inattentive that we could sit for hours watching clouds go by. That's what I did as a 10-year-old. The world slipped by while I made cloud pictures in the sky, lying on the cool green grass, enjoying the breeze blowing through my hair.

I won't forget my 6 p.m. meeting tomorrow night. I'll be there early and ready to go. But I won't be able to concentrate because, more than likely, my clothes will make me feel uncomfortable. I may have a headache because the weather is changing. I won't be able to hear what people are saying, because I can't filter out other sounds and will be terribly distracted.

As I've gotten older and wiser, I've learned an important lesson: ADHD doesn't define me. I am a woman, a wife, a mother, a daughter, a sister, and now a grandmother with an ADHD brain. I can choose to focus on my challenges, or I can celebrate my strengths. I raised two wonderful daughters who care more about people's feelings and well-being than what I cooked for them when they were kids.

I make paintings that are shown in galleries. I play five instruments, all self-taught. I write. I am, I think, a good friend. I have a good marriage (yes, that takes work, but most things do). I like to think that I help other people, like you, like me.

And I have ADHD.
[Watch This Free Webinar Replay: The Happiness Project for Women with ADHD]

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I'm an ADHD Expert - and I Still Struggle With ADHD

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I always know where my keys are. I don't generally lose things. I remember to lock the doors at night. I'm almost always early for appointments and meetings. I earned two college degrees. I've written two books on women with attention deficit disorder ( ADHD or ADD), and I am considered an expert in the field.

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Contrary to rampant misperceptions, procrastination is not a time-management problem. Procrastination is an emotion-management problem. Procrastinators use avoidance to cope with negative feelings around a task - and about themselves.

In a way, we can think of procrastination as that petulant 6-year-old, alive and well in all of us, whose catchphrase is, "I don't wanna!" Daily planners, timers, and similar tools, although necessary, are not sufficient to address the underlying emotional issues behind needless stalling and delaying.

Setting intentions that specify where and when we're going to do a task (also known as implementation intentions) is one overlooked but effective strategy to decrease procrastination. Concrete intentions help mitigate frustration and overwhelm around an undesirable task, and they carve out a clearer path forward.

How to Set Intentions for ADHD Brains

To reduce procrastination, build your intentions around conditional statements like, "If/when I am in situation X, then I will do Y." Putting the cue for action into the environment like this (in situation X) is very helpful for getting outside of our habits and even establishing new habits. Research has shown that these implementation intentions are most effective when we consider the following elements:

Time: Too often, we banish undesirable tasks to "some time tomorrow," "over the weekend," or "soon." Vague, poorly defined time frames relieve us of accountability - we feel no pressure to live up to the plan. We can think of these as anemic intentions. They lack strength or motivational force. Instead, specify a time and place when you intend to act - something like "this Saturday morning at 10 a.m." - to tackle the task.
[Download: Stop Procrastinating! 18 ADHD-Friendly Ways to Get Things Done]

Environmental cue: Research shows that specifying a cue for an action (the "X" in the statement above) increases follow-through. Think: "This Saturday morning, when I have finished my coffee (the cue), I will do Y." Another benefit of an environmental cue is that it frees up working memory, a known deficit in attention deficit hyperactivity disorder (ADHD). If the cue is an event that will undoubtedly occur, you don't have to work so hard to remember it.

Action: Avoid broad, abstract actions like, "I am going to finish the project." Instead, state specific actions like, "I will read the next five pages." Concreteness is an important aspect of effective intentions. Vague actions often add confusion and increase feelings of overwhelm around a task. It's also difficult to feel a sense of accomplishment, or to hold ourselves accountable, for vaguely defined actions. In addition, a concrete action, no matter how small, brings the task to the present and adds a sense of urgency to it, making it more likely that you'll act on it today. Even a little bit of progress on a goal is enough to feed motivation and make us feel good. Clearly delineated actions also give you the license to stop - if you don't feel like doing more, you don't have to.

The Hard Truth of Procrastination

Just because we set intentions, complete with specific cues and concrete actions, that doesn't mean that we'll always feel up to the task. The 6-year-old inside all of us fights hard to avoid frustration, so we have to expect to feel this resistance and act whether or not that 6-year-old feels like it. We don't have to "be in the mood" or "to feel like it" to take action. As one person wrote to me: "For a chronic procrastinator, that's a bitter pill to swallow. But I've found that the more I embrace this hard fact of life and put it into practice, the less I allow my anxiety, frustration, and craving for immediate mood fixes to dictate my actions in the moment."

How to Set Intentions: Next Steps
The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, "Stop Procrastinating and Get Things Done" with Timothy A. Pychyl, Ph.D., which was broadcast on November 12, 2014.
View Article Sources
¹Gollwitzer, P. M. (1993). Goal achievement: The role of intentions. In W. Stroebe & M.
Hewstone (Eds.), European Review of Social Psychology, 4, 141-185.https://doi.org/10.1080/14792779343000059
SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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How to Set Intentions to Crush Procrastination

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How can you break the procrastination habit? Try setting intentions by using statements like "If/when I have finished X, then I will do Y." Learn how to craft effective statements, create structure, and mitigate the emotional overwhelm of procrastination.

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You can't hide from your to-do list forever. Use these 11 strategies for de-cluttering, managing paper, overcoming distractions, and getting things done.

A man buried in a mountain of incomplete work when he needs to be getting things done.

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A woman with ADHD uses her phone to help her get things done

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A to do list, one way to get things done with ADHD

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A calendar can help people with ADHD get things done

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A cluttered desk, which can make a person with ADHD feel too overwhelmed to get things done

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A woman sits at her computer and plans how to get things done

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A person with ADHD marks a deadline on a calendar

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A woman with ADHD opens her front door with junk mail in her hands

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A Get-Things-Done Guide for the Overwhelmed and Overloaded

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Getting things done is about more than syncing calendars - it is about proving that ADHD does not rule our lives. Start by letting go of perfectionism. Then use these 33 tips and tools to fight chronic disorganization everyday.

A woman is sorting clothes thinking, "my life is a mess."

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A man struggles to make a decision, making life a mess. Set time limits for decision-making.

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2. Fight the tendency to over-commit. For each new commitment you make, give up an old one. If you agree to join the school fund-raising committee, for instance, give up the neighborhood watch committee. ADHDers tend to spread themselves too thin.3. Keep your to-do lists brief. Using big, bold letters, make a list of no more than [...]

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Tired woman turns off alarm she set to stay on task and on time.

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A planner is used to schedule Medication and Socialization and get your life in order.

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A woman carrying shopping bags shopped smart to avoid clutter.

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Piles of paper create clutter in your mind and your life.

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A person sorts through a pile of magazines and mail to reduce clutter and chaos.

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A woman hags a shirt on a hanger as she sifts through her closet to simplify and reduce the chaos in her life.

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A pile of sticky notes sits on a desk, ready to mark where to pick back up again when you need to step away from a task.

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Lots of papers on a desk can be restricted by placing papers where they need to end up when you get them.

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Man is managing his financial accounts online to reduce clutter and keep track of his finances.

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It doesn't make sense. I've built a successful life and business, yet at times I find it overwhelming to the point of tortuous getting simple things done. The wiring of my ADHD brain allows me to accomplish complex tasks under stressful situations, yet the simple act of sending out an email can inspire procrastination for days, even weeks. Some emails just never get sent.

Over the years, I've come to accept that logic is not a factor here. It is what it is. And If I want to create a better life for myself with less stress, I had better figure out a way to get things done. What started as a personal quest has evolved into a process that I now share with my clients who are struggling to improve productivity and stave off procrastination.

The process is called MW5. It's simple and effective because it's not about the process; it's about you - what naturally works best for you. Better than anyone else, you know what helps you to work productively, and what does not.

For example, many experts say that focus only happens in a quiet room. This may be true for some, but many of my clients with ADHD say they are driven crazy in a silent environment; they produce great work at Starbucks. MW5 is about figuring out how you work best - and it starts with the 5 Ws.

What: Define Your First Step

Relieve that "overwhelming" feeling that usually leads to procrastination by defining the first tangible behavioral step you can take.
[Click to Download for Free: 10 Rules for ADHD-Proof Productivity]
For example, if your goal is to reorganize your office, a behavioral step would be to clear your bookshelf of any unneeded reports. If your goal was to create a new website, your behavioral step could be to spend an hour researching competitive sites. Cleary, these single behavioral steps are not as overwhelming as the larger task.

Why: Tie the Task to a Larger Purpose

Connect your to-do list to a greater, more motivating purpose. The more motivated you are, the more likely you are to start and complete the task successfully.

An excellent example of this is Glenda, a psychiatrist at a hospital in the Midwest. She's a caring doctor who receives glowing reviews from her patients, but she was struggling to get her reports done on time. I asked her why it was important to get the reports done. She said: "It's my job and it's important that other members of the medical team access the information."

This was true, but not terribly motivating, so I asked her what happened when she didn't get the reports done. She told me that she worked late trying to catch up three to four nights a week. I asked her if these late nights caused any issues with her family. She gave me a look that clearly confirmed what I thought: Not being home with her family was the primary source of her anxiety.
[Download This! 19 Ways to Meet Deadlines and Get Things Done]
I asked her to close her eyes and describe a life where all her reports were completed before the end of each day. She described arriving home before dinner and enjoying her evening with her husband and kids, free of anxiety. It was clear: the greater purpose for Glenda was experiencing life without anxiety and having more quality time with her family. Realizing this, Glenda was now much more motivated to get the job done.

Who: Delegate or Share Responsibility

Perhaps the world's most famous and successful entrepreneur with ADHD, Sir Richard Branson controls more than 400 companies today. Long before he founded the Virgin Group, he says he learned that delegation was his most important strategy for success. I agree.

Just because you can do it (or feel that you should be able to do it) doesn't mean that you are the best person for the job. Ask yourself:

Can this be delegated to someone with better expertise? Would my time be better spent working on something better aligned with my skills? Your goal is to spend your time on things that give you, your family, and your company the greatest value.

Can I outsource? The ability to outsource many tasks has never been easier. Talented freelancers from around the world are available to help on platforms like Upwork.

Who can help me with this? At times, a five-minute conversation with the right person can save hours of frustration.

Assuming that it doesn't make sense to delegate this task, we move on to the remaining Ws below.

Where: Work in a Productive Setting

Environment impacts your ability to get things done. For example, Glenda struggled to finish her daily reports in her office, which was in a busy section of the hospital that invited many unexpected visits and distractions from other doctors and nurses. A closed-door policy wasn't practical, so Glenda found a conference room down the hall from her office where she was able to hide away and get her reports done on a laptop.

Some people need silence to work. Others work best at a busy coffee shop. And some find the library a relaxing place to get things done with a set of headphones. In short, everyone is different, and you may need to get creative when exploring places to work.

Benjamin, another client, came to see me for help in studying for his BAR exams. Buckling down to study was very challenging for him as there was a lot of material and it was extremely dry. We experimented with different locations. We tried his house, the school library, his backyard, and a park. Nothing worked! During one session, he told me about a recent trip to Niagara Falls with his family. While sitting in the back seat of the car, he told me, he could study. So I suggested a novel idea: After the morning rush, board a subway that is not busy and try to study as the train moves. Despite his initial doubts, he gave it a try. Guess what, it worked. A few weeks later, Benjamin passed the BAR exam!

When: Book the Ideal Time

Poor time management is a common productivity hurdle. This could mean the task was attempted at the wrong time, or that it wasn't explicitly scheduled.

In my office, the conversation with clients usually goes something like this:

Me: "When are you going to do this task?"

Client: "I'll do it later this week."

Me: "What day this week?"

Client: "On Thursday."

Me: "What time on Thursday?"

Some of my clients get frustrated , but most will pick up their calendar or their phone and say, "OK, I am free at 3 o'clock." At that point, I have them create an appointment in their calendar because the success rate is three or four times higher for tasks that are scheduled.

It is also important to discover what times you are most effective at certain types of tasks. This goes beyond "I'm a morning person" For example, when are you most effective doing creative work vs. administrative tasks? Record these and schedule your time accordingly, where possible.

Key Factors for Success and Failure

People often ask me what contributes to success or failure with this system. And that brings us to the "M" in MW5: Mindfulness.
The more mindful you are, the more successful you will be in overcoming all of your ADHD challenges.
By mindfulness, I mean slowing down (even just a bit) and noticing what's going on and what you're doing in the moment. The point is not to stop getting distracted. The point is to notice when you get distracted, and to be mindful of the time passing - one minute, one hour, or possibly the rest of the day. This requires you to notice when you're not doing what you set out to do before it's too late, and then make a conscious decision to refocus your attention on your primary purpose.

Mindfulness is essential training for all my clients and I typically begin with a 10-day commitment program that looks like this:

Day 1 - 2: Three-minute check in

Day 3 - 6: Breath (10 minutes)

Day 7 - 8: Mindfulness of the body

Day 9 - 10: Breath (15 minutes)

For free access to the meditations, see my tools and resources and choose a standard place and time where you will not be disturbed while listening to the daily recordings.

Another key contributor to failure is cognitive distortion, or incorrect thinking styles that do not serve you. An example of this is "All or Nothing" thinking, which sabotages many clients trying to build a new habit or follow a new system. They are doing great and then, for whatever reason, they miss a day. And that's it, they quit or want to move on to something new. Big mistake!

There will be days when things don't work. I can almost guarantee this (especially at the start, before the system is integrated as a habit). The key to success is accepting failure as temporary and resolving to restart the next day.

Success is measured by the progress you make. Transformation rarely happens overnight; it occurs slowly as you consistently move forward each day toward what is truly important to you.

I wish all of you a year of health, happiness, and progress.

How To Stop Procrastinating: Next Steps

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A Deceptively Simple System for Getting More Done with ADHD

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We all have them - those tasks or projects that tax all of our executive functions and require excessive effort to complete. Here is a system for centering and prioritizing ADHD brains that works with your strengths and encourages mindful attention to what's working.

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"Lost time is never found again." - Benjamin Franklin

No one knows this better than someone with attention deficit hyperactivity disorder (ADHD), who may lose, mismanage, underestimate, squander, and search for time daily. After all, warped time perception is a core facet of ADHD.

That translates into poor time management in the moment, and problems organizing toward the future. It means perpetually wasting precious time, falling into unpredictable hyperfocus, and turning your back on that onerous task - again. For various reasons, ADHD minds struggle to "see" time and "feel" the future. As such, the most useful time-management strategies for ADHD brains make time salient to the mind's eye and pull the future into the present, which is felt the most.

Why Time Management Eludes ADHD Brains

Time Management Requires Attention Management

Effective time management prioritizes future goals over present needs or wants. It charts daily steps that lead the way predictably, reliably toward a desired destination.

As such, solid time management requires attention management - a defining difficulty of ADHD. It also demands dynamic attention regulation, wherein our attention shifts fluidly and frequently based on how it relates to our goals.
[Get This Free Download: Keep Track of Your Time]
On one end of the attention regulation spectrum is difficulty resisting distractions. Phone notifications, random (and ill-timed) down-the-rabbit-hole Internet searches, and other distractions work hard to hijack our attention from the task at hand. To resist immediate bits of stimulation and maintain focus on future goals, we need to practice potent response inhibition - another skill affected by ADHD.

At the other end of the attention regulation spectrum is hyperfocus, wherein intense absorption in a task becomes a type of distraction in itself - one that causes time to fall to the wayside. The antidote to unproductive or unhealthy hyperfocus is constant internal monitoring - " Do I keep my attention on what I'm doing, or do I shift to something else? " But this self-awareness, too, is impaired by ADHD.

Time Blindness and the Time Horizon Problem

Our individual time horizons determine the proximity of a task or event before we act on it. (In other words, how close in time does a deadline need to be for it to hit your mental radar? A week? A day? Twenty minutes ago?) Generally, the closer a task is in time, the easier it is to pay attention to. We won't pay as much attention to a task that is further out in the future.

ADHD time horizons are typically shorter than those for neurotypical people. Russell Barkley, Ph.D., noted that for people with ADHD, time is all but split into two parts: the "now" (what's on our radar) and the "not now" (what's beyond our radar).
[Read: Intention Deficit Disorder - Why ADHD Minds Struggle to Meet Goals with Action]
This relationship with time, according to Barkley, causes a "myopia to impending future events." In order words, planning feels impossible for people with ADHD because they don't see the future as clearly. They take action toward a future goal (the not now) only when that distant goal moves into the present (the now). By then, frantic scrambling is often required to get the task done before it's too late, much to the stress of others who see the future sooner.

ADHD and Temporal Discounting

If short time horizons explain why people with ADHD can't "see" the future, temporal discounting explains why they can't "feel" it.

Temporal discounting is why so many of us, ADHD or not, struggle to delay gratification. We delay a restful night's sleep to squeeze in a few more episodes of an exciting show. We delay starting on a project, knowing it will mean stress, cramming, and all-nighters later on. We pass on healthy habits, even if we know those habits will serve us in the future. As shown in the famous marshmallow test, it's hard not to select immediate payoffs over delayed rewards of greater value. That's because we generally "feel" the present more than we feel the future. The pleasures of the moment outweigh the pain of the future.

That feeling is multiplied in ADHD brains. "Now" is a siren song that tempts people with ADHD to maximize the moment, future costs be damned. The pain or pleasure of the present is felt even more strongly than is the pain or pleasure of the future - until the moment of reckoning comes.

Temporal discounting helps to explain why ADHD is so often thought of as a performance disorder. Knowing what to do is the easy part. The hard part is turning intention into action, which requires feeling the future more fully and being motivated by it to sacrifice in the present.

How to "See" Time and "Feel" the Future: Time Management Solutions for ADHD

Time blindness, short time horizons, and greater temporal discounting work together to shine a spotlight on "now" and hide "tomorrow" in the shadows. Organizing toward the future is difficult when it's nowhere to be seen.

Follow these time-management strategies - with intention - to help you manage attention, dislodge from the present, and stretch your time horizon to feel the future.

To Manage ADHD Attention

Reduce Temptations

Every interruption is like a roll of the dice - you never know if you'll be able to get back on track. Sheer willpower is too unreliable to resist these time-wasting distractions; you need rules and systems. If you're tempted to check social media during your workday, for example, keep your phone away from you, or at least on silent mode. Make use of web-blocking tools to take willpower out of the equation.

Make the Right Stuff Stand Out

As you preemptively reduce and eliminate distractions, make sure to elevate the tasks that need your focus.

To See Time More Accurately

Don't Rely on Your Internal Clock

Use analog clocks where you can see time move.

Set reminders on your phone or a simple kitchen timer (sprinkle them liberally throughout your house or job).

Consistently Use a Planning Tool That Works for You

Whether a digital calendar, productivity app, or paper planner, the best scheduling system is the one you'll use consistently. The more you use a system, the better it works. Even partial usage leads to tangible benefits.

Include important information pertinent to each task or event - like addresses, phone numbers, video conferencing passwords - as you add it to your planning tool. Your future self will thank you.

Schedules are not blood oaths. If the stars don't align, you can always move the task later. Also, don't over-commit if you're not sure where to sneak a task into your schedule, as this will only lead to hesitation and anxiety. Remind yourself of your future self to increase motivation to accomplish what you set out to do in a given time frame.

Your schedule is for you, and you alone. Your schedule is supposed to help you accomplish more of what you want to do. Being forced to use a planning tool (even the impression alone) kills motivation to use it. Knowing that the schedule is for you might motivate you to stay consistent.

Schedule To-Dos

To-do lists quickly become graveyards of failed aspirations. Why? Because we struggle to answer this question: Is now the time to work on that? What about this other task instead?

Add tasks to your schedule so they don't languish on your to-do list or even fall off your radar. Making tasks time-specific increases the likelihood that you'll see them through. Plugging tasks into your calendar will also fill your schedule and make time more concrete for you.

To Feel the Future

Engineer Consequences

Temporal discounting elongates the space between action and consequence. That's why waiting for natural consequences - far off in the horizon - doesn't often work for people with ADHD. Rig the system by shortening that space between present and future.

Make consequences immediate to increase motivation to act on tasks and adhere to your plans. Make rules for yourself: I can't watch my favorite TV show tonight until I spend at least 30 minutes paying and filing bills.

Make consequences frequent. One-on-one check-ins with your boss every other day rather than weekly, for example, might help you stay on track and increase productivity. Cater to your boss's self-interest (you will hit their deadlines) to increase buy-in.

Externalize consequences. Aim for salient consequences that you will actually feel. For example, tell your friend that dinner is on you if you're more than 10 minutes late to meet them.

Pause and Picture

Compensate for temporal discounting by pausing to visualize how you will feel in the future if you do (or don't) act now.

Picture consequences as vividly as possible. Ask yourself: "How will I feel during the big work meeting a week from now if I don't give myself sufficient time to prepare? Worried? Ashamed?"

Lay out the pros and cons of action and inaction. "If I wait until the eleventh hour to get this done, I risk losing time with my family or a restful night's sleep."

Think of yourself in two forms: present-you and future-you. How does the latter feel about the former?

"Do I want to do this now?" is the wrong question because the answer is always the same. ("No, I don't want to do this.") Whether it's far away or due ASAP, the task will never be appealing. That's why it's better to consider how future-you will feel based on the decisions of present-you.

Wasting Time and ADHD Time Perception: Next Steps
The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, "Why Is Time So Slippery? Understanding Time Blindness in People with ADHD" [Video Replay & Podcast #424]," with Ari Tuckman, Psy.D., MBA, CST which was broadcast on October 4, 2022.
SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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How ADHD Warps Time Perception: Strategies to Stop Wasting and Start Managing Time

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ADHD impairs time perception. The ADHD brain, locked in the present and oblivious to the future, is prone to hyperfocus, time blindness, and poor time-management skills. Learn how to train your brain to "see" beyond now and "feel" tomorrow to improve time management and productivity.

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When your to-do list becomes just another beast to avoid, it's time to find a system that speaks to your ADHD brain. Physical journals and planners work for many ADDitude readers, 61% of whom said they prefer paper over digital tools. Some creative thinkers prefer bullet journals and two-page spreads with space for notes. Perfectionists gravitate toward undated and customizable calendars. Simple note pads pair well with a need for simplicity, and printable PDFs are budget friendly.

We asked ADDitude readers to share their favorite paper planners, and they delivered, below. Leave your product reviews in the Comments section!

Best Journals & Planners for ADHD Brains

"The Emergent Task Planner by David 'Sri' Seah (and his virtual co-working group) provides the external scaffolding I need to build a successful career despite attention difficulties, including both inattentiveness and hyperfocus that cost me time. I combine this with information from ActivTrak.com to fill in the blanks." - Courtney

"Rocketbook by Everlast. It's got an erasable pen and pages you can wipe clean. It encourages me to scan my notes and organize them digitally. It gives me a fighting chance of keeping them organized. I like its versatility; I can scribble down a quick thought and erase it once I've dealt with it. Or, I can take longer notes and scan them into Evernote to organize and tag." - Zoe

"Wisdom Supply Company's large Zero-Waste Weekly Planner is the best, most ADHD-friendly planner I've ever used. The day is broken into three areas on weekdays, so there's plenty of room to organize without having to read past (and get distracted by) something that's not time-relevant. There's one lined, blank page on every two-page spread, so you can scribble down and prioritize or dismiss repetitive thoughts. And there are smaller grid calendars for each month and year to plan ahead... The bottom of each page can be torn off so you can find your place easily without having to use (and repeatedly lose) a paperclip or placeholder. The planner is recycled, printed with plant-based inks, and 100% recyclable... which eases my constant concern over the environment. Check out the budget-friendly PDF version, too." - An ADDitude Reader

Honorable Mention

"I've tried lovely, expensive journals before and because I'm a perfectionist, I would barely use them. My writing is so chaotic and messy. I felt I was ruining the journal. I've found that the cheapest possible note pad works best for my brain with daily lists and notes. I can make mistakes, chuck out pages, and doodle all over; it doesn't bother my perfectionist brain!" - Emma, Australia

More Great Planners and Journals for ADHD Brains

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As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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15 Best Journals & Planners for 2023: Our Readers' Favorites

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When your to-do list becomes just another beast to avoid, it's time to find a system that speaks to your ADHD brain. Physical journals and planners work for many ADDitude readers, 61% of whom said they prefer paper over digital tools. Some creative thinkers prefer bullet journals and two-page spreads with space for notes.

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What Is the Eisenhower Matrix?

It's human nature. When a fire sparks up, we drop everything to fight it. But in our ADHD lives, there are little fires everywhere. And we get so busy extinguishing flames sometimes that we can spend a whole day - maybe a week - spinning around and around in a mess of fire retardant. We're exhausted but have nothing to show for our time or energy.

If this sounds familiar, let me introduce you to the Eisenhower Matrix, a decision-making tool devised by the 34th President of the United States - a five-star general who accomplished a dizzying amount of important work in his two terms. Use the chart below to help determine which flare-ups could be delegated or ignored, and which ones actually deserve your precious attention.

For more on using the Urgent-Important Matrix in your life, visit additu.de/dr-saline
NOTE: This resource is for personal use only.

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The Eisenhower Matrix for ADHD Decision-Making

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It's human nature. When a fire sparks up, we drop everything to fight it. But in our ADHD lives, there are little fires everywhere. And we get so busy extinguishing flames sometimes that we can spend a whole day - maybe a week - spinning around and around in a mess of fire retardant.

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Are there any differences between being hyperfocused and being in a flow state? Yes! A hyperfocused ADHD brain is completely absorbed in its task - to the point of seemingly ignoring or tuning out everything else. Some people describe hyperfocus as a dream-like state wherein the outside world ceases to exist.

A child in hyperfocus may become too engrossed in a video game to hear his parents call his name. An adult in hyperfocus may be reading a book so intently that they lose track of time and miss an appointment.

Some neurotypical people may occasionally experience a hyperfocus-like state. However, it occurs more often in people with conditions that reflect attention issues, such as attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD).

Hyperfocus can prove helpful when you're able to channel its intense focus into difficult tasks, such as paying bills or completing homework. People with ADHD experience the frustrating and time-wasting side of hyperfocus when they ignore pressing responsibilities because they are too immersed in unproductive activities. Basically, you get too engrossed in enjoyable things (like online shopping) and practically forget about your to-do list priorities (like the taxes due next week.)

Hyperfocus vs. Focus vs. Moderate Focus

Focus is the spotlight of your attention. Here's an example of finding focus. Try making a fist, putting your hand on your forehead and pretending it's a beam of light. Where are you directing this beam? You'll find an immediate answer: "Oh, okay, what I'm paying attention to is this. This is what I'm working on." You may also notice what you are not paying attention to. That's part of observing your focus.

Moderate focus happens when we're doing something but may experience some distraction. You are more aware of your surroundings and can interact briefly.
[Free Download: How to Focus (When Your Brain Says 'No!')]
Hyperfocus is a more extreme version of focus. It is when everything else falls away, and the only thing we're paying attention to and engaged with is the task or activity we're doing.

Flow State vs. Hyperfocus

Being in a flow state is much more common than hyperfocusing. In Flow: The Psychology of Optimal Experience, author Mihaly Csikszentmihalyi, Ph.D., writes that most people will experience flow at one time or another.

Csikszentmihalyi interviewed a composer who described flow like this: "You are in an ecstatic state to such a point that you feel as though you almost don't exist. I have experienced this time and again. My hand seems devoid of myself, and I have nothing to do with what is happening. I just sit there watching it in a state of awe and wonderment. And [the music] just flows out of itself."

When we are in a flow state, we're moving and you're grooving, but we're not so zoomed into a task that we're unaware of our surroundings. Sometimes, I like to put on music and dance in the kitchen when I clean. I'm not hyperfocused. I'm just trying to get into the flow of cleaning. A hyperfocused person would not stop cleaning until it was well beyond what most consider clean.
[Free Expert Resource: Secrets of Your ADHD Brain]
How Much Hyperfocus Is Too Much?

Some people become concerned about exiting a hyperfocused state and never returning. If they try to stop hyperfocusing (after working on something for four hours without eating, drinking, or going to the bathroom), will they be able to get back into what they were doing? One of my clients said she didn't stop because she didn't know if she could re-engage. You get into this mentality: "If I could just do one more thing, that will make this time even more productive." So, you just keep going and going.

When this happens, we're thinking so hard that we are using up fuel in our brains. Those energy reserves are glucose. The glucose centers (fuel) in our brain get depleted and adrenaline (cortisol) kicks in to keep us going. Hyperfocusing for long periods can cause stress reactions. Forgetting to eat, sleep, and hydrate, causes people to become irritable because they are running on fumes.

For hyperfocus to be useful, you need to give yourself a scheduled, screen-free break. Take a walk or have a snack. Read the paper or a magazine. Do a Sudoku or crossword puzzle. When you consider your planned break, do something that is pleasurable in its own way but won't drag you in. For example, I love to walk outside in the winter, but after 15 or 20 minutes, I'm cold, so I'll come home. I like to be outside, but I don't want a frozen nose. Think about how you're setting up your scales of balance and set a time limit for your break.

These pauses give you time to integrate the work that you've just completed and let your brain simmer with leftover ideas. Before pausing, leave notes about where you were and what you were thinking about. That's the important thing. If you're writing, empty your head. Your note doesn't have to be grammatically correct. Then when you come back, you know where to begin and what to do.

How to Transition Out of Hyperfocus

One of the problems with getting out of hyperfocus is that whatever you do after will not be as compelling. After all, now your brainpower is so supercharged, energized, or maybe depleted. It's hard to shift, right? The lure of the dopamine surge is strong.

Transitioning from a hyperfocused, high-dopamine-reward activity to a lower-dopamine one requires a lot of impulse control, emotional regulation, and metacognition. These skills do not come naturally to ADHD brains, especially developing ones, so start by creating and following schedule. Setting time restrictions and using alerts for watching YouTube videos or playing video games can help you (and your kids too) better transition off that hyperfocus activity into whatever comes next.

Articulation helps with the transition because you're naming the activity you're shifting to. Try saying to yourself: "I'm going to stop writing this report, use the bathroom and breathe some fresh air. Maybe get an iced tea. Then I can begin again."

Encouraging self-talk is just as important for adults as it is for kids. The difference is that kids with ADHD usually need some help coming up with the phrases to say to themselves during the transition process: "I've stopped playing my game. I'm now walking into another room because I'm going to eat dinner," or "I'm leaving the game. I'm going to play cards with my mother," or "I'm leaving the game. We're going for a run." And by using language this way, you're not just engaging some attention on that activity and assigning some value to it but also nurturing metacognition-self-awareness.

Hyperfocus Transition Tips for Kids

How can you help manage your child's hyperfocus? First, set firm time limits for their high dopamine, hyperfocus activities (usually screen time).

Second, offer them an appealing alternative to this activity and a reward for ending it. For example, "If you get off your video game after the allotted time, we will play cards right away or you can pick the family movie for tonight."

Third, help your child transition to lower dopamine activities by identifying the ones that really interest them and posting that list in the kitchen. Something that is fun and not a chore. Maybe it's listening to music, helping with cooking, or riding a stationary bike. It's hard for a child to transition from a video game and go straight to doing homework or chores. They need an in-between.

Harnessing Adult Hyperfocus

How can adults harness their hyperfocus and use it for their own benefit? Begin by listing all your daily tasks, prioritizing them into a smaller list with just three items and approach them one by one. Break down tasks into smaller chunks so that you can work on something, feel a sense of accomplishment, and then work on something else.

Set a timer to hold yourself accountable during periods of hyperfocus. You could also ask a friend, colleague, or family member to call or email you at a specific time. This can help break up intense periods of hyperfocus. On the flip side, when someone with ADHD is deeply engaged in doing something, a person may come in and innocently interrupt the work session without understanding the consequences to you. You might get irritable or be unable to return to what you were doing. It's important to talk to our loved ones and colleagues about ADHD hyperfocus - when you do it and why it matters. If your hyperfocus is humming away on a work-related or school-related task, they need to respect the process and come back during a break time. You want to maximize your productivity and minimize your distractions.

Ultimately, the best way to cope with hyperfocus is not to fight it or forbid certain activities but to harness it and set limits. It can be a superpower if you learn how to manage it effectively.

Hyperfocus vs. Flow State: Next Steps

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View Article Sources
¹Csikszentmihalyi,M. (1990). Flow: The Psychology of Optimal Experience. HarperCollins.

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Flow State vs. Hyperfocus: On Channeling Your Unsteady ADHD Attention

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"When you are in a flow state, you're moving and you're grooving, but you're not so zoomed into a task that you're unaware of where you are. Sometimes, I like to put music on and dance in the kitchen when I clean. I'm not hyperfocused. I'm just trying to get into the flow of cleaning."

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Habits are the building blocks of our lives. How we behave, think, and move through the world all come down to our habits.

But not all habits are good habits. And changing or developing a new habit, as we all know, can be difficult to do.

Understanding how habits work, while important, is rarely enough to unlock real change. Learn how to disrupt and redefine the most difficult patterns of behavior.

How to Change Habits: The Path to Making Real Breakthroughs

1. Understand the components of a habit

All habits, good or bad, old or new, consist of these components:

Cue, sometimes called the "trigger"

Routine, or the behaviors carried out after the cue

Reward, or what signals that the habit cycle is complete

[Download This Free Resource: Get Control of Your Life and Schedule]
To change any habit, simply target any of these three components. For example, if you want to go to bed at an earlier time, you might

Change the cue: Set an alarm indicating "wind-down" time or take three deep breaths to signal the bedtime transition. Even deciding to feel differently about sleep (e.g. "An early bedtime is a healthy, smart thing to pursue") counts as a cue change.

Change the routine: Think about what drives your current bedtime behaviors. If you're going to bed late because of your daily responsibilities, can you make time for them earlier? Other ideas: Journal instead of browsing through your phone until you're sleepy; set a timer to complete your bedtime routine; prep your room and yourself for sleep (e.g., close the shades, place sleep mask and ear plugs on your nightstand).

Change the reward: A restful night of sleep is a reward in itself. When we sleep well, we can find better mood, clarity and focus in the morning.

[Read This Next: These 6 Healthy Habits Can Improve Memory & Focus]
2. Why are old habits hard to break?

Sometimes, a change of habit comes painlessly, delivering fast results in a short amount of time.

Unfortunately, many habits feel impossible to change. After all, simple does not mean easy. Old habits are hard to break because they

are familiar (they've been executed so many times);

require less time and effort (we're really good at them);

feel "safe" (they're tried and trusted);

are tied up with beliefs about who we are

That's why knowing how habits work, or even having the desire to form new habits, isn't always enough to create change.

3. How to make a new, desired habit stick

Use these tried-and-true techniques to become a master of your habits:

Set your vision. Aiming for drastic change is a common mistake. Start small with your habit changes by setting a goal or plan that is doable, limited, and singular.

Apply effort daily, consistently, and purposefully. No matter how tiny the goal, you'll strive to achieve it with your whole heart. Pursue the habit as if it is the only thing that matters in your life. Yes, it's important to elevate the new habit to that level.

Believe in yourself. You can't set your vision or truly apply effort if you don't believe in your ability to change. Anyone can instill new patterns in their life for good. Believing in yourself also comes down to habit - practice being kind and patient with yourself. It will help you commit and show up for yourself confidently and reliably.

Fight, fight, fight. Old habits don't want to die. As you work on changing your habits, old ones will rage and roar. When we slack off with our new habits, the old ones are ready to pounce. To change a habit, you'll need to consciously fight the part of you that is connected with old patterns. Adopt the right mindset for change by repeating an affirming statement like, "I release the old habit because I prefer the new habit. And this is the new me."

Changing a habit, especially one that is deeply ingrained, feels difficult because you're changing your identity to fit the new behavior. As daunting as the task might be, remember that life is your creation. When you believe that you are the boss of your life, your mind and body will align to support your desires.

How to Change Habits: Next Steps
The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled "Revenge Bedtime Procrastination: How Women with ADHD Can Break the Cycle of Delayed Sleep and Stress" [Video Replay & Podcast 382] with Christine Li, Ph.D., and Tracy Otsuka, JD, LLM, AACC, which was broadcast live on December 8, 2021.
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How to Change Habits: 4 Ways to Make New Behaviors Stick

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Old habits are hard to break, in part, because they are tied to our identity and because change is inherently difficult. To break out of old patterns, you must first understand how habits work and believe in your capacity for personal revolution.

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Willpower alone cannot increase productivity in the ADHD brain. Also not helpful: the standard tips, tricks, and strategies designed for a neurotypical person. If you're searching for effective, ADHD-friendly ways to get things done, look no further than the ADDitude community - and other readers like you who have found winning strategies by trial and error.

Recently, we asked ADDitude readers to share their experience with buzz-worthy productivity tools, including brown noise, binaural beats, and bionic reading. Have you tried any of the methods below? Let us know if they worked for you (or didn't) in the Comments below.

Bionic Reading and Binaural Beats

"I had a huge contract to read and sign, which is a nightmare with inattentive ADHD and dyslexia. I knew I could read it more easily online with bionic reading, but wanted a saved copy, too. It took a while to print the many sub-documents into bionic text PDFs, but then it was so easy to read it all! Wow, what a difference in my stress level. I felt I understood the content, rather than fighting with it." - An ADDitude Reader
[Free Guide: 19 Symptoms of Adult Dyslexia]
"I only recently started listening to binaural beats playlists while focusing on work projects that require deep concentration. I find it helps keep me in 'the zone.' I prefer the faster tempos, as they seem to create the sense of urgency that I apparently depend on to get things done." - Kelly, UK

Brown Noise vs. White Noise

"White noise was making my brain itch in an uncomfortable way. I was a bit hesitant to try out brown noise, but it has been a great experience for me. I'm able to stay on one task, like clean a room, even if I had to leave the room. I'm able to stay on my mission and don't get sidetracked as easily." - An ADDitude Reader

"I listen to a loop of brown noise on my noise-canceling headphones when I have to block out the world and focus on a single task. I have found that it can really help as long as it isn't a task that requires me to talk myself through the problem." - Aimee, Florida

" The only [tool] that has ever worked for me is white noise. Something like a fan is even better. The more recent stuff makes my brain feel awful... With the trendiness of fidget toys, I found some really great ones that help when I'm out and about, but brown noise and weird beats and sounds? Not so much." - Elly, Canada
[Listen: 13 Productivity Playlists to Center and Focus ADHD Brains]
"I discovered brown noise in college, which was great for masking the sound of my roommates and helped me relax. Not all brown noise is the same, though. I really only like the one from SimplyNoise.com." - Jecca, Utah

"I saw an ad related to brown noise and it was fascinating. It really did provide a bit of an 'off-switch' when I listened to it. I'm going to try it when attempting to block out other distractions or when I'm feeling anxious." - An ADDitude Reader

Productivity Apps to Try

"What's worked for me is following Tiago Forte's methodology for building a 'second brain.' It enables me to store my thoughts, notes, medical information, and other things I need to access at a moment's notice in a centralized, searchable note-taking app without getting overwhelmed by too much information. I use Craft, though others use Evernote, Notion, Obsidian, etc. It's been invaluable to my distractible, forgetful ADHD brain." - Russ, Mississippi

"I use an app called Unpluq that, in short, warns you when you are screen sucking on your phone. You can continue, but only after passing a barrier that delays you for a few seconds, which is just enough time to consider if it's worth your time. If not, it's easier to abort because you are already out of your flow." - Ilse, Netherlands

"[email protected] has surprised me. It reduces the tug of other tasks and increases your desire to get the task done in a set time. Surprising for something that sounds like a broken chainsaw." - Andrea, Australia

"Rain Rain is my go-to app for sleep noise. You can mix multiple noises and many are free. I like mixing 'leaves in the wind,' 'brown noise,' and 'crackling fire.' I also watch ASMR and restoration videos on YouTube to help me wind down before bed. I know screens aren't great before bed, but it works for me and helps avoid the inevitable anxiety spiral if my mind is left to its own devices." - Katelyn, Ontario

ADHD Productivity Hacks: Next Steps

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Brown Noise? White Noise? Binaural Beats? What Helps ADHD Brains Focus

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Are you a bionic reader? A binaural beats listener? Taking sides in the brown noise vs. white noise debate? Perhaps you're still seeking that magic productivity tool to hack your ADHD brain. Here, ADDitude readers share their experience with emerging focus tools.

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Our loved ones with ADHD are vibrant, creative, and generous. They push us outside our comfort zones, and remind us to laugh. Sometimes, their ADHD symptoms also make them harder to love. Here, real-life couples share their biggest ADD-related relationship challenges and frustrations.

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The ADHD Strain: How Relationships Collapse Under the Weight of ADD

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Our loved ones with ADHD are vibrant, creative, and generous. They push us outside our comfort zones, and remind us to laugh. Sometimes, their ADHD symptoms also make them harder to love. Here, real-life couples share their biggest ADD-related relationship challenges and frustrations.

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Individuals with ADHD may be more likely to experience emotional abuse, unhealthy relationships, and gaslighting, according to a recent ADDitude webinar titled "How to Recognize (and End) Toxic Relationships with ADHD." During the live event lead by Stephanie Sarkis, Ph.D., we received a staggering number of questions about responding to gaslighting and recognizing the signs of a toxic relationship. Here are some of those questions answered by ADDitude editors - with links to relevant resources.
Q1: "What if I'm only attracted to gaslighters? When a nice guy comes along, I tend to get bored."
Gaslighters will create an environment full of emotional ups and downs. They're great at putting their partners on a pedestal; they're also experts at knocking that pedestal to the ground. While the ADHD brain might feel stimulated by the dopamine hits of tumultuous relationships, rest assured a healthy relationship can be dynamic and rewarding. Start by recognizing the signs of a toxic relationship and treating your ADHD through therapy, medication, and/or coaching, which should help diminish your craving for unhealthy sources of dopamine.

Next Steps:
Q2: "Can people with ADHD also be gaslighters?"
Certain manifestations of ADHD can mimic gaslighting behavior; the difference is willful intent. While gaslighters seek to manipulate others, people with ADHD struggle with symptoms outside of their control. Anyone can be a gaslighter, but this behavior requires purposeful control and abuse by another person. Some individuals with ADHD struggle with telling the truth, however they report that their lies rise from shame, social anxiety, and embarrassment.

Next Steps:

Q3: "Recognizing love bombing when it's happening is hard to do, especially when dating someone with ADHD. How do you know when it's intentional and malicious?"

Take the time to learn about the many signs and symptoms of ADHD. People with this disorder feel emotions intensely and might hyperfocus on their partner, especially at the outset of a new, exciting relationship. To understand intentions, try communicating your concerns and setting boundaries. If you find yourself being blamed, dismissed, and devalued, it's time to consider cutting off contact.
Q4: "I'm like a magnet for gaslighting and abuse in the workplace. What can I do to break this cycle in a professional setting?"
Whether a boss or a coworker, toxic employees should be avoided as much as possible during your workday. Look up your employer's HR harassment policy, if available, or read the EEOC's documentation on harassment. Stephanie Sarkis, Ph.D., recommends getting a labor attorney, especially if your workplace does not have a human resources department. Make a point to document toxic workplace interactions on your personal device, and always report abusive behavior.

Next Steps:
Q5: "How do I heal after leaving an emotionally abusive relationship?"
Toxic relationships can lead to trauma, anxiety, and emotional withdrawal. Step one: Get help. Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and other forms of therapy are highly recommended to help you heal using positive coping mechanisms. Use ADDitude's guidelines for finding a good therapist or doctor.

Next Steps:
Q6: "What is the difference between a gaslighter and a narcissist?"
According to WebMD, symptoms of narcissistic personality disorder (NPD) include an inflated ego, need for attention, sense of righteousness, and mood swings. Individuals with NPD are absorbed with meeting self-fulfilling needs. On the other hand, gaslighters are slow and strategic. They will lie, question their partner's behavior, deny any wrongdoing, and attempt to isolate you. Gaslighting is seen in individuals with NPD but is also present without a diagnosable disorder.
The content for this article was based on questions submitted by live attendees during the ADDitude ADHD Experts webinar titled, "Gaslighting, Love Bombing & Beyond: How to Recognize (and End) Toxic Relationships with ADHD" [Video Replay & Podcast #410] with Stephanie Sarkis, Ph.D., which was broadcast live on July 7, 2022.
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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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How to Respond to Gaslighting - In Your Relationship and In Yourself

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Individuals with ADHD may be more likely to experience emotional abuse, unhealthy relationships, and gaslighting, according to a recent ADDitude webinar titled "How to Recognize (and End) Toxic Relationships with ADHD." During the live event lead by Stephanie Sarkis, Ph.D., we received a staggering number of questions about responding to gaslighting and recognizing the signs of a toxic relationship.

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What's the secret to making a relationship work with ADHD? Many of our readers know far too well that things can get complicated when one or both partners in a relationship have ADHD. But happily ever after is hardly out of the question.

According to ADDitude readers, some in decades-long relationships, the key to a strong and healthy partnership is in communication, self-awareness, acceptance, and handling all things with grace. Read on for more relationship tips and advice, and tell us how you make your own ADHD relationship work in the comments below.

How to Make a Relationship Work, According to ADHD Couples

"My husband and I have been married for 26 years and dated for four years before that. It has been important for me to realize how I could have handled things differently in the past, whether for my own recognition or the relationship's. Being willing to accept ownership of our mistakes doesn't mean that we are less important in a relationship." - Anonymous

"My partner and I have ADHD, but our executive dysfunction issues are slightly different. I can't tackle large projects, but I'm efficient at getting smaller tasks done. My partner, on the other hand, has no problem with big tasks, but gets stuck on execution. We try to meet in the middle, and get to feel accomplished for tackling our challenges together." - Anonymous
[Get Free Download: Manage ADHD's Impact On Your Relationship]
"We look forward to snuggling up at the end of the day and sharing through 'story time.' Touch is our main 'love language,' so snuggles and handholding are automatic connection points for us. If one of us pulls away because of worry or anger, we've found that a back rub can help the other relax and calm down. Even when we're annoyed with each other, touch is a powerful, healing force for us." - Anonymous

"My partner and I were together for over seven years before we realized that we both have ADHD. Things make so much more sense now. ADHD explains our intense chemistry and 100mph lifestyle. Unfortunately it also helps to explain some of the most challenging parts of our relationship - the intense up and down cycles, the constant chaos and overwhelm. Thankfully, now we have an explanation, so we approach everything with tons of grace and humor. We trust that each other is doing their best." - K

"More than 40 years in, we realize that the key is in accepting the other person, even if you don't understand them. It's in recognizing and appreciating each other's strengths, and being ready to step up when there's a weakness to face. It's also in knowing that you can't change one another - and that trying to will only frustrate and alienate you both. Remember too, it's our differences that make us interesting and keep us growing. How boring life would be if we all saw the world in just one way! - Beth

"My wife and I both have ADHD, and we've been married for more than 17 years. We treat each other as equals. We talk about everything, we have each other's backs, and we make sure to make intimacy a priority. Our traits also seem to complement each other. My wife is extremely empathetic, and I am a little more selfish. She helps me have a little more empathy toward others, and I help her pull away when she starts giving too much to others. We have a great dynamic, but that doesn't mean we are trouble free. (We argue as passionately as we love each other.)" - Dave
[Read: Does Your Lover Have ADHD? Read This.]
"I was diagnosed with ADHD at 45 years old. Though I was well aware of my challenges (and struggled with a lot of shame), I began to learn more about how ADHD impacts me and those around me after the diagnosis. I am fortunate that my partner, who does not have ADHD, is patient and supportive. We share openly and regularly about what's working well, what's not, and how we can improve. It is much easier to be supportive in a relationship when your partner is doing their own work. I let him know often how grateful I am for him and for his efforts to make my life easier." - Alyce

"Communication is a huge part of any successful relationship, and even more so when ADHD is involved. My brain doesn't work the same way as my partner's, so I'm bad at guessing, and need things to be verbalized. I find some 'simple' tasks hard to do, so I need to speak up if I need different accommodations to do things. Understand yourself and your 'quirks' as much as you can, communicate openly and honestly, and apologize when you are in the wrong - even if it's because of your ADHD. Working on this together has given us a strong and lasting relationship in which our different strengths benefit both of us. It's a win-win!" - Anonymous

"My husband and I have been together for 13 years, and we both have ADHD. We took our relationship low and slow when we first started dating, even though we were infatuated with each other. When we finally got married (five years after we started dating), we really knew each other well and were very sure of ourselves and of our relationship. We do a lot of our hobbies together, and we share a number of special interests, which allows us to constantly share what we are most passionate about." - E. Prybylski

How To Make a Relationship Work with ADHD: Next Steps

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"We Each Trust That the Other Is Doing Their Best"

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How to make a relationship work with ADHD? By practicing patience, forgiveness, understanding, and communication - and by knowing when to step in or step back. Here, learn about the secrets to a strong ADHD relationship, straight from our readers.

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What Is Gaslighting?

Gaslighting is a form of psychological or emotional abuse - a series of manipulative techniques designed to gain control of another person. By blatantly and repeatedly lying or challenging reality, the gaslighters keep their victims off-kilter and make them question themselves. Many times, a person's diagnosis of ADHD is used against him or her by the gaslighter. I have been a therapist for 20 years, and lately I have seen more and more clients with ADHD reporting being gaslighted in their relationships and at their jobs.

One of the best defenses against gaslighting is to educate yourself about this kind of emotional abuse. Adults with ADHD may be more vulnerable to gaslighting due to issues with self-esteem, difficulty with past relationships, and feelings of guilt and shame. Know that there is hope, and you can rebuild your life after living with gaslighting for months or even years.

Gaslighting Behaviors

Gaslighters sometimes hide their partners' belongings and blame their partners for being "irresponsible," "lazy," or "so ADHD" when they can't find the items. A gaslighter may also tell their partner that they don't need to take medication for ADHD because "I know what you need better than some doctor does."

Gaslighting behaviors include:

Telling you that you didn't see or hear something

Cheating often, but obsessively accusing you of cheating

Saying that other people think you are crazy

Pitting you against people (this is known as "triangulating")

Idealizing you, then devaluing you, and finally discarding the relationship

[Take This Self-Test: Emotional Hyperarousal in Adults]
Why and How Gaslighters Target People with ADHD

Gaslighters sense vulnerabilities in a person. They specifically target people who are grieving a loss or who feel inadequate or isolated. If you have ADHD, you probably grew up with the feeling that you were "less than." You may have had difficulties maintaining friendships or relationships. You may have been dismissed by others who said you were "difficult."

When you meet a gaslighter for the first time, he or she will do something called " love bombing." They will tell you everything you have wanted to hear from someone, especially after a lifetime of rejection. The purpose of the behavior is to hook you. Once you are committed to the relationship, the gaslighter begins abusive behavior.

Early on, the gaslighter asks you about your fears and inadequacies. It feels good to have someone listening to you and caring about what you have to say. However, the gaslighter is gathering data to be used as ammunition against you later. You may eventually hear, "No wonder your sister doesn't talk to you anymore. She knows you're crazy, too."
[Download This: 6 Ways ADHD Sabotages Relationships]
If you leave the relationship, the gaslighter will " hoover " - drawing you back. They will send messages through friends and family that they miss you. They will promise you the world, but will never apologize. They don't think they did anything wrong. The threat of losing their ability to manipulate you motivates a gaslighter to get you back in their clutches. But once you return, everything promised to you disappears, and your relationship becomes more abusive than before.

How to Escape Gaslighting In a Relationship

For most people, leaving a gaslighting relationship means " no contact - at all." Block phone numbers and email addresses. Tell friends and family that you will not listen to any messages sent through them. You should also meet with a licensed mental health professional; having ADHD makes you vulnerable to anxiety and mood disorders. Set up and follow through with an ADHD treatment plan, and re-establish connections with the healthy people in your life. If you have children with a gaslighter, meet with an attorney to establish a detailed parenting plan.

Gaslighting at the Workplace

Sometimes bosses and coworkers take advantage of the fact that someone has ADHD. They will accuse you of being forgetful or not caring about your work.

Ask your boss or coworker to send you an email with instructions or details of an assignment. If you complete the assignment and are told later that you didn't do what was asked, refer to that email, instead of blaming yourself. Also, get to know the Equal Employment Opportunity Commission's definition of workplace harassment, found at eeoc.gov/laws/types/harassment.cfm.

Gaslighting and ADHD: Next Steps
Stephanie Sarkis, Ph.D., the author of Gaslighting: Recognize Manipulative and Emotionally Abusive People (#CommissionsEarned), is a licensed and board-certified mental health counselor, and a Florida Supreme Court-certified family and civil mediator based in Tampa. She is a best-selling author, the host of the Talking Brains podcast, and is a contributor to Psychology Today, Forbes, and HuffPost. You can reach Stephanie at stephaniesarkis.com. [Subscribe to the ADDitude Newsletter for Women with ADHD]
#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication

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The Gaslighting Risk: Why Adults with ADHD Are Particularly Vulnerable to Manipulation

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Gaslighting is a form of psychological or emotional abuse - a series of manipulative techniques designed to gain control of another person. By blatantly and repeatedly lying or challenging reality, the gaslighters keep their victims off-kilter and make them question themselves. Many times, a person's diagnosis of ADHD is used against him or her by the gaslighter.

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Like many girls with ADHD, you grew up thinking you were either smart or dumb, happy or sad, nice or mean. Perhaps one day you felt strong and confident, but the next you became overwhelmed, even paralyzed by your ADHD symptoms and negative thoughts again. Perhaps you still do.

Changing perspectives and fluctuating moods are not unique to the ADHD brain. We all have periods of irrational thinking and moments of clarity. Sometimes we yell at a person we love and we feel bad, but we can be kind to a stranger. We are different at different times, even in the course of a single day.

This is normal, but to the ADHD brain these human inconsistencies are upsetting and confusing. Why? The ADHD brain tends to think in terms of drastic polarities - motivated vs. lazy, creative vs. boring, organized vs. a mess. Your brain feels it must pick sides. But because we are forever changing and vacillating, this psychological tendency keeps us flip-flopping from day to day, relegated to reactivity instead of intentional thought and action.

The good news is it's possible to be more intentional in our thoughts and actions, and to allow for more gray space in our view of the world. We can learn to rewrite the stories we tell ourselves, but not without first understanding who we are - and acknowledging that we are not the sum of our ADHD symptoms.

Replacing All-or-Nothing ADHD Thinking with Wholeness

Healing means "restoring to wholeness." In order to heal and regain confidence, we need to be able to hold all of who we are in one image that embraces a diverse set of characteristics. That means no longer over focusing on only our challenges or only our strengths.
[Take This Test: ADHD Symptoms in Women]
When we overemphasize one aspect of ourselves and dismiss the rest, we engage in reductionism. We reduce ourselves to one oversimplified or exaggerated attribute. Moving into a more complete narrative requires that we distance ourselves from reductionism and fill in the whole picture of ourselves.

Step One: Stop Trying to 'Fix' Yourself

As a clinical psychologist, I see many women with ADHD who are extremely self-critical - in part because they've been fed a continuous diet of shame. They're so ashamed of their challenges they believe it's not possible to live well with ADHD unless they "fix" themselves.

They succumb to unhealthy if/then thinking: When I get organized (or improve my time-management skills or become more productive...) then I'll be happy (or take the class I've been putting off or feel good about myself, etc.). They pour so much every day into trying to manage their challenges that they start to believe it's not possible to be happy unless they fix their brain and fix their ADHD symptoms. The thing is, that's pretty backwards.

You are much more than your ADHD. ADHD plays into who you are, certainly, because interacting frequently with your brain-based challenges can't be completely avoided. There will always be the question, "Is it me, or is it my ADHD?" But those two pieces - you and your ADHD - are unique, but intertwined. They combine to form the whole person. Accepting that we can't fully separate our brains and our bodies is a step in the right direction.
[Get This Free Resource for Women and Girls: Is It ADHD?]
Step Two: Adopt a "Yes, and..." Ethos

My "radical" approach to healing considers the whole person in a way that acknowledges an individual's strengths, plus their need to manage their symptoms. I teach my patients with ADHD how to say to themselves, "I am able to pursue some of my dreams and passions and improve my self-care," or "I'm able to do these things even though I still struggle." This break from unhealthy black-or-white thinking allows my patients a way to move forward and to formulate a whole picture of themselves. I call this the "yes, and" space.

I love this quote by Geneen Roth, a writer and teacher, known for her insights around eating disorders: "I'd tried versions of not fixing myself before, but always with the secret hope that not fixing myself would fix me."

The quote sums up what I think is the hardest part about living with a chronic condition - trying to find the fix. And then recognizing - at least in our minds - that we need to surrender because there is no fix.

It's okay to struggle with this idea and to have periods where you wish you your ADHD would just go away. But true healing emerges only through the process of reminding yourself that people don't need fixing. Once you accept that it's OK and normal to experience strengths and weaknesses simultaneously, you begin to approach managing your challenges with some self-compassion - and that is the key to doing the hard work of real change

Step Three: Understand Who You Are

You know your ADHD challenges very well. In fact, you have probably over focused on them throughout your life. Drawing an authentic picture of the whole you means giving equal weight to your strengths or the dreams that reflect your values. But many people are blind to these areas or find them difficult to access.

Below are several prompts to help you reflect on and assess various aspects of your life with ADHD. Read through these questions and jot down what comes to mind:

Assessing Your ADHD Strengths

1. What do you do really well that seems to come naturally to you?

2. What could you teach or contribute to others?

3. What skills or talents have you developed through the years?

Assessing Your ADHD Challenges

1. What are your most challenging ADHD symptoms?

2.  Describe the issues you confront in daily life or in moving forward because of these challenges.

3.  How does ADHD show up in your life, even with treatment?

Assessing Your Personal Attributes

1.  What makes you you?

2.  How do you respond to the ups and downs of life when you are at your best?

3.  What endures within you that makes the difference for you?

4.  What do you most appreciate about yourself?

5.  How would you describe yourself if you were a character in a book?

6.  What special qualities have you always had that you still have-perseverance, a sense of humor, compassion, creativity?

Step Four: Follow Your Own True North

We talk about the importance of values a lot, but rarely use them as a guide. For women who are buffeted by the push and pull of the ADHD brain, it is critical to look inward and return to an internal compass to know what we want our lives to be about.

When you feel you're going in circles, pause and remind yourself who you are and what's important to you. Following your internal compass, your values - not the distractions of ADHD - will guide better choices when you feel lost or emotionally overwhelmed.

Once you know what you value, you can write a personal mission statement (see below), just as you would if you were running your own company. After all, you're running your own life.

Step Five: Write Your Personal Mission Statement

Ask yourself the following questions. Use honest answers to compile your personal guide and start living by your values and strengths:

What is most meaningful to you?

What do you stand for?

What do you want your life to be about?

What are your core values?

What do you want people to know about you?

When you look back on your life, what would you like to say about yourself?

Answers these questions on a cheat sheet designed to help you act on your values if you're too tired or challenged to think through a situation in real time. You might write your values and mission statement on a card and post it near your desk, carry it in your wallet, or write it in your phone to remind you of what you're all about.
Article derived from [Click to Read: Sister. Wife. Mother. Living with ADHD.] A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers (#CommissionsEarned), by Sari Solden, M.S., and Michelle Frank, Psy.D. Reprinted with permission: New Harbinger Publications, Inc. Copyright © 2019 [Sari Solden and Michelle Frank] and from the 2019 ADDitude webinar with Michelle Frank titled "Beyond Shame and Guilt: Transformative Strategies for Women with ADD"
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You Are Not the Sum of Your ADHD Challenges

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The ADHD brain gravitates toward black-or-white, all-or-nothing thinking. The problem is that human beings are complicated and contradictory. As a result, many women with ADHD ping-pong between extreme perceptions of themselves - bad or good, dumb or smart, motivated or lazy.

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Attention deficit/hyperactivity disorder is a confusing, contradictory, inconsistent, and frustrating condition. It is overwhelming to people who live with it every day. The diagnostic criteria that have been used for the last 40 years leave many people wondering whether they have the condition or not. Diagnosticians have long lists of symptoms to sort through and check off. The Diagnostic and Statistical Manual of Mental Disorders has 18 criteria, and other symptom lists cite as many as 100 traits.

Practitioners, including myself, have been trying to establish a simpler, clearer way to understand the impairments of ADHD. We have been looking for the "bright and shining line" that defines the condition, explains the source of impairments, and gives direction as to what to do about it.

My work for the last decade suggests that we have been missing something important about the fundamental nature of the ADHD brain. I went back to the experts on the condition - the hundreds of people and their families I worked with who were diagnosed with it - to confirm my hypothesis. My goal was to look for the feature that everyone with ADHD has, and that neurotypical people don't have.

I found it. It is the ADHD nervous system, a unique and special creation that regulates attention and emotions in different ways than the nervous system in those without the condition.

The ADHD Zone

Almost every one of my patients and their families want to drop the term Attention Deficit Hyperactivity Disorder, because it describes the opposite of what they experience every moment of their lives. It is hard to call something a disorder when it imparts many positives. ADHD is not a damaged or defective nervous system. It is a nervous system that works well using its own set of rules.
[Take This Test: Could You Have ADHD?]
Despite ADHD's association with learning disabilities, most people with an ADHD nervous system have significantly higher-than-average IQs. They also use that higher IQ in different ways than neurotypical people. By the time most people with the condition reach high school, they are able to tackle problems that stump everyone else, and can jump to solutions that no one else saw.

The vast majority of adults with an ADHD nervous system are not overtly hyperactive. They are hyperactive internally.

Those with the condition don't have a shortage of attention. They pay too much attention to everything. Most people with unmedicated ADHD have four or five things going on in their minds at once. The hallmark of the ADHD nervous system is not attention deficit, but inconsistent attention.

Everyone with ADHD knows that they can "get in the zone" at least four or five times a day. When they are in the zone, they have no impairments, and the executive function deficits they may have had before entering the zone disappear. People with ADHD know that they are bright and clever, but they are never sure whether their abilities will show up when they need them. The fact that symptoms and impairments come and go throughout the day is the defining trait of ADHD. It makes the condition mystifying and frustrating.
[Get This Free Download: What Every Thorough ADHD Diagnosis Includes]
People with ADHD primarily get in the zone by being interested in, or intrigued by, what they are doing. I call it an interest-based nervous system. Judgmental friends and family see this as being unreliable or self-serving. When friends say, "You can do the things you like," they are describing the essence of the ADHD nervous system.

ADHD individuals also get in the zone when they are challenged or thrown into a competitive environment. Sometimes a new or novel task attracts their attention. Novelty is short-lived, though, and everything gets old after a while.

Most people with an ADHD nervous system can engage in tasks and access their abilities when the task is urgent - a do-or-die deadline, for instance. This is why procrastination is an almost universal impairment in people with ADHD. They want to get their work done, but they can't get started until the task becomes interesting, challenging, or urgent.

How the Rest of the World Functions

The 90 percent of non-ADHD people in the world are referred to as "neurotypical." It is not that they are "normal" or better. Their neurology is accepted and endorsed by the world. For people with a neurotypical nervous system, being interested in the task, or challenged, or finding the task novel or urgent is helpful, but it is not a prerequisite for doing it.

Neurotypical people use three different factors to decide what to do, how to get started on it, and to stick with it until it is completed:

1. the concept of importance (they think they should get it done).

2. the concept of secondary importance - they are motivated by the fact that their parents, teacher, boss, or someone they respect thinks the task is important to tackle and to complete.

3. the concept of rewards for doing a task and consequences/punishments for not doing it.

A person with an ADHD nervous system has never been able to use the idea of importance or rewards to start and do a task. They know what's important, they like rewards, and they don't like punishment. But for them, the things that motivate the rest of the world are merely nags.

The inability to use importance and rewards to get motivated has a lifelong impact on the lives of individuals with ADHD:

How can those with an ADHD diagnosis choose between multiple options if they can't use the concepts of importance and financial rewards to motivate them?

How can they make major decisions if the concepts of importance and rewards are neither helpful in making a decision nor a motivation to do what they choose?

This understanding explains why none of the cognitive and behavioral therapies used to manage ADHD symptoms have a lasting benefit. Researchers view ADHD as stemming from a defective or deficit-based nervous system. I see ADHD stemming from a nervous system that works perfectly well by its own set of rules. Unfortunately, it does not work by any of the rules or techniques taught and encouraged in a neurotypical world. That's why:

People with ADHD do not fit in the standard school system, which is built on repeating what someone else thinks is important and relevant.

People with ADHD do not flourish in the standard job that pays people to work on what someone else (namely, the boss) thinks is important.

People with ADHD are disorganized, because just about every organizational system out there is built on two things - prioritization and time management - that individuals with ADHD do not do well.

People with ADHD have a hard time choosing between alternatives, because everything has the same lack of importance. To them, all of the alternatives look the same.

People with an ADHD nervous system know that, if they get engaged with a task, they can do it. Far from being damaged goods, people with an ADHD nervous system are bright and clever. The main problem is that they were given a neurotypical owner's manual at birth. It works for everyone else, not for them.

Don't Turn Individuals with ADHD into Neurotypicals

The implications of this new understanding are vast. The first thing to do is for coaches, doctors, and professionals to stop trying to turn people with ADHD into neurotypical people. The goal should be to intervene as early as possible, before the individual has been frustrated and demoralized by struggling in a neurotypical world, where the deck is stacked against him. A therapeutic approach that has a chance of working, when nothing else has, should have two pieces:

Level the neurologic playing field with medication, so that the ADHD individual has the attention span, impulse control, and ability to be calm on the inside. For most people, this requires two different medications. Stimulants improve day-to-day performance for a person with ADHD, helping him get things done. They are not effective at calming the internal hyperarousal that many with ADHD have. For those symptoms, the majority of people will benefit by adding one of the alpha agonist medications ( clonidine/ Kapvay or guanfacine/ Intuniv) to the stimulant.

ADHD medication, though, is not enough. A person can take the right medication at the right dose, but nothing will change if he still approaches tasks with neurotypical strategies.

The second piece of ADHD symptom management is to have an individual create his own ADHD owner's manual. The generic owner's manuals that have been written have been disappointing for people with the condition. Like everyone else, those with ADHD grow and mature over time. What interests and challenges someone at seven years old will not interest and challenge him at 27.

Write Your Own Rules

The ADHD owner's manual has to be based on current successes. How do you get in the zone now? Under what circumstances do you succeed and thrive in your current life? Rather than focus on where you fall short, you need to identify how you get into the zone and function at remarkable levels.

I usually suggest that my patients carry around a notepad or a tape recorder for a month to write down or explain how they get in the zone.

Is it because they are intrigued? If so, what, specifically, in the task or situation intrigues them?

Is it because they feel competitive? If so, what in the "opponent" or situation brings up the competitive juices?

At the end of the month, most people have compiled 50 or 60 different techniques that they know work for them. When called on to perform and become engaged, they now understand how their nervous system works and which techniques are helpful.

I have seen these strategies work for many individuals with ADHD, because they stepped back and figured out the triggers they need to pull. This approach does not try to change people with an ADHD nervous system into neurotypical people (as if that were possible), but gives lifelong help because it builds on their strengths.
[Read This Next: 6 Things You Didn't Know About the ADHD Brain] William Dodson, M.D., is a member of ADDitude's ADHD Medical Review Panel.
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Most people are neurologically equipped to determine what's important and get motivated to do it, even when it doesn't interest them. Then there are the rest of us, who have attention deficit - ADHD or ADD - and the brain that goes along with it.

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Amanda, 33, struggles with ADHD. She takes medication and sees a coach to help her with organization and time management skills, but her mood swings are her biggest remaining problem - snapping at others when feeling overwhelmed or impulsively taking on too many responsibilities when she is feeling better. She worries that her boyfriend will leave her because he is tired of her defensiveness when she is forgetful and her unloading her work-related stress on him. Amanda wants to work through these behaviors - for herself and for her relationship - but she needs a new approach to help her.

Progress in Non-Medical Treatment Options for ADHD

One of the heartening advances in treating ADHD is the increasing number of non-medical options available to people looking to improve their lives. Adults who take medication often find that adjunctive approaches, such as cognitive-behavioral therapy ( CBT) and coaching, help them better manage the effects of ADHD on their lives. But unfortunately, even though these treatments are effective for many adults, they don't work for everyone. And they illustrate the paradox of psychosocial treatment for ADHD: Behavior change requires specialized skills and strategies, but, as most of us know, implementing them is tough for adults with ADHD.

Amanda needed other options for her persistent problems. So she turned to an important innovation within the CBT family of treatments: dialectical behavior therapy (DBT). DBT focuses on the social and emotional challenges in one's life. It is not a new therapy, having come on the scene with other CBT-oriented treatments for adult ADHD in the early 2000's. DBT offers advice to improve self-regulation skills that may be helpful for those who do not respond to other approaches. Read on to learn the history of DBT, why it works for ADHD, and how it might help you.
[Free Resource: 11 ADHD Coping Mechanisms]
Wasn't DBT Designed to Treat BPD?

DBT was used to treat other mental conditions before it was adapted to treat adult ADHD. It is the brainchild of Marsha Linehan, Ph.D., ABPP, a professor of psychology at the University of Washington and founder of The Linehan Institute. DBT was designed to withstand bouts of emotional turmoil - including self-harming behaviors, such as cutting - for those diagnosed with borderline personality disorder (BPD). BPD is characterized by unpredictable mood swings and reckless behaviors, chaotic relationships, extreme reactions to stress, and a chronic risk for self-harm and suicide.

Why Is DBT Becoming the Go-To Treatment for ADD?

Linehan's DBT is now the go-to treatment for improving emotional regulation skills, in those diagnosed with anxiety and ADHD. DBT rests on scientifically sound behavioral and cognitive strategies, and incorporates skills like mindfulness and acceptance principles. DBT skills include fostering the "wise mind" (the balance between the logical and emotional minds), self-soothing activities, and acting in ways that are in contrast to the immediate, distressing emotion - for instance, smiling during an upsetting situation.

These and other coping strategies are presented in a series of skill-based modules in weekly group sessions, with each session focused on a particular skill. By-the-book DBT is a group treatment, with each group member also having an individual therapist for additional support to personalize the use of these skills in life situations.

Alexandra Philipsen, M.D., and Bernd Hesslinger, M.D., as well as their colleagues in Germany, saw many similarities in the challenges of BPD and adult ADHD, such as impulsivity, low self-esteem, and difficulties with emotional self-control. They tailored the session topics to make them better fit the needs of adults with ADHD.
[Free Resource: Everything You Need to Know About CBT]
The Key to DBT: Accepting Intense Emotions

So what does DBT offer adults with ADHD who want to improve their lives? DBT is heavily based on CBT with one exception: It emphasizes validation, or accepting uncomfortable emotions before trying to change them. By coming to terms with troubling thoughts and emotions, change appears possible, and patients can work with their therapists to create a plan for recovery. The therapist's role in DBT is to find the balance between acceptance and change.

Self-control is a theme running through group sessions. This involves recognizing behavioral and thinking patterns, and learning strategies for dealing with stress and impulsivity.

Although designed as a group treatment for adult ADHD, DBT is also used as an individual therapy. A benefit of the group format, though, is the chance for members to share experiences, to realize "I'm not the only one dealing with this." There is mutual support while discussing solutions and practicing new skills in the group. DBT may be the right choice for adults with ADHD, like Amanda, looking to improve their lives.

Four Ways to Manage Thoughts and Behaviors

DBT skills training is made up of four modules designed to assist individuals in better managing behaviors, emotions, and thoughts.

1. Mindfulness skills help members focus on the present and attend to what is happening in the here and now in a calm way. This helps people slow down and focus on doing what is needed to care for oneself in the moment.

2. Distress tolerance helps people get through times when emotions are running high. It teaches people to soothe themselves in healthy ways rather than becoming overwhelmed by emotions or hiding from them.

3. Interpersonal effectiveness skills involve helping people understand their needs in relationships and to develop ways of dealing with others to have those wants met in a healthy fashion. This involves respecting the self and others, listening and communicating effectively, repairing relationships, and being able to say no.

4. Emotion regulation skills teach patients to decrease the intensity of their feelings, without acting on them.

[Read This Next: The Truth About Treating ADHD with Cognitive Behavioral Therapy (CBT)]

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DBT: The Emotional Control Therapy You Need Now

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Amanda, 33, struggles with ADHD. She takes medication and sees a coach to help her with organization and time management skills, but her mood swings are her biggest remaining problem - snapping at others when feeling overwhelmed or impulsively taking on too many responsibilities when she is feeling better.

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CBT is a unique therapy that targets the dysfunctional thoughts and feelings that are preventing you from managing time, completing projects, and scheduling your life productively with ADHD.

Man talks to his therapist, participating in cognitive behavioral therapy techniques for ADHD.

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CBT helps with both cognitions and behavior, including organizing your calendar, desk, and life.

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Man procrastinates by throwing a paper airplane in his office. CBT can improve procrastination.

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Man takes pills to treat his ADHD because medication works differently than CBT.

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A depressed man talks to his therapist about which condition they should address with CBT first.

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CBT teaches how to categorize tasks into urgent now and important (urgent later).

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An organized desk illustrates the CBT practice of having everything in front of you needed to complete a task and nothing distracting.

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A woman researches cognitive behavioral therapy techniques for adhd on her laptop.

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"I am a failure."
"I can't even do the simplest things."
"Any normal person would be able to do this."

These are some of the statements I hear from clients diagnosed with ADHD. To help them see themselves the way I see them - and to notice all the ways in which they are successful - I use a therapy technique called cognitive restructuring.

What is Cognitive Restructuring?

Cognitive restructuring is one of the primary techniques used in cognitive behavioral therapy (CBT). The premise of CBT is that our thoughts and beliefs influence our feelings, which in turn influence our behavior. So if we think crappy things about ourselves, we will feel crappy and be less able to do the things necessary to live well with ADHD. Cognitive restructuring is a fancy way of saying, "Change the way you think."

How do you change the way you think? You can try choosing to believe the opposite of your negative thoughts: I am successful. I can do anything I set my mind to. I am normal. Affirmations like these have their place in your positive-thinking repertoire, but there's likely to be a part of you that says, "Yeah, right."

Cognitive Restructuring Tip #1: Seek Out a Different Perspective

One way to change the way you think is to actively seek out a different perspective. What is another way of looking at it? A guy I met at a party said to me, "Everyone has issues. Everyone." Of course, I argued with him (we with ADHD are pretty good at arguing any point). But I couldn't meet his challenge to name one person who is without issues. This is now one of my mantras when I'm feeling down on myself. I feel less alone, less of a victim.
[Read This Next: How Cognitive Behavioral Therapy Works]
You can also use evidence gathering, another staple of CBT. Think about all those times when you were successful, when you didn't fail. The more examples you come up with, the more you will be able to start to believe that it isn't true that you fail at everything. You can believe you are successful some of the time.

Cognitive Restructuring Tip #2: Use Metaphor

Using metaphor in cognitive behavioral therapy is an approach I'm especially fond of - and it is effective for my clients. CBT founder Aaron T. Beck, M.D., championed the use of metaphor early on. He saw it as a powerful way to generate alternative ways of thinking. A metaphor applies a concept we understand to something harder to grasp, in a vivid, catchy way. A good metaphor is paradigm altering; you can't un-see it once you've seen it.

To be therapeutically effective, you want the metaphor to be strength-based. You could equate ADHD to quicksand, but that's likely to keep you stuck. You want the metaphor to suggest a new, positive way of thinking about the situation.

Edward Hallowell, M.D., a leading authority on ADHD and co-author of the best-selling Driven to Distraction, likens ADHD to having a race-car brain and bicycle brakes. He explains to his newly diagnosed patients that their brain is very powerful and capable of winning races (doing well in life). But they have bicycle brakes, so they can't slow down very well; they are impulsive on many fronts. He describes himself as a brake specialist.
[Click to Read: The Success Mindset for ADHD Procrastinators, Dreamers & Survivors]
Cognitive Restructuring Tip #3: Reframe Distractions

I like to share the "paperweight metaphor" with my clients. Imagine you and a colleague decide to go to the park and get some work done. You each go to a picnic table and spread out your papers (there are no electronics in this metaphor). You arrange them in neat stacks. You look over and notice that your colleague has done the same. But she puts a paperweight on each of her stacks.

Paperweights, brilliant! But you don't have any paperweights. The wind blows and your papers fly away. Your colleague looks up for a moment, smiles at the breeze, and gets right back to work, her papers safely secured. You have to track down your papers. You finally gather them up, lay them out, and start to work again. And the wind blows again and you're back to chasing papers, because you don't have any paperweights.

You and your colleague are equally smart, equally talented, equally capable. She gets more done because she isn't affected by the wind (distractions). You are not "less than" just because you weren't given paperweights at birth like 95 percent of the population.

Cognitive Restructuring Tip #4: Make Sure Your "On" Switch Isn't Turned "Off"

Another metaphor I like to use with clients with ADHD is the circuit and the switch. Everyone, neurotypical or not, can be compared to a simple electrical circuit. Current runs through the circuit and powers equipment such as a light bulb. Everyone's circuit has a switch in this metaphor. Turn on the switch and the light comes on. Turn off the switch and the light goes out. The current in people with ADHD is just as strong as anyone's, and our light just as bright. But our switch is not reliable. It turns itself off when we get distracted or overwhelmed and our light goes out.

We have to keep an eye on the switch and be ready to turn it back on. That means we have to use our coping strategies without fail. Structure, good sleep, diet, exercise - those are the things that keep the switch on. It seems unfair that some people have more reliable switches. But it's just the switch. There's nothing wrong with our basic circuitry. That's the point I want my clients to get.

With metaphor, we can move from "It's a given that I'm (insert negative belief here)" to the ability to challenge that assumption and generate hope. We can make sense of the problem. We come out of that dark place of feeling alone and misunderstood. There's a sense of "Ah, that's a thing."
[Relax! It's Part of Your Treatment Plan]
Another good thing about metaphors in therapy is that they help clients remember what was said in the session. Information is more likely to be remembered if it's accompanied by vivid imagery.

Some clients use metaphors to help the therapist fully understand their experience. They can be used to describe a feeling, a thought, or a belief that may be too complex to describe in simple sentences. This shared understanding leads to improved rapport and therapeutic alliance. Metaphors that come from the client are more likely to resonate with them, so I encourage them to do it.

Sometimes in sessions I find the client and I will pass a metaphor back and forth, each expanding on it as we gain clarity. We use it as shorthand: "What happened to your switch?" "What do you want to use as a paperweight?" or "Yeah, there go my bicycle brakes again." The ADHD community feels misunderstood. Shared metaphor lets them know they are understood, accepted, and valued.

Cognitive Restructuring and ADHD: Next Steps
Beth Main, LCPC, BCC, is an ADHD coach, therapist, and founder of ADHDSolutions.net. She specializes in using a cognitive-behavioral approach to helping people with ADHD overcome their challenges and achieve success.
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How Cognitive Restructuring Reframes Failure and Erases ADHD Self-Doubt

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"I am a failure." "I can't even do the simplest things." "Any normal person would be able to do this." These are some of the statements I hear from clients diagnosed with ADHD. To help them see themselves the way I see them - and to notice all the ways in which they are successful - I use a therapy technique called cognitive restructuring.

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ADHD is not an excuse. But it is the neurological basis for so many of your child's greatest executive dysfunctions - challenges that impact behavior on a daily basis. Responding to bad behavior with neurotypical parenting techniques is counterproductive because it ignores the root problem - which is why so many families use these strategies from behavioral parent training.

behavioral parent training (BPT) for adhd

It is not your fault. Your child's ADHD was not caused - or worsened - by your parenting. But you are the best person (and maybe the only one) to teach him the skills he needs to thrive because - despite the anger, frustration and impulsivity - your child really does want to please you.

This is the core premise behind behavior parent training (BPT), an evidence-based therapy that focuses squarely on addressing executive dysfunctions (the hallmarks of ADHD) in a way that corrects the core problems underlying bad behavior.

Behavior Parent Training for ADHD

How and why does BPT work for children with attention deficit hyperactivity disorder (ADHD or ADD)? It is a different approach to parenting that prioritizes positivity and finding the 'right fit' for your child - in other words, the parenting approach that gets your child to respond.

Developing that 'right fit' is important when it comes to keeping a child on track; children who find it with their caregivers are much less likely to experience severe, negative long-term outcomes. BPT recognizes that, and it also recognizes that the best fit for a neurotypical child is rarely the same as that for a child with ADHD. Different brains require different parenting strategies.

For example, some neurotypical children may shift their behavior to avoid or end punishment. Punitive measures like grounding, however, rarely work for kids with ADHD. They respond better to positive dopamine charges than they do to negative ones. Consider your favorite boss and why you liked working for them. They were probably inspiring and allowed you to choose what your day looked like. They likely praised when you made good choices and didn't harp too much on your mistakes. Just as you strove to wow that boss, your kids are going to work harder for you when you decrease the reprimands and increase the positive feelings.
[Self-Test: Oppositional Defiant Disorder in Children]
The core tenets of BPT for parents look like this:

Improved behavior is a byproduct of a healthy parent-child relationship

Children respond best to increased positive attention and reinforcement

Children respond worst to harsh and inconsistent parenting

Progress is made by focusing on one desired behavior at a time (and ignoring other behaviors purposely for a time)

Change happens incrementally

Raising a child with ADHD is taxing, and parents need help, too

How Behavior Parent Training Strengthens Executive Functioning

ADHD is a deficit of executive function. It causes children (and adults) to lose lots of things - including their temper, their homework, their track of time, and their self-confidence. To understand that these deficits are not willful, but rather neurological, is important. To further know how to help your child with ADHD overcome these deficits is life changing.

BPT provides insight into these difficulties and offers specific strategies for responding in a way that helps your child understand what you want and learn appropriate behavior in the process. This approach takes practice and consistency - but the payoff is real. Following these strategies will help your child feel better about himself and help you feel more in control of your parenting.

ADHD Challenge #1: Working Memory Deficits
The inability to take something and hold it in memory and then do something with that information later in a way that's appropriate.
The Problem: Slow, Nagging, Frustrating Mornings

Q: "My child takes forever to get ready in the morning and I have to follow him around reminding him to focus and move quickly to the next task. This is exhausting and stressful every single morning."

BPT Strategy #1: Create Checklists and Schedules

It's really important for kids to understand what's coming next and what's expected of them. Use checklists and visual schedules to create some structure that allows your child to take ownership of his or her obligations, so it's not just you having to nag and reinforce and nag and reinforce.

For younger kids, make simple drawings or find images of each task on the Internet (toothbrush, hair brush, clothing) and tape them on the wall near the bathroom sink. Seeing each part of the morning routine will encourage them to independently complete the task, and provide the opportunity for your child to demonstrate that they can. Remember kids want to please their parents.
[Your Free Guide to Parent Training Programs]
BPT Strategy #2: Give Simple Commands and Recognize Progress

Multi-step commands tax the working memory of a child with ADHD.

BPT teaches parents that commands stated simply are the most effective. Telling your child to clean up the clutter near the front door will likely be met with confusion. Instead, use one-step commands that are very specific, such as: Please pick up your shoes. Good job. Now please put your shoes in your cubby. Great.

Breaking down the task into that level of specificity helps your child understand cause and effect in a way that enables him to make the connection "Ah, when I listen, and I follow through, my parents are happy with me."

When commands are bunched together, it makes a lot harder for them to succeed, and it gives you fewer opportunities to praise them. Hearing frequent praise helps children with ADHD feel confident, which is very important.

BPT Strategy #3: Slow Down

Resist the urge to issue rapid-fire commands. Due to the slow processing speeds associated with ADHD, I recommend waiting at least 10 seconds (slowly count to yourself: 1 Mississippi, 2 Mississippi...) before re-issuing the same command. Doing this may feel long to you but it gives your child time to process what you've said.

To ensure that your child understands what you've asked, make eye contact and stand close to him before issuing commands. Then assess for understanding. You can ask him if he understands what you've asked and wait for his response.

BPT Strategy #4: Praise Progress, Not Perfection

Imagine you're a kid with ADHD who's trying really hard that day and you're listening when mom asks you to pick up your shoes, go up to your room, and get dressed. If you have working memory issues, you might be able to get through the first two steps. But if your parents find you doing something else instead of the third step, you'll likely be scolded. And that, on the whole, does not help kids or motivate them to do things a little differently next time.

Most kids with ADHD are reprimanded by the adults in their lives - chastised or given negative feedback about something they've done - frequently throughout each day. Add this up, and it becomes pretty clear pretty quickly that by the time they're adolescents they've heard a whole lot more disappointment than encouragement.

ADHD Challenge #2: Poor Response Inhibition
Poor response inhibition is the ability to keep yourself from doing something you know is not appropriate.
The Problem: Aggressive Response to Frustration

Q: "My child gets frustrated easily and lashes out - hitting or yelling or both - at family members, even when we're trying to help."

BPT Strategy #1: Practice the Preferred Behavior

BPT teaches parents to use reinforced practice of prosocial behavior. This means teaching your child how to do something better or different to replace that hitting behavior, and then reinforcing that with practice.

Reinforced practice means having your child practice the preferred behavior in various parts of the house under various circumstances, and using little rewards to reinforce that. A younger child might receive a Skittle every time he uses the words "Will you share with me?" or "Mom, I need your help," instead of hitting. Getting in the reps, just as you would lifting weights, is necessary in order for the newly-acquired skill to become automatic.

BPT Strategy #2: Use Praise Strategically

Look for ways to increase praise or catch your child doing good. If your four-year-old typically hits his sister after they've been playing for five minutes, try interrupting the play before it goes south. Come in and praise them for playing nicely at the three-minute mark. "Hey, I love how well you guys are sharing toys. That's great." The point is to catch them doing good instead so that that behavior, the one that you want, increases.

ADHD Challenge #3: Delay Aversion
Waiting - for either reward or punishment - is painful or even impossible with ADHD.
The Problem: Rewards Do Not Motivate Good Behavior

Q: "We promised my child a new bike if she earns mostly As on her next report card, but she is totally unmotivated by this reward and her grades are suffering."

BPT Strategy #1: Offer Incremental Rewards

This is not a problem of motivation, but of delay aversion - and BPT teaches parents how to change the reward schedule and increase the frequency of rewards to boost their effectiveness. In this example, think about how to break up the steps involved in getting good grades and how to measure those steps in a way that will allow your child to earn incremental rewards.

For example, if you want to improve their homework completion time, you could focus on that every night instead. For every assignment that your child completes within this period of time, he earns the ability to pick a fun activity after the homework is done.

By increasing the frequency of rewards, you are also increasing your child's ability to experience success. Kids with ADHD will almost always choose a much smaller reward for much smaller effort now rather than bigger effort over a longer period of time for a bigger reward later. So, we want to use that to our advantage and provide some more frequent feedback about how they are performing.

BPT Strategy #2: Use Timers to Divide Up Long Tasks

Parents can also help improve delay aversion by using timers that chunk work into smaller bits. If the whole homework routine, which lasts an hour, is too painful for your child, set the timer for 10 minutes of active work and then let him take a short break or earn a small piece of a reward for later.

BPT Strategy #3: Pair Short-Term and Long-Term Rewards

Use a combination of short-term and long-term rewards. A short-term reward would be, for example, earning screen time based on performance with the routine you're targeting. But then to encourage consistency over many days, you can offer longer-term rewards like weekly ones that are delivered on the weekend. If your child met their morning routine goals on four out of the five days, for example, they would have access to XYZ on the weekend.

BPT Strategy #4: Keep Your Goals Fair - and Achievable

When setting up these behavioral programs, the goals must be fair. To do this, use baseline data to set the goals and adjust as needed. If you're working to decrease the frequency of disrespectful language, for example, the first thing you should do is tally how many times a day you're hearing disrespectful language before the intervention begins. You need to understand the natural frequency of this so that the goals you're are setting are fair and within reach.

Why is this important? Because kids with ADHD can spot a fake from a mile away. So if we tell them, "You can earn this special reward if you are not disrespectful at all today," they're going to look at you and say, "No thank you." If you want them to be motivated right away they have to believe the reward is within reach.

BPT Strategy #5: Make Sure Your Rewards Matter

Don't guess about what you think might motivate your child. Instead, ask them. You can say something like "Your whole Saturday this Saturday is completely free. You can choose whatever activities that you want to do. What are they?" Keep some notes on that so you a sense of the things that they might be willing to work for in a behavior reward plan.

I also recommend using an award store - a simple stash of various rewards that you switch up every so often. Replace ones that get boring with some new ones. It's important to make our economy in BPT look like the economy that kids really want to use where they have some choice and flexibility in it.

ADHD Challenge #4: Oppositional Defiant Behavior

The Problem: Children Will Test Limits to Measure Your Resolve

Q: "We are focusing on reinforcing good behavior with positive feedback, but how do we respond to bad behavior when it happens? We can't just ignore the bad behavior, can we?"

BPT Strategy #1: Use Planned Ignoring

In BPT, praise and rewards are prioritized over punishment. BPT also teaches parents how to use planned ignoring. That's a fancy way of saying you are going to choose just a few behaviors, not the most severe ones, that you completely ignore. It's a very effective way of getting kids to stop the annoying behavior, and so all of the programs use that to some degree.

BPT Strategy #2: Dole Out Punishments Sparingly

This is important because too much punishment makes it less likely your child will work with you. They won't want to replace those negative behaviors with the new ones that we need to see them do. When some form of punishment is warranted, most behavioral parent training programs focus on a timeout or job grounding approach.

Timeout is what it sounds like: a timeout from positive reinforcement. Depending on the age of your kid, that can be pretty brief - as brief as it takes for them to calm themselves down. Or it could be a little bit longer - total number of minutes based on their age. Again, the goal here is to help kids understand cause and effect. If I do X, Y is what's coming next. Consistency is important for comprehension. Kids are more likely to understand when they receive a timeout every time the bad behavior happens.

Job grounding is a method that is effective for older kids. Job grounding essentially is a way of having kids be grounded from the things that they like to do and to instead complete a brief chore.

No matter what punishment you're using, it needs to meet these four criteria.

1. It must be fair and fit the crime

2. It needs to be mild

3. It needs to be delivered immediately following the undesirable behavior

4. It needs to be consistent

How Can I Find a Good BPT Program?

1. Effectivechildtherapy.org has a list of top-notch referral resources and questions to ask when interviewing a BPT therapist.
Your pediatrician may also be able to refer you to an effective program.

2. Visit abpp.org to search for board-certified psychologists; that's a mark of quality and a sign the psychologist is using evidence-based interventions.

3. Russell Barkley's books about parenting children with ADHD (#CommissionsEarned) are a go-to resource

4. Joel Nigg has an excellent book too called Getting Ahead of ADHD (#CommissionsEarned) that addresses other aspects of parenting kids with ADHD - like the importance of sleep or diet in managing ADHD.

5. The American Academy of Pediatrics has a parenting book about ADHD as well, and a new one coming out soon. And if you're concerned about using screen time as a reward, the academy also has a really great media planner that I recommend often.

The content for this article came from Carla Counts Allan, Ph.D. webinar "[Download This: ADDitude's Guide to Better Behavior Through Therapy] The Best Kind of Discipline: How Behavioral Parent Training Can Transform Your Home Life." That webinar is available for replay here.
#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication

Updated on October 8, 2020

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How Behavioral Therapy Targets Executive Dysfunction - with Positivity and Praise

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ADHD is not an excuse. But it is the neurological basis for so many of your child's greatest executive dysfunctions - challenges that impact behavior on a daily basis. Responding to bad behavior with neurotypical parenting techniques is counterproductive because it ignores the root problem - which is why so many families use these strategies from behavioral parent training.

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Facing a to-do list top-heavy with critical, complex tasks, adults with ADHD often tackle the easier items - ones that keep them busy but not productive. Called "procrastivity," this self-defeating ADHD time-management habit can be helped by cognitive behavioral therapy approaches that teach patients how to prioritize tasks.

https://www.pexels.com/photo/typewriter-1750268/

"Procrastivity" and its Role in ADHD

A combination of "procrastinate" and "activity," the term "procrastivity" aptly describes a tussle common among adults with ADHD who are always busy but never seem to make headway on life's important goals. At its root is an implementation problem: the individual knows what they need to do, but they won't or can't do it, so they keep occupied with more palatable but less critical tasks.

Filing taxes, for example, is a high-priority, strict-deadline task that an adult with ADHD might put off for re-seeding the lawn. While a worthwhile activity if the grass is indeed bare, this gardening is not critical, especially when April 15 looms. If tending to the lawn is the priority task, on the other hand, some adults with ADHD might find opting to watch or read the news in a bid to stay informed. Productive? Yes, but low on the scale of priorities.

Procrastivity can especially affect people with attention deficit disorder ( ADHD or ADD), as the disorder, at its core, is a struggle with executive functions and self-regulation. Completing everyday tasks is often more difficult for people with ADHD compared to their neurotypical peers - and all that back up effectively creates a breeding ground for procrastivity.

Why do some tasks that would be otherwise avoided suddenly become more appealing in the face of higher priority to-do items? And can the ADHD mind be trained to steer clear of this low-hanging, time-wasting fruit? This is the conundrum of procrastivity and the promise of its match: cognitive behavioral therapy.

Using CBT to Address Procrastivity

Cognitive behavioral therapy - a type of brain training - has been shown to help patients manage their ADHD symptoms and improve functioning. CBT an as ADHD therapy aims in part to reframe the often negative perceptions patients with ADHD have of themselves - a result of living the ADHD experience in a neurotypical world - by providing coping strategies, tools to manage negative expectations and emotions, and analysis of behavioral patterns that interfere with the strategies.
[Get This Free Booklet: Everything You Need to Know About CBT]
Sometimes, however, procrastivity prevents patients with ADHD from following through on the strategies and approaches discussed in CBT sessions, thereby rendering fallow the very tools they need to solve the underlying problem. But by dissecting procrastivity into its root causes and manifestations, its elements can be used to employ CBT techniques that help ADHD patients actualize the important work.

Procrastivity Inside the ADHD Brain

What are the key differences between the small, unimportant tasks that ADHD patients tend to choose over the more critical, deferred ones?

1. Manual focus: Often, the lower-priority task is physical and less cognitively demanding than the higher-priority task. Getting the lawn mower out of the shed, starting it up, and pushing it to the lawn is less cognitively challenging than preparing taxes - a nebulous and mentally taxing, so to speak, activity. This also explains why some patients opt to read when faced with a daunting writing task.

2. Familiar script: Individuals are more likely to tackle tasks with a pre-existing "menu". Laundry and other household chores that can be done on auto-pilot tend to fall under this umbrella, but writing a research paper does not.

3. Time frame: Procrastivity tasks often have a more firm and predictable time frame; there is little doubt how long they will take. Deleting unread e-mails may take 10 minutes, but the same cannot be said for preparing a work presentation.

4. Task progress: Procrastivity tasks often have a clear measure of a beginning, middle, and end. Lawn mowing starts with removing the mower from the shed, and you're halfway through when half of the grass blades are cut. It ends with the mower going back in the shed. But a task like studying for a final exam does not have crisp progress points; it's more difficult to tell if you're making progress, and how much.

[Download This Free Resource: Better Time Management with Adult ADHD]
Preferred procrastivity tasks tend to align with a patient's own perceived efficacy. They will opt for it even if the activity being avoided may actually take less time and effort.

Harnessing Procrastivity Insights in CBT

With procrastivity pulled apart, clinicians can harness the attributes that draw patients to low-priority tasks in order to create a CBT-based priority task plan that includes behavioral, emotional, and other implementation strategies:

Behavioral Approaches to Productivity

1. Attach manual, step-by-step descriptions to must-do tasks. This strategy allows the individual to engage steadily and progressively in the priority task. "To study," therefore, becomes "go to the study station" followed by "remove item from backpack" or "open the document on the computer" and "re-read the last two paragraphs you wrote."

2. Lower the bar on progress. This strategy associates the priority task with time, another task, or terrain. This can mean working on the task during commercial breaks only, or focusing on the activity for 600 seconds rather than 10 minutes. The goal of the technique is to make the priority task "do-able" by changing how time around it is conceptualized.

3. Define time by start and end. The aim in creating a "bounded" work period is to reduce the cognitive load associated with priority tasks for patients. Ambiguous work periods are more overwhelming than the work itself. But having your patient work only until the hourglass (probably the best tool because of the ability to "see" time) needs to be turned over can help.

Emotional Approach to Productivity

Reframe discomfort. Another cognitive reframing technique that helps remind your patients that they do not have to be in the mood to do something in order to do it. Having patients acknowledge their discomfort aloud can also help, as it demonstrates that the feeling isn't necessarily tied to action.

Implementation Strategies for Productivity

1. If x then y. Studies show that putting tasks in this structure can help patients develop executive functioning cues. If I can sit at my desk, a patient might say, then I can work on math homework for 10 minutes. The desk may eventually become a visual cue for patients, where they associate it with being able to work for 10 minutes.

2. Tipping point. Create a plan that helps patients identify and handle points during a task that maintain workflow. This includes the starting point, a method for handling interruptions, and thinking of how to re-engage in a task after a break.

[Get This Free Guide: Focus Your ADHD Brain With 5 Helpful Tips] Russell Ramsay, Ph.D., is a member of the ADDitude ADHD Medical Review Panel. The content for this article came from J. Russell Ramsay's "Turning Intentions Into Actions: Implementation-Focused CBT For Adult ADHD" presentation delivered for APSARD's 2018 Symposium. "Procrastivity" will also be covered in Dr. Ramsay's forthcoming book, "Rethinking Adult ADHD: Helping Clients Turn Intentions into Action." (APA).
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Updated on September 17, 2020

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Why the ADHD Brain Chooses the Less Important Task - and How CBT Improves Prioritization Skills

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Facing a to-do list top-heavy with critical, complex tasks, adults with ADHD often tackle the easier items - ones that keep them busy but not productive. Called "procrastivity," this self-defeating ADHD time-management habit can be helped by cognitive behavioral therapy approaches that teach patients how to prioritize tasks.

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Deficient emotional self-regulation (DESR) is a new term describing an age-old problem of impulsive emotion and emotional self-regulation difficulties among people with attention deficit hyperactivity disorder (ADHD or ADD). Specifically, DESR refers to deficiencies in these four aspects of emotional regulation:

The ability to inhibit inappropriate responses triggered by strong emotions

The ability to self-soothe to reduce the severity of an intense emotion

The ability to refocus attention from emotionally provocative events

The ability to substitute healthier responses in the interest of long-term welfare

Though it's not included in the condition's DSM-5 criteria, DESR and emotional impulsivity are fundamental components of ADHD that shape an individual's experiences and challenges throughout their lifetime.

Because DESR is a novel concept to many, questions abound. Below, I answer several posed during my recent ADDitude webinar titled "Deficient Emotional Self-Regulation: The Overlooked ADHD Symptom That Impacts Everything."

Q: Does emotional dysregulation change over time? Does it ever improve?

Emotional dysregulation does change and it can improve, but it depends on the individual and the factors involved. For instance, emotional self-regulation is rarely elevated as an issue in toddlers. We don't expect 4-year-olds to manage their emotions very well. Parents are typically more concerned with the impulsive aspect of emotion at this stage.

But by the time we get into late adolescence, and especially adulthood, we do expect individuals to have developed that second stage of emotional control: top-down executive management (or moderating emotional reactions to evocative events). However, DESR impairs just that -processes related to emotional self-regulation. And that leads to more disparaging moral judgment about adults with ADHD than it would in much younger individuals.

It's almost like the two components of this emotion problem in ADHD - emotional impulsivity (EI) and DESR - trade places as individuals age. The former is more problematic in children, while the latter becomes a more compelling deficit for the adult individual.
[Get This Free Download: 5 Emotional Control Strategies for Kids with ADHD]
We also know that ADHD symptoms fluctuate over time for many individuals, which may mean that issues like emotional dysregulation also change in severity or degree of impairment. And keep in mind that ADHD mostly persists to some degree from childhood to adulthood for 90% of people.

But can emotional regulation be "trained?" In children, the chances of that are quite slim because they haven't yet developed the appropriate self-regulation skills that such training would require. Interventions like medication, parent training, and controlling for environmental triggers may be most helpful for this stage. Adults, however, may benefit from cognitive behavioral therapy ( CBT) and mindfulness-based programs especially reformulated for adult ADHD in recent books, both of which help the individual deal with many aspects of emotional dysregulation.

Q: Do men and women with ADHD experience emotional dysregulation differently?

Generally, we know that males are more prone to exhibit aggression and hostility, which are associated with externalizing disorders, while females are more prone to anxiety and mood disorders. Both, however, do struggle with impatience and frustration, and the emotional dysregulation component in ADHD will only exacerbate that.

Q: When might DESR symptoms start to appear in children?

DESR usually appears between ages 3 and 5, though it may be quite obvious in a younger child who is significantly hyperactive and impulsive. Still, many families write off this behavior, believing it to be developmentally normal (i.e. the terrible twos), only realizing later on that the child is quite hot-headed and emotional compared to peers. Some of these children will go on to develop oppositional defiant disorder ( ODD). If we accept DESR as a core feature of ADHD, we can see why the disorder poses such a significant risk for ODD and related disorders.
[Read: Why Is My Child So Angry and Defiant? An Overview of Oppositional Defiant Disorder]
Q: Can parents manage DESR in children with ADHD without medication?

It will be very, very difficult to do so. With ADHD in children, we're looking at a dysregulated brain with a highly variable, immature executive circuitry - part of which includes this problem with emotional expression and regulation. To expect to try to find some other social or psychological intervention that can change that underlying neural network problem is asking for too much of psychotherapy. It may be best to work with the aforementioned interventions as parents await the greater maturity of these neurological systems that comes with further development.

Q: Is there residual emotional difficulty in children and adults even after taking ADHD medication?

Yes - sometimes medications can create their own problems. Stimulants, for example, may create emotional blunting, which is the absence of natural emotion in some children or adults. As stimulants wear off, it's not uncommon for the emotional brain to go through a rebound. In some cases, that may look like irritability, a proneness to weepiness or crying, and sadness.

These experiences with stimulants are not universal, but remember that you've been suppressing an emotional brain and, as medication wears off, that could come to the fore. We don't see this issue with non-stimulants so much because they're not suppressing the emotional circuitry of the brain. Ultimately, each drug works on the brain a little differently, and therefore works on emotion a little differently. It's why some clinicians sometimes opt to combine these medications to get much broader coverage over patient symptoms than any single drug could do alone.

Q: You noted that a parent's own ADHD symptoms could exacerbate their child's symptoms and thus make emotional dysregulation worse. Can you give some examples?

Let's say a child is engaging in some defiant, oppositional behavior. A parent with ADHD may experience a much stronger reaction to that compared to a typical parent. They might exhibit a more impulsive reaction of anger or hostility toward the child, or they may arrive at that level of emotional upset faster than would a parent without ADHD.

When a parent exhibits these behaviors, they are, in effect, modeling these reactions to their child. They are also provoking the child, who has their own emotional regulation problems. What you have, I think, is an emotional tornado in the family - each person is triggering the other to higher levels of conflict.

Q: Does trauma exacerbate DESR? What about PTSD?

It's bi-directional. Research suggests that ADHD, because of the emotional dysregulation factor, especially, puts children at a higher risk for exposure to trauma. And once trauma has occurred in a child with ADHD, it's more likely to progress to a PTSD reaction. This is why ADHD is one of the strongest predictors of who will develop PTSD if exposed to trauma. Once PTSD develops, it will only worsen existing emotional regulation problems.

Q: Is it ever too late to get help for emotional dysregulation?

Absolutely not. It is never too late to get help for ADHD and its symptoms, even if emotional dysregulation has been an impairing factor for a long time. Multiple studies show that a diagnosis in late life and subsequent treatment only benefits the individual.

DESR and Emotional Dysregulation: Next Steps

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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DESR: "Does ADHD Emotional Dysregulation Ever Fade?"

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Emotional dysregulation is a core facet of ADHD that is excluded from official diagnostic criteria and most symptom tests - a contradiction that is pushing researchers and clinicians to further investigate the connection. One such ADHD expert is Russell Barkley, Ph.D., who has coined the term deficient emotional self-regulation (DESR) to describe this fundamental trait.

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Over the years, I have given career advice to attorneys, florists, accountants, nurses, doctors, stay-at-home dads, therapists, clergymen, and even a professional skateboarder with attention deficit disorder (ADHD or ADD).

It's a misconception that certain jobs are not right for people with ADHD. As I've found, there seems to be no limit to the careers that adults with ADHD find fulfilling. But it is true that ADHD can make choosing a satisfying career a challenge.

That leaves you asking: "What is the best career for me?" If you're like many of the students I work with, you changed your major in college at least once. Similarly, many of us have such varied interests that picking a career path to pursue is difficult.

Just about every job involves some mundane tasks, but finding work that is interesting most of the time is critical to an adult with ADHD's job satisfaction and performance. Boredom can sidetrack us, which causes our performance to plummet. But if your job ties in to your passions, you'll thrive. Maintaining a realistic assessment of your strengths and weaknesses are part of the job of planning for - and keeping - a job.

Getting started

I often ask clients, "What would you do if you knew you could not possibly fail?" This bold question can point people in the right direction, freeing them from automatically crossing something off their list because it might, at first, seem an unrealistic choice.
[Free Download: 8 Dream Jobs for Adults with ADHD]
It's also important to know what you value. Would you rather work to serve others, get recognition, make lots of money, or meet interesting people? Work with a career coach or take an online quiz to help you evaluate what's really important to you. Testing can identify careers that suit your personality-and can eliminate those careers that may sound great, but don't mesh with your personality or abilities.

Knowing your strengths-and weaknesses

Skills for workplace success may be grouped into two main categories: hard and soft. Hard skills are job-specific and they vary, depending upon the industry or field in which you want to work. For instance, a graphic artist must have the computer skills that go with that job.

Soft skills are those personal characteristics that go with a variety of jobs; they include sociability, problem solving, communication, time management, and organization. People who prefer to work alone, for instance, might find research particularly appealing.

Time management and organization, for those of us with ADHD, are the most daunting skills to master, but they must be mastered. You can start working on your organizational skills during the career search itself. Buy a file or notebook, or use your e-mail program, to store information you will need in your investigation, such as contact names and numbers. Use a calendar for recording appointments.
[These 18 Questions Will Reveal Your Ideal Career]
Start a prioritized task list that includes the basics: assessment testing (for skills, personality traits, interests, and values), career counseling through your school, researching specific careers, and requesting informational interviews.

Testing will tell you which hard skills and soft skills you possess and which need improvement.

I learned the value of testing early. When I was in college, I worked during the summers as a camp counselor. It paid poorly, but it was fun and I was good at it. One summer, my aunt told me that a friend of hers was a manager at the telephone company and could get me a summer job as a switchboard operator and I could earn twice as much. I jumped at the chance-I knew I was a shoo-in!

Fortunately, my aunt's friend didn't skip protocol and give me the job without testing me first. I knew one minute into the test, which was supposed to assess my ability to recall lengthy sequences of numbers, that this was not the job for me, no matter how much it paid! Years later, my aunt told me that her friend had confided that, in all her years at the company, she had never seen anyone do so poorly on the test. That test saved me from what could have been the worst job ever.

Taking side roads

If your skills and dreams don't quite match, don't give up. It's possible to take a side road into an area you'll enjoy by applying the skills you have. If you want to be a chef and go to culinary school, but find out that you're dangerously clumsy with knives, you might use writing skills to make a career as a cookbook author or restaurant critic. It's the matching up of talents and abilities with interests that makes or breaks a career.

One of my first clients was torn between career choices. She had a natural talent for art and was passionate about the environment. Her dream was to become an environmental engineer. But she was rejected from all of the engineering programs to which she applied. Eventually, she decided to apply to an art institute, where she was accepted and did very well. She now uses her artistic talent to increase public awareness of environmental issues by designing and creating scale models of habitats.

Going forward

Choosing a career is only the first part of your job. You may have made the perfect fit for a career in terms of abilities, interests, experience, and knowledge but fail miserably because of impulsive interactions with coworkers or poor social skills. If so, you must recognize what is happening and take steps to correct it before you lose your dream job.

Also, look for a mentor - a person in your field but not necessarily at your workplace - who can guide your career, and point out trouble spots before they become barriers to advancement.

What is most important is to work with what we have and recognize and accept ourselves for who we are. No amount of money or prestige can make us happy without self-acceptance. Love who you are, and it will be easier to love what you do.
[Quit It! The 10 Worst Jobs for Restless Minds and Creative Spirits] Edward Hallowell, M.D., is a member of ADDitude's ADHD Medical Review Panel.
Career-Advice Resources

A number of books and websites offer career advice and assessment tests, as well as tips on narrowing your search. Here are a few:

What Color Is Your Parachute? A Practical Manual for Job-Hunters and Career-Changers by Richard Nelson Bolles (Ten Speed). The site is jobhuntersbible.com.

myplan.com offers a free values-assessment test. There are also a skills profiler and personality tests for under $10.

assessment.com offers free career tests and analysis. A complete report is $19.95. Additional test packages are priced up to $129.95 and cover a range of career-related areas (e.g., leadership qualities).

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How to Align Your Career with Your Passions

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Over the years, I have given career advice to attorneys, florists, accountants, nurses, doctors, stay-at-home dads, therapists, clergymen, and even a professional skateboarder with attention deficit disorder (ADHD or ADD). It's a misconception that certain jobs are not right for people with ADHD.

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Rejection sensitive dysphoria is part of ADHD. It’s neurologic and genetic, and it can be debilitating.

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Rejection Sensitive Dysphoria (RSD) and ADHD

"Stop being so sensitive," everyone told me when I was younger. "If you stop crying, they'll stop teasing you."

I was the kid who couldn't handle red marks on my homework, who melted down at any sign of criticism. I'd dissolve into tears. I'd sometimes stomp away. I'd curl up into myself and feel worthless, miserable, and guilty. The shame was overwhelming. It led to self-harm in my teens and early 20s. I could not cope with the normal slings and arrows of daily life. Everything bad was my fault.

My psychiatrists thought I was depressed and put me on an SSRI. It didn't help much, because I wasn't depressed. Like so many women, I went through many diagnoses before my doctors finally hit on ADHD. I wasn't manifesting depression or isolated anxiety issues. I was dealing with rejection sensitive dysphoria (RSD).

RSD is a condition that the psychiatric community at large, and the ADHD community, is just beginning to understand. ADHD expert William Dodson, M.D., calls it "an extreme emotional sensitivity and emotional pain triggered by the perception - not necessarily the reality - that a person has been rejected, teased, or criticized by important people in his or her life. RSD can also be triggered by failing to meet [your own] or others' high expectations."

As women, we know about high expectations, the failure to meet them, and the emotional backlash when we fall short. Add an actual, diagnosable psychiatric condition to that response, and you have a recipe for some serious psychological damage. It started with teasing from my peers in childhood over my reactions to not getting an A on every single paper; along with forgetting my homework or losing a book or doing any number of things girls with attention deficit disorder (ADHD or ADD) do regularly - missing social cues, flubbing personal interactions, blurting things out. I berated myself, and it didn't help that others berated me too. I played those criticisms as a soundtrack of self-loathing.
[Self-Test: Could You Have Rejection Sensitive Dysphoria?]
Rejection Sensitive Dysphoria: Extreme Sensitivity to Criticism

It's no surprise that a childhood like that, combined with RSD, left me with a hair-trigger response to criticism. I'm in my 30s now, and RSD is still the devil on my shoulder, the voice in my head, the soundtrack to my life. It affects every relationship in my life, from my parenting to my marriage to my friendships. I once took a much-anticipated trip to meet work friends in another state. I had fun for four hours before a comment had me convinced that these women hated me, that they thought I was an idiot.

I spent the rest of the trip in near tears. It took me months to recover. I've since realized that all of this was in my head, and my friends were, as they professed to be, my friends. They liked me.

I often feel like a terrible parent. The normal things that parents do - lose their temper, say - seem life-altering to me. I feel that I'm destroying my children's lives. I may cry in apology in front of them. RSD means having to say you're sorry more than anyone on the planet.
[Free Resource: Understanding Rejection Sensitive Dysphoria]
Rejection Sensitivity: Impact on Marriage and Parenting

RSD has a big impact on my marriage. I would encourage anyone who thinks he or she may be suffering from RSD to enter marriage counseling. It will help your spouse understand that when he or she asks you to take out the garbage, it may lead to an hour-long argument, complete with tears. Of course, you should have taken out the garbage long ago and why haven't you done it sooner and what's wrong with you, anyway? The person only said "Could you please take out the trash?" He's baffled and upset that you're flying into accusations.

RSD can imitate a mood disorder, including rapidly cycling bipolar disorder complete with suicidal ideation. Guanfacine or clonidine helps some patients, says Dodson. MAOIs can also be effective, but they come with a list of don'ts, including ADHD meds. Talk with your doctor.

Many people with ADHD experience some form of RSD. In women, it usually turns inward. So you're not the only one feeling that guilt, shame, and rejection. I understand. I am right there fighting them with you.

RSD: Next Steps

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Rejection sensitive dysphoria causes feelings of guilt, shame, and rejection. This on top of your ADHD - and mixed in with the resulting anxiety or depression. I struggle with RSD, and I'm here to say you are not alone - and you are not weak.

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The DSM-V - the bible of psychiatric diagnosis - lists 18 diagnostic criteria for ADHD. Clinicians use these to identify symptoms, insurance companies use it to determine coverage, and researchers use it to determine areas of worthwhile study.

The problem: These criteria only describe how ADHD affects children ages 6-12. The signs of ADHD in teens, adults, and the elderly, on the other hand, are not as well known. This has led to misdiagnosis, misunderstanding, and failed treatment for these groups.

Most people, clinicians included, have only a vague understanding of what ADHD means. They assume it equates to hyperactivity and poor focus, mostly in children. They are wrong.

When we step back and ask, "What does everyone with ADHD have in common, that people without ADHD don't experience?" a different set of symptoms take shape.

From this perspective, three defining features of ADHD emerge that explain every aspect of the condition:
1. An interest-based nervous system
2. Emotional hyperarousal
3. Rejection sensitivity
[Self-Test: Could You Have Rejection Sensitive Dysphoria?]
1. Interest-Based ADHD Nervous System

What is an interest-based nervous system?

Despite its name, ADHD doesn't actually cause a deficit of attention. It actually causes inconsistent attention that is only activated under certain circumstances.

People with ADHD often say they "get in the zone" or "hit a groove." These are all ways of describing a state of hyperfocus - intense concentration on a particular task, during which the individual feels she can accomplish anything. In fact, she may become so intently focused that the adult with ADD may lose all sense of how much time has passed.

This state is not activated by a teacher's assignment, or a boss's request. It is only created by a momentary sense of interest, competition, novelty, or urgency created by a do-or-die deadline.

The ADHD nervous system is interest-based, rather than importance- or priority-based.
[Free Download: 3 Defining Features of ADHD That Everyone Overlooks]
How do I recognize an interest-based ADHD nervous system?

Clinicians often ask, "Can you pay attention?" And the answer is typically, "Sometimes."

This is the wrong question. Parents, loved ones, and teachers answering it often express frustration because they have seen you hone in on something you enjoy - like video games - for hours, so your inability to conjure that same focus for other tasks and projects is interpreted as defiance or selfishness.

Instead, practitioners should ask, "Have you ever been able to get engaged and stay engaged?" Then, "Once you're engaged, have you ever found something you couldn't do?"

Anyone with ADHD will answer along these lines: "I have always been able to do anything I wanted so long as I could get engaged through interest, challenge, novelty, urgency, or passion."

"I have never been able to make use of the three things that organize and motivate everyone else: importance, rewards, and consequences."

What can I do to manage an interest-based nervous system?

An effective ADHD management plan needs two parts:

medication to level the neurological playing field

a new set of rules that teach you how to get engaged on demand

Stimulant medications are very good at keeping the ADHD brain from getting distracted once they are engaged, but they do not help you get engaged in the first place.

Most systems for planning and organization are built for neurotypical brains that use importance and time to spark motivation. Instead, you must create your own "owner's manual" for sparking interest by focusing on how and when you do well, and creating those circumstances at the outset.

This work is highly personal, and will change over time. It can involve strategies like "body-doubling," or asking another person to sit with you while you do work. Or "injecting interest" by transforming an otherwise boring task through imagination. For example, an anatomy student who is bored with studying can imagine she is learning the anatomy to save her idol's life.

2. ADHD Emotional Hyperarousal

What is emotional hyperarousal?

Most people expect ADHD to create visible hyperactivity. This only occurs in 25% of children and 5% of adults. The rest experience an internal feeling of hyperarousal. When I ask people with ADHD to elaborate on it, they say:

"I'm always tense. I can never relax."

"I can't just sit there and watch a TV program with the rest of the family."

"I can't turn my brain and body off to go to sleep at night."

People with ADHD have passionate thoughts and emotions that are more intense than those of the average person. Their highs are higher and their lows are lower. This means you may experience both happiness and criticism more powerfully than your peers and loved ones do.

Children with ADHD know they are "different," which is rarely experienced as a good thing. They may develop low self-esteem because they realize they fail to get engaged and finish what they start, and because children make no distinction between what you do and who you are. Shame can become a dominant emotion into adulthood as harsh internal dialogues, or criticism from others, becomes ingrained.

How do I recognize emotional hyperarousal?

Clinicians are trained to recognize mood disorders, not the increased intensity of moods that comes with ADHD. Many people with ADHD are first misdiagnosed with a mood disorder. On average, an adult will see 2.3 clinicians and go through 6.6 antidepressant trials before being diagnosed with attention deficit disorder.

Mood disorders are characterized by moods that have taken on a life of their own, separate from the events of the person's life, and often last for more than two weeks. Moods created by ADHD are almost always triggered by events and perceptions, and resolve very quickly. They are normal moods in every way except for their intensity.

Clinicians should ask, "When you are upset, do you often 'get over it' quickly?" "Do you feel like you can't rid your brain of a certain thought or idea when you want to?"

What can I do to manage emotional hyperarousal?

To counteract feelings of shame and low self-esteem, people with ADHD need support from other individuals who believe they are a good or worthwhile person. This can be a parent, older sibling, teacher, coach, or even a kind neighbor. Anyone, as long as they think you are good, likeable, and capable - especially when things go wrong. This "cheerleader" must be sincere because people with ADHD are great lie detectors.

A cheerleader's main message is, "I know you, you're a good person. If anybody could have overcome these problems by hard work and just sheer ability, it would have been you. So what that tells me is that there's something we don't see that's getting in your way and I want you to know I will be there with you all the way until we figure out what it is and we master that problem."

The true key to fighting low self-esteem and shame is helping a person with ADHD figure out how to succeed with their unique nervous system. Then, the person with ADHD is not left alone with feelings of shame or blamed for falling short.

3. Rejection Sensitivity

What is rejection sensitivity?

Rejection sensitive dysphoria (RSD) is an intense vulnerability to the perception - not necessarily the reality - of being rejected, teased, or criticized by important people in your life. RSD causes extreme emotional pain that may also be triggered by a sense of failure, or falling short - failing to meet either your own high standards or others' expectations.

It is a primitive reaction that people with ADHD often struggle to describe. They say, "I can't find the words to tell you what it feels like, but I can hardly stand it." Often, people experience RSD as physical pain, like they've been stabbed or struck right in the center of their chest.

Often, this intense emotional reaction is hidden from other people. People experiencing it don't want to talk about it because of the shame they feel over their lack of control, or because they don't want people to know about this intense vulnerability.

How do I recognize rejection sensitivity?

The question that can help identify RSD is, "For your entire life, have you always been much more sensitive than other people you know to rejection, teasing, criticism, or your own perception that you have failed?"

When a person internalizes the emotional response of RSD, it can look like sudden development of a mood disorder. He or she may be saddled with a reputation as a "head case" who needs to be "talked off the ledge." When the emotional response of RSD is externalized, it can look like a flash of rage. Half of people who are mandated by courts to receive anger-management training had previously unrecognized ADHD.

Some people avoid rejection by becoming people pleasers. Others just opt out altogether, and choose not to try because making any effort is so anxiety-provoking.

What can I do to manage rejection sensitivity?

98-99% of adolescents and adults with ADHD acknowledge experiencing RSD. For 30%, RSD is the most impairing aspect of their ADHD, in part because it does not respond to therapy.

Alpha-agonist medications, like guanfacine and clonidine, can help treat it. Only about one in three people experience relief from either medication, but 60% experience robust benefits when both are tried. When successfully treated, people with RSD report feeling "at peace," or like they have "emotional armor." They still see the same things happening that would have previously wounded them, but now it bounces off without injury. They also report that, rather than three or four simultaneous thoughts, they now have just one thought at a time.

More Recommended Reading

1. Self-Test: Could You Have Adult ADHD / ADD?

2. Exaggerated Emotions: How and Why ADHD Triggers Intense Feelings

3. Free Download: Inattentive ADHD - Explained

William Dodson, M.D., is a member of ADDitude's ADHD Medical Review Panel.

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3 Defining Features of ADHD That Everyone Overlooks

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The textbook signs of ADD - inattention, hyperactivity, and impulsivity - fail to reflect several of its most powerful characteristics; the ones that shape your perceptions, emotions, and motivation. Here, Dr. William Dodson explains how to recognize and manage ADHD's true defining features of rejection sensitivity, emotional hyperarousal, and hyperfocus.

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An expert on attention deficit and learning disabilities talks about the biology behind ADHD and why it's sometimes so difficult to diagnose and treat symptoms in children.

What Does ADHD Look Like?

In my 40 years as a child and adolescent psychiatrist, I have treated thousands of youngsters. With some children, I am able to make a quick evaluation about attention deficit hyperactivity disorder (ADHD or ADD) and outline a course of ADHD treatment.

With others - more often than I care to admit - I have to tell parents that it's not clear what is wrong. It's not that I lack the expertise or diagnostic skills. It's just that psychiatry isn't quite as far along as other medical specialties.

A pediatrician can do a throat culture and tell at once whether a child needs an antibiotic; appropriate treatment follows the diagnosis. In contrast, psychiatrists are often required to initiate a specific treatment and worry about clarifying the diagnosis later on. As I often tell parents, we must "put out the fire and blow the smoke away" before we can figure out what started the fire.

What Is ADHD vs. Another Condition?

If a child is having problems in school, he may have ADHD, but it's also possible that he has a learning disability. Or a mood disorder. Or anxiety. Sometimes what looks like ADHD is the result of family tensions.

If ADHD seems to be even a part of such a mixed clinical picture, I typically prescribe ADHD medication. If this solves the problem, terrific. But in many cases, another intervention is needed to address persistent academic, emotional, or family problems. Only weeks or months after treatment has been initiated will the full clinical picture become clear.
[Free Download: Secrets of the ADHD Brain]
I understand parents' concern about medicating their children. My clinical knowledge notwithstanding, I agonized over whether my granddaughter, who has ADHD, should be on meds. (Ultimately, we decided she should.) I have found, however, that parents often feel better about ADHD meds when they understand a bit about neurotransmitters, the remarkable compounds that govern brain function.

How Neurotransmitters Work In ADHD Brains

Before I tell you about these special brain chemicals, let me explain a bit about brain anatomy.

There are millions of cells, or neurons, densely packed into various regions of the brain. Each region is responsible for a particular function. Some regions interact with our outside world, interpreting vision, hearing, and other sensory inputs to help us figure out what to do and say. Other regions interact with our internal world - our body - in order to regulate the function of our organs.

For the various regions to do their jobs, they must be linked to one another with extensive "wiring." Of course, there aren't really wires in the brain. Rather, there are myriad "pathways," or neural circuits, that carry information from one brain region to another.

Information is transmitted along these pathways via the action of neurotransmitters (scientists have identified 50 different ones, and there may be as many as 200). Each neuron produces tiny quantities of a specific neurotransmitter, which is released into the microscopic space that exists between neurons (called a synapse), stimulating the next cell in the pathway - and no others.

How does a specific neurotransmitter know precisely which neuron to attach to, when there are so many other neurons nearby? Each neurotransmitter has a unique molecular structure - a "key," if you will - that is able to attach only to a neuron with the corresponding receptor site, or "lock." When the key finds the neuron bearing the right lock, the neurotransmitter binds to and stimulates that neuron.
[Self-Test: Could You Have a Working Memory Deficit?]
Neurotransmitter Deficiencies In ADHD Brains

Brain scientists have found that deficiencies in specific neurotransmitters underlie many common disorders, including anxiety, mood disorders, anger-control problems, and obsessive-compulsive disorder.

ADHD was the first disorder found to be the result of a deficiency of a specific neurotransmitter - in this case, norepinephrine - and the first disorder found to respond to medications to correct this underlying deficiency. Like all neurotransmitters, norepinephrine is synthesized within the brain. The basic building block of each norepinephrine molecule is dopa; this tiny molecule is converted into dopamine, which, in turn, is converted into norepinephrine.

A Four-Way Partnership

ADHD seems to involve impaired neurotransmitter activity in four functional regions of the brain:

Frontal cortex. This region orchestrates high-level functioning: maintaining attention, organization, and executive function. A deficiency of norepinephrine within this brain region might cause inattention, problems with organization, and/or impaired executive functioning.

Limbic system. This region, located deeper in the brain, regulates our emotions. A deficiency in this region might result in restlessness, inattention, or emotional volatility.

Basal ganglia. These neural circuits regulate communication within the brain. Information from all regions of the brain enters the basal ganglia, and is then relayed to the correct sites in the brain. A deficiency in the basal ganglia can cause information to "short-circuit," resulting in inattention or impulsivity.

Reticular activating system. This is the major relay system among the many pathways that enter and leave the brain. A deficiency in the RAS can cause inattention, impulsivity, or hyperactivity.

These four regions interact with one another, so a deficiency in one region may cause a problem in one or more of the other regions. ADHD may be the result of problems in one or more of these regions.

Trial and Error

We don't know which brain region is the source of ADHD symptoms. Nor can we tell whether the problem lies with a deficiency of norepinephrine itself or of its chemical constituents, dopa and dopamine. Thus, doctors must rely on clinical experience to determine which medication to try for each child, and at what dosage.

Someday, when our knowledge of the brain is greater, the diagnosis and treatment of ADHD will be more nuanced. Instead of diagnosing simply "ADHD," and prescribing a stimulant, we might be able to say, "Billy's ADHD is caused by a deficiency of dopa in the frontal cortex, so he needs medication A," or "Mary has a type of ADHD caused by a deficiency of dopamine in the limbic system, so she needs medication B," or "José has ADHD caused by a deficiency of norepinephrine in the reticular activating system, and he needs medication C."

What do ADHD medications do? In simple terms, they raise the level of norepinephrine within the brain. (Stimulants work by causing the brain to synthesize more norepinephrine; nonstimulants by slowing the rate at which norepinephrine is broken down.) Once the level is where it should be, the brain functions normally, and the individual becomes less hyperactive, inattentive, and/or impulsive. Once the drug wears off, the level falls - and symptoms return.

And so we come to the conclusion of Neuroscience 101. I hope you have a greater knowledge of, and appreciation for, the human brain. I also hope you have a better understanding of neurotransmitters and how they are linked to ADHD.

In years to come, I'm sure we will gain a more comprehensive understanding of ADHD - and new medications that will be more effective than those we have now. I can't wait.
[Self-Test: Signs of Emotional Hyperarousal] Larry Silver,M.D., is a member of ADDitude's ADHD Medical Review Panel.
Updated on December 19, 2019

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An expert on attention deficit and learning disabilities talks about the biology behind ADHD and why it's sometimes so difficult to diagnose and treat symptoms in children. In my 40 years as a child and adolescent psychiatrist, I have treated thousands of youngsters.

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Is It ADHD? Does It Cause Executive Dysfunction?

A child or an adult with attention deficit disorder ( ADHD or ADD) might be hyperactive, inattentive, and/or impulsive. Clinicians have always understood hyperactivity and impulsivity. The understanding of inattention, though, has shifted from primarily "the inability to stay on task" to a broader concept called executive function disorder (EFD), which involves a pattern of chronic difficulties in executing daily tasks. This is sometimes called executive dysfunction.

What Is Executive Function?

Think of executive function as what the chief executive officer of a company must do - analyze, organize, decide, and execute. Around the time of puberty, the frontal part of the cortex of the brain matures, allowing individuals to perform higher-level tasks like these:

1. Analyze a task

2. Plan how to address the task

3. Organize the steps needed to carry out the task

4. Develop timelines for completing the task

5. Adjust or shift the steps, if needed, to complete the task

6. Complete the task in a timely way

What Is Executive Dysfunction?
And what is executive function disorder (EFD)?
Executive dysfunction is a brain-based impairment that causes problems with analyzing, planning, organizing, scheduling, and completing tasks at all - or on deadline.

A child without problems with executive function may appear like this: A middle-schooler's teacher assigns the class a book to read, and writes the due date for the book report on the board. A student must be able to determine where to get the book and how long he thinks it will take to finish reading it. If the teacher has a specific book-report format, the student will have to keep it in mind as he reads the book and takes notes. He needs enough time to write a rough draft, get help from teachers or parents, if needed, and write a final draft by the due date. If the student has good executive function skills, the work will get done on time. If he has EFD, it won't.
[Self-Test: Could Your Child Have an Executive Dysfunction?] Recognize the signs and symptoms of executive dysfunction.
Children and adults with EFD have problems organizing materials and setting schedules. They misplace papers, reports, and other school materials. They might have similar problems keeping track of their personal items or keeping their bedroom organized. No matter how hard they try, they fall short.
A Tale of Two Children: One Diagnosed With EFD and ADHD, One Diagnosed With EFD and LD
Marcus, a fifth-grader, had difficulty staying on task and completing his schoolwork. He also had problems keeping his backpack and papers organized and remembering what to bring home from or take to school. Psycho-educational testing showed that he was bright, but that he had difficulties with processing speed and working memory. These findings, plus other studies, showed evidence of difficulties with executive function. The psychologist concluded that Marcus had ADHD, inattentive type, and started him on a stimulant medication. He showed significant improvement in all areas.

Ethan, a sixth-grader, received the same diagnosis but had a different result. The presenting problems, and the psycho-educational test results, were the same as Marcus'. Ethan was given a stimulant, but his symptoms didn't improve. A closer review of his psycho-educational test results showed that he had problems retaining what he read and with written work. Ethan had EFD, but his problems resulted in Learning Disabilities (LD). He needed tutoring, plus accommodations, to overcome his challenges.

Signs and Symptoms of EFD and LD

If you look at the criteria used to diagnose ADHD, inattentive type, you could understand why a child with EFD might be diagnosed as having ADHD. But it's important to know that EFD can cause learning disabilities (LD).
[Free Download: Executive Function Worksheet]
Martha Bridge Denckla, M.D., an expert on executive function disorder, says, "EFD can be a reflection of ADHD, but it might also indicate an LD." When a professional evaluating a child or adult finds evidence of EFD, it is essential for her to clarify whether the disorder results in ADHD, LD, or both. Only then can the child or adult receive the appropriate treatment for his specific problem.

In elementary school, a child learns to read, to write, and the basics of spelling, grammar, punctuation, and capitalization. She learns basic math concepts - addition, subtraction, fractions, and decimals. In middle and high school, with expanded executive function abilities, the student has a greater ability to organize and process information.

When reading, the student must organize the content before it can be stored. This is reading fluency. When writing, a student must be able to pull information from memory and to organize this information before he can start. A teacher might ask, "Can you tell me the theme of the book, and give examples to illustrate it?" The ability to retrieve and organize information in order to write a response is called writing fluency. Solving math problems requires retrieving learned concepts (formulas, rules) as well as known facts (multiplication tables) - and to use this information to find the answer.

A student with executive dysfunction might have difficulty organizing information before storing it in memory, or difficulty organizing information that is retrieved from memory. He might read a chapter but not retain what he has read. He might know the material but be unable to write an answer or start a paper because he cannot organize his thoughts. He might be able to write out math equations, but makes careless errors along the way.

When such students are tested, the results might show that their problems stem from EFD, but professionals are too quick to decide that the problem is ADHD. Professionals must look closely at the educational part of the assessment. If the results show that the student has difficulties with reading, writing, or math fluency, the EFD is also a reflection of an LD. It is vital to make the correct diagnosis - for the child's sake.

Not all practitioners understand that executive function disorder can bring a diagnosis of ADHD, LD, or both. Even when psycho-educational test results support a diagnosis of LD, some conclude that the child has ADHD, inattentive type.

Signs and Symptoms of ADHD and EFD

Russell Barkley, Ph.D., who has been at the forefront of exploring the relationship between ADHD and EFD, says, "It is not that the individual does not know what to do. It is that somehow it does not get done."

The symptoms of ADHD, inattentive type, often improve with a stimulant. The symptoms of LD don't improve with medication. The best way to manage LD is through specialized accommodations and one-on-one work with a learning specialist.

Observe your child closely at home. Now that you understand how EFD affects learning, look for signs of LD and ADHD. If the only focus is on ADHD, talk with your family doctor and school professionals about your concerns.

If necessary, share this article with the school administrators and other professionals to educate them about the relationship between EFD, LD, and attention deficit.
[How ADHD (Inattentive Type) Looks A Lot Like Learning Disabilities] Larry Silver, M.D., is a member of ADDitude's ADHD Medical Review Panel.

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Executive dysfunction is a brain-based impairment that impacts a person's ability to analyze, organize, decide, and execute things on time. It causes assignments to be lost, deadlines to be missed, and projects to overwhelm. Learn how to recognize the signs of executive dysfunction, and how to differentiate them from ADHD and/or learning disabilities.

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Universal Design for Learning: 5 Strategies That Benefit Neurodiverse Students

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What is Universal Design for Learning?

Universal Design for Learning (UDL) prompts teachers to proactively avoid the one-size-fits-all methods of instruction that so rarely work for neurodiverse students. Under UDL, teachers plan lessons, create projects, develop assessments, and reinforce classroom management - all with the aim of providing flexible options for all types of learners, including those with ADHD and learning differences.

The goal here is to leverage students' individual strengths to increase confidence and reduce anxiety so that everyone can absorb new information and develop new skills.

How can teachers best support a group of neurodiverse learners through UDL? These five strategies have been proven effective in the classroom.

Universal Design for Learning: Effective Classroom Strategies

1. Plan active lessons.

Students with attention and learning challenges rarely learn best when asked to sit and remain focused for long periods. Typically, their engagement increases when they're active. In other words, they're better on their feet.

An active lesson may comprise hanging blank posters around the room and having students move from wall to wall, adding answers and other information with markers. Math teachers can design kinesthetic activities to complement the procedures and algorithms. For example, they can ask students to stretch masking tape on hard floors to practice perimeter and area.
[Get This Free Download: 20 Learning Strategies Designed for Students with ADHD]
But active lessons can also incorporate technology. If students have access to class computers, they can create shared docs like Google Jamboard to post questions or comments during lessons or at designated times. In my experience, students with ADHD are usually skilled with computer apps, and giving them this opportunity works with their strengths.

2. Incorporate personal interests into projects.

A simple but effective way to sustain student engagement is to integrate a student's personal interests and talents into their learning during classroom instruction, homework, and/or large projects.

Are there TV shows or video games that your students love? Do they have backpacks and belongings with stickers? Do they participate in after-school activities? Figure out how to include these interests in your teaching. If they are fans of a specific movie, TV show, book or comic, have students practice their analytical skills on their favorites. And when you've assigned them to read a book, ask them to compare the narratives/characters they love with the ones in the assigned text.

As for math, sports and physical activity use angles, measurements, statistics, data, and other concepts. When we make math applicable to the real world, we open the possibilities of relating it to a student's interests.
[Read: Teaching Strategies for Students with ADHD: Ideas to Help Every Child Shine]
3. Give options for expression.

I recently worked with a high school student who struggled to produce written work. His humanities teacher had assigned multiple pages of questions as a comprehension assessment to their government unit. I consulted with the teacher and student, and we agreed that this task would have taken him forever and ended in frustration. Instead, the teacher tested the student by having a conversation with him about the material, as he was enthused about the topic and had a lot of related thoughts and ideas.

Flexibility benefits all assignments. Speech-to-text options, for example, can help students who struggle with writing to increase their written expression. I've seen students who've produced only minimal writing with pencils increase their output when given tablets with voice recognition enabled.

Encourage students to use their talents and creativity to show what they've learned. A student with drawing talent could sketch out a poster representing the Bill of Rights. Another might want to write a song explaining the water cycle. Students may display more comprehension while recording a podcast about "The Odyssey" than while taking a test on it.

4. Build in executive function support.

Executive function interventions are typically reserved for individual students with ADHD, but these supports can be built into lessons, projects, and daily routines to benefit the entire class.

For large projects, provide students with step charts so they can track each phase - from brainstorming to outlining to writing to preparing supplemental resources - on the way to project completion. Incorporate calendars to help build planning and time management skills. These tools and strategies ultimately teach students how to break down tasks into incremental steps.

I once made a "baking checklist chart" for a student who baked as a hobby, to help him learn to edit his own writing. The visual guide compared writing an essay to baking a cake. He was enthused that his special interest was now part of an academic skill.

5. Provide options for the working environment.

More schools and teachers now understand that some kids focus and learn better when they can stand up and walk around, either intermittently or continuously. Alternative seating promotes engagement and also accommodates students' varied ergonomic preferences.

Some students find that listening to music helps calm their minds and sustains focus on independent work. Though I've seen teachers play soothing music for the whole classroom, a child who benefits from music could wear headphones when doing quiet work.

Fish can't climb trees. Neither can elephants. But ask a fish to navigate a river, or an elephant to carry a heavy load, and they're on it. Incorporating universal design into our classrooms allows neurodiverse students to work with their strengths and creativity to learn new material, develop new skills, and stay engaged.

Universal Design for Learning: Next Steps

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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Universal Design for Learning: 5 Strategies That Benefit Neurodiverse Students

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Universal Design for Learning is a teaching approach that aims to support and encourage all types of students, including those with ADHD and learning differences. Teachers can use these strategies - from planning active lessons to supporting executive functions - to break free from one-size-fits-all methods of instruction.

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5 Academic Challenges Rooted in ADHD Executive Dysfunction

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Executive dysfunction is difficult to recognize. When manifested in the classroom, EF challenges are often mistaken for disobedience, laziness, defiance, or apathy.

Here are five common (and commonly misinterpreted) executive functioning hurdles - and proven strategies for each.

EF Challenge #1: Getting Started

Prompt the student to start working by giving them a private signal like tapping your head or pulling your ear.

Ask a classmate to tap on the student's desk as a reminder to keep working.

Set a timer or alarm reminder to start or resume work.

EF Challenge #2: Finishing Work

Encourage students to complete and submit their work in Google Docs that automatically save and can't be easily lost.

Alternatively, allow students to submit completed homework via email with a scan attachment.

Assign student pairings to mutually double check work completion.

Religiously put completed assignments in the book bag each evening after homework.

[Get This Free Download: Smart Homework Strategies for Teachers & Parents]

Designate row captains to check that homework is turned in and that new homework assignments are written down.

Send homework assignments to students and parents via an app like Remind.

Designate a student to write down all assignments and distribute the list at day's end or via email.

Post concise class rules.

Write assignments on the board or print out instructions for each student.

When lining up to leave the classroom, ask a fidgety student to lead the line and set an example for others.

EF Challenge #5: Regulating Emotions

Give students a sheet of five or six basic emoji icons and ask them to circle how they are feeling each day.

As a class, read the flipbook, I Know What to Do When I'm Feeling(#CommissionsEarned), which is all about teaching emotional regulation.

Conduct a class-wide check on students' emotional health by asking them to place one sticky note each on a chart displaying five or six feelings: "I'm great." "I'm OK." "I'm meh." I'm struggling." "I need a check in." To maintain confidentiality, students should write their names on the back of the sticky note.

Hang a poster offering 10 self-calming tips - for example, take deep breaths, count to 10, listen to music, or walk it off.

How to Control Emotions & Other Classroom Challenges: Next Steps

Schoolhouse Blocks: Foundational Executive Functions

Access more resources from ADDitude's Schoolhouse Blocks: Foundational Executive Functions series exploring common learning challenges and strategies to sharpen core EFs at school.

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5 Academic Challenges Rooted in ADHD Executive Dysfunction

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Executive dysfunction is difficult to recognize. When manifested in the classroom, EF challenges are often mistaken for disobedience, laziness, defiance, or apathy. Here are five common (and commonly misinterpreted) executive functioning hurdles - and proven strategies for each. Prompt the student to start working by giving them a private signal like tapping your head or pulling your ear.

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What Is ADHD From? Is It Hereditary?

Attention deficit hyperactivity disorder (ADHD or ADD) is a brain disorder with a number of likely causes - though the medical community still can't pinpoint exactly which one explains the symptoms of ADHD. Researchers suspect that a gene involved in the creation of dopamine, a chemical that controls the brain's ability to maintain regular and consistent attention may be traced back to ADHD. But conclusive studies are far outnumbered by ADHD myths and misperceptions today.

ADHD is not caused by bad parenting, too much sugar, or too many video games. It is a brain-based, biological disorder. Brain imaging studies and other research show many differences in the brains of individuals with ADHD. Other studies reveal that a child with ADHD is four times as likely to have had a relative also diagnosed with the condition.

Is ADHD Genetic?

Available evidence suggests that ADHD is genetic-passed down from parent to child. ADHD seems to run in at least some families. At least one-third of all fathers who had ADHD in their youth have children with the condition. What's more, the majority of identical twins share the ADHD trait.

Researchers in the U.S. and Europe are working now to determine which genes, specifically, make an individual susceptible to ADHD. Scientists are investigating many different genes that may play a role in developing ADHD, especially genes linked to the neurotransmitter dopamine. They believe it likely involves at least two genes, since ADHD is such a complex disorder.
[Get This Free Download: Unraveling the Mysteries of Your ADHD Brain]
There's still a lot of work to do on the genetic aspect of ADHD. The discovery of genes that contribute to ADHD could make diagnosing the condition easier. It might also make it possible to find better treatments for people with varying symptoms of ADHD.

What Parts of the Brain Are Affected by ADHD?

ADHD brains exhibit structural and functional differences.

The image above shows differences between an adult with ADHD (right) and a non-ADHD brain. (The purple halo surrounding the brain image is an image artifact and not part of the brain.)

Scans and other neuro-imaging research have shown that the brains of children with ADHD mature more slowly than do those of children without the disorder. In addition, recent studies with fMRI imaging show variations in areas of the brain that control many ADHD symptoms. In children with ADHD, several brain regions and structures (pre-frontal cortex, striatum, basal ganglia, and cerebellum) tend to be smaller by roughly 5%. While this average difference is observed consistently, it is too small to be useful in making the diagnosis of ADHD in a particular individual.
[Read This Next: One Family's History With ADHD]
These findings may one day lead to using brain imaging to diagnose ADHD, however this remains a rare and somewhat controversial practice today.

How Does ADHD Impact the Brain?

ADHD brains also exhibit chemical differences.

ADHD was the first disorder scientists found to result from the deficiency of a specific neurotransmitter - in this case, dopamine - and the first disorder found to respond to medications designed to correct this underlying deficiency. Children and adults with ADHD seem to have low levels of dopamine.

ADHD appears to impair neurotransmitter activity in four functional regions of the brain:

Frontal cortex. This region orchestrates our high-level functioning: maintaining attention, organization, and executive function. A deficiency of dopamine within this brain region might cause inattention, problems with organization, and/or impaired executive functioning.

Limbic system. This region, located deeper in the brain, regulates our emotions. A dopamine deficiency in this region might result in restlessness, inattention, or emotional volatility.

Basal ganglia. These neural circuits regulate communication within the brain. Information from all regions of the brain enters the basal ganglia, and is then relayed to the correct sites in the brain. A dopamine deficiency in the basal ganglia can cause information to "short-circuit," resulting in inattention or impulsivity.

Reticular activating system. This is the major relay system among the many pathways that enter and leave the brain. A dopamine deficiency in the RAS can cause inattention, impulsivity, or hyperactivity.

These four regions interact with one another, so a deficiency in one region may cause a problem in one or more of the others. ADHD results from problems in one or more of these regions.

Is ADHD Caused by Toxins and Pollution?

Scientific research suggests that exposure to chemicals - everyday toxins found in foods, carpeting and flooring, cleaning and lawn products, and personal-care products, like toothpastes - may contribute at least somewhat to disorders such as ADHD, autism, and learning disabilities. Infants and children are especially vulnerable to chemical exposure because their biological systems are still developing. During fetal development, exposure to even minuscule amounts of toxins at critical junctures can have a lifelong impact on the child's brain and physical health. Brain development may be impacted by these toxins. These findings come from research that is not widely respected by all members of the medical community.

In 2010, the Learning and Developmental Disabilities Initiative (LDDI) released the first-ever report identifying chemical pollution in people from the learning and developmental disability community, called " Mind, Disrupted: How Chemicals May Affect How We Think and Who We Are." It concluded that you don't have to live next to a waste site to be exposed to brain-damaging chemicals. Examples of household chemicals include:

Perfluorinated compounds (PFCs) are used to prevent food and other substances from sticking to carpets, drapes, and cooking pans. Teflon and Scotchgard are examples.

Polybrominated diphenyl ethers (PBDEs), used as fire retardants, are found in clothing and furniture, as well as bedding.

Triclosan is an antibacterial agent found in soaps, toothpastes, and many other personal-care products.

Bisphenol A (BPA) is an epoxy resin used to line food cans and other containers. It is also used to make plastic containers, like infant bottles, and certain paper products.

Phthalates make rubber-based materials soft and pliable. They are found in vinyl, plastic bottles, toys, shower curtains, and raincoats. They are also used to make personal-care products, air fresheners, and shampoos.

Every participant in the Learning and Developmental Disabilities Initiative tested positive for at least 26 of the 89 chemicals studied.

A 2015 study, completed by the University of Calgary, linked the chemicals used in making plastic (BPA and BPS) to hyperactivity in zebrafish, which are often used to study embryonic brain development because they share 80 percent of the genes found in humans, and have similar developmental processes. They called the results of their study, "a smoking gun" that linked negative changes in brain development to BPA and BPS exposure.

Lead exposure may also cause ADHD symptoms, according to a study published in Psychological Science in 2015. The study's researchers emphasized that lead exposure is not the only cause of ADHD symptoms; rather, it's one environmental factor that may lead to a formal ADHD diagnosis. Similarly, lead exposure doesn't guarantee an ADHD diagnosis, but it may provide doctors with further clues about the root of a child's symptoms.
[With Evidence That ADHD Is Genetic Mounting, Should Testing Become a Family Affair?]
Is ADHD Impacted by Nutritional Factors?

At one time, doctors believed that refined sugar and food additives made children hyperactive and inattentive. As a result, parents were encouraged to stop serving children foods containing artificial flavorings, preservatives, and sugars.

However, after studying the data, researchers from the National Institutes of Health (NIH), the federal agency responsible for biomedical research, held a major scientific conference to discuss the issue in 1982. These scientists concluded that removing sugar and food additives only seemed to help about 5 percent of children with ADHD, mostly either young children or children with food allergies.

Despite a lack of conclusive research, many families still swear by the 40-year-old Feingold Program, a nutrition plan that claims to reduce symptoms of ADHD in children by eliminating their consumption of food additives and coloring, artificial sweeteners, and certain preservatives.

How Does Culture Impact ADHD Symptoms and Diagnoses?

A newer, more controversial theory contends that ADHD is a byproduct of our fast-paced, stressed-out, consumer-driven lifestyle. Michael Ruff, M.D., a clinical associate professor of pediatrics at Indiana University, believes that this cultural influence explains parts about ADHD that genetics can't.

In an article in Clinical Pediatrics, Dr. Ruff called ADHD an 'epidemic of modernity.' "I'm talking about the cultural environment that prevails today - the modern way of life and its impact on the developing brain," says Ruff. "Today's children are immersed in a world of instant messaging and rapid-fire video games and TV shows. When kids get accustomed to such a rapid tempo, it's hard for them to adjust to the comparatively slow pace of the classroom. They transfer the sense of urgency they've seen at home to their academic endeavors."

Dr. Ruff suggests we ask, "Have we failed to acknowledge the extent to which environmental factors influence these processes?"

There's no disputing that ADHD is a complex disorder and likely has many different causes and factors - all currently under investigation. Still, while environmental and cultural factors can alter behavior and child development, research confirms that ADHD is primarily a biologically-based disorder.
[Read This Next: I Wonder Where My Son Gets That From?] Larry Silver, M.D., is a member of the ADDitude ADHD Medical Review Panel.
View Article Sources

1 John M. Grohol. Causes of Adult Attention Deficit Hyperactivity Disorder (ADHD). PsychCentral (Feb 2017). https://psychcentral.com/adhd/causes-of-adult-attention-deficit-hyperactivity-disorder-adhd/
2 ADHD Genetic Research Study. National Human Genome Research Institute (Mar. 2014). https://www.genome.gov/Current-NHGRI-Clinical-Studies/ADHD-Genetic-Research-Study-at-NIH
3 Singh, Ajay et al. "Overview of Attention Deficit Hyperactivity Disorder in Young Children." Health psychology research (Apr. 2015). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768532/
4 Philip J. Landrigan, Jordan Slutsky. Are Learning Disabilities Linked to Environmental Toxins? Learning Disabilities Worldwide. https://www.ldworldwide.org/environmental-toxins
5 Abulafia, Laura et al. Mind, Disrupted: How Chemicals May Change How We Think And Who We Are. A Biomonitoring Project With Leaders of the Learning and Developmental Disabilities Community. http://www.minddisrupted.org/documents/Mind%20Disrupted%20report.pdf
6 Bill Graveland. Hyperactivity in fish linked to bisphenols used to make plastic. The Globe and Mail (May 2018). https://www.theglobeandmail.com/life/health-and-fitness/health/hyperactivity-in-fish-linked-to-bisphenols-used-to-make-plastic/article22428491/
7 Nigg, J. T., Elmore, A. L., Natarajan, N., Friderici, K. H., & Nikolas, M. A. Variation in an Iron Metabolism Gene Moderates the Association Between Blood Lead Levels and Attention-Deficit/Hyperactivity Disorder in Children. Psychological Science (2016). https://journals.sagepub.com/doi/abs/10.1177/0956797615618365#articleCitationDownloadContainer
8 Ruff, M. E. Attention Deficit Disorder and Stimulant Use: An Epidemic of Modernity. Clinical Pediatrics (Sep. 2005). https://journals.sagepub.com/doi/abs/10.1177/000992280504400701#articleCitationDownloadContainer

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What causes ADHD? Is it a genetic or hereditary condition? Influenced by culture and environment? What about nutrition? We don't know for certain what causes attention deficit, but medical research points to genetic and neurological explanations for symptoms exacerbated by some external factors.

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Face It - People with ADHD Are Wired Differently

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On a hot summer day in my new office, my client and I were shivering cold. "The air conditioning is hyperactive, maybe?" I jokingly wondered as we pulled on sweaters. I turned the thermostat up to 76 degrees, then 80, but the cold air wouldn't stop.

"Our HVAC system seems overactive," I explained later to my husband. "Could it be too big for the office space?"

"It's probably the thermostat, not the air-conditioner," he said. His insight didn't warm my office, but it made sense. It wasn't a cooling-system problem, but a control-system problem. Punching temperature control buttons wasn't helpful if the instructions weren't getting to the air-conditioner.

A few days later, I met an office neighbor. When I told him about my problem, he proposed another theory: "Your thermostat doesn't work. My thermostat controls your air conditioner. We aren't really sure if it controls my offices. No matter how much I lower it, we're always too hot." A little more investigation revealed that his thermostat didn't control my office, and that no one - not even the building's owners - understood the wiring.

Understanding how ADHD brains are wired is critical for understanding how to explain and treat the disorder. For decades, we weren't sure how ADHD brains worked, and this led to many misunderstandings about the syndrome. Many doctors, therapists, social workers, and coaches tried to teach children with attention deficit disorder ( ADHD or ADD) to slow down using the self-control methods that neurotypical children use. They thought they were programming the right thermostat.
[Free Download: Secrets of the ADHD Brain]
"Take a deep breath and press the following buttons on your activity thermostat" makes sense if the wiring is standard, but not if the wires are connected differently, as they are in children and adults with ADHD. The most current research on brain imaging is starting to let us trace the wiring, so we can untangle the misconceptions that experts, as well as those with ADHD, have about the disorder and the brain. Our new understanding of the brain promises to change the way we treat ADHD.

The Brain Up Close

Researchers use structural imaging, which provides two- or three-dimensional pictures, to uncover the anatomy of the brain. Computed tomography (CT) scans and magnetic resonance imaging (MRI) are examples of structural imaging techniques. The images are used to measure the size and volume of the whole brain or specific areas within the brain.

To study brain functions, researchers use scans that show physiologic activity inside the brain. You've probably seen these studies covered in the press. The coverage usually includes statements like "X is the part of the brain that 'lights up' when people do Y." Older functional scans - electroencephalography (EEG) and single-photon emission computed tomography (SPECT) - measure patterns of nerve activity or blood flow, respectively. Newer methods, such as positron emission tomography (PET), use radioactive tracers that can be seen in the brain.

Much of what we know about dopamine function in the brain results from the radioactive tracer raclopride, which is injected into the body and attaches to empty dopamine receptors. Raclopride binding is higher in the brains of children or adults with ADHD, so we "see" that their dopamine activity levels are low. Raclopride binding drops to normal levels an hour after stimulant medications are taken. This is why neuroscientists now say that stimulants normalize dopamine function in the brains of people with ADHD.
[Neuroimaging and ADHD: Findings, Limitations, and Promise]
Functional imaging gives information about activity in specific areas of subjects' brains before and during task performance. Functional magnetic resonance imaging (fMRI) shows oxygen uptake in areas of high nerve activity, and magnetoencephalography (MEG) shows us nerve activity in detail. A promising variant of fMRI, called fMRI-DTI (for diffusion tensor imaging), measures the connection between different regions of the brain. Crosstalk - the ability of different regions of the brain to communicate with each other - is vital to brain function, and it is significantly reduced in ADHD brains.

Many different techniques are used in brain imaging - though not all provide valid or generalizable information - and they give researchers useful glimpses into brain wiring and structure. In order to understand the causes of ADHD better and to treat it more effectively, we need to know the wiring of the brain and how it operates.

The ADHD Brain: Structurally Different

Neuroimaging studies have revealed the structural differences in the ADHD brain. Several studies have pointed to a smaller prefrontal cortex and basal ganglia, and decreased volume of the posterior inferior vermis of the cerebellum - all of which play important roles in focus and attention.

What this means is ADHD is not a difference in behavioral preference. Instead, ADHD appears to be partially attributed to a difference in how the brain is structured. What may look like behavioral choices - laziness, sloppiness, and forgetfulness - are likely due to differences in brain structure.

Researchers at Cambridge, England, and Oulu, Finland, followed 49 adolescents diagnosed with ADHD at age 16 and examined their brain structure and memory function in young adulthood (between 20 to 24 years old), compared to a control group of 34 young adults. The results showed that the group diagnosed in adolescence had reduced brain volume as adults, leading to poorer memory function, even if they no longer met the diagnostic checklist criteria for ADHD. Researchers saw reduced gray matter in a region deep within the brain known as the caudate nucleus, the brain region that integrates information across different parts of the brain and supports cognitive functions, including memory.

Because the structural differences persist into adulthood for most children with ADHD, the chance that a child will outgrow ADHD is not as great as we once thought. Sixty to 75 percent of adults who had ADHD in childhood continue to meet diagnostic criteria in adulthood. Most of those who "outgrow" ADHD continue to manifest many of its symptoms. Adults may score just under the cutoff on diagnostic checklists, but they are likely to continue to have abnormal brain structure, as well as functional impairments in relationships and the workplace.

The Changing Brain

Researchers once thought that each human function was assigned to a specific part of the brain, and that a part damaged by trauma or disease permanently lost its function. Now, research has shown that the human brain changes in response to stimulation; brains have neuroplasticity. The good news is that your brain retains this ability to change from birth to old age. ADHD brains that have deficits in one area will attempt to rewire themselves to accomplish a task.

There are activities that can increase the brain's effectiveness. Meditation, for example, changes the brain in important ways. Researchers worked with people who'd never meditated before (ADHD was not accounted for as a variable), and put one group through an eight-week mindfulness-based stress-reduction program. The primary difference was in the posterior cingulate, which is involved in mind wandering and self-awareness. Another notable change was in the left hippocampus, which assists in learning, cognition, memory, and emotional regulation. Subsequent studies applied this research using ADHD participants, and similar changes were noticed.

The ADHD Brain: A Network of Its Own

Researchers at Harvard University studied ADHD and non-ADHD subjects as they responded to a challenging cognitive task. While both groups had difficulty with the task, the ADHD group failed to activate their anterior cingulate cortex, which plays two significant roles in attentional processing: adjusting the focus of a person's attention (where and when) as well as balancing the focus of attention (how much attention for how long). ADHD participants engaged a different, less specialized part of their brain when tackling the task.

What this means. This research highlights what individuals with attention deficit already know. It is difficult to know what to do and when to do it. This is because of an apparent lack of ability to engage the most effective part of their brain, the anterior cingulate cortex.

The default mode network (DMN) represents the regions of the brain that are active when no specific task is being performed - while daydreaming, say, an activity that is undervalued by researchers and society. In the past, this was called the "resting state." Once functional scans showed how active the brain is at rest, the name was changed.

The DMN takes care of task-irrelevant mental processes, mind-wandering, contemplation, and reflection. It comprises the precuneus/posterior cingulate cortex, the medial prefrontal cortex, and the lateral and inferior parietal cortex. The DMN is more active when individuals are at wakeful rest, engaged in internal tasks, such as daydreaming, recovering memories, and assessing others' perspectives. Conversely, when individuals work on active, willful, goal-directed tasks, the DMN deactivates, and attentional pathways engage. The DMN and cognitive control networks work in opposing directions to accommodate attentional demands.

In ADHD, the daydreaming brain doesn't quiet down when the attention circuits turn on. Several studies have focused on the connectivity of the DMN in individuals with ADHD. Weak connections between control centers and the DMN cause an inability to modulate DMN activity. Many studies of children, adolescents, and adults with ADHD, taking and not taking medication, have found that the balance between the cognitive control network and the DMN is either reduced, or absent, in those with ADHD.

The lack of separation between the cognitive control network and the DMN in the ADHD brain suggests why there are attentional lapses. People with ADHD can instruct their focus control system to pay attention to the task at hand - say a pile of bills that need to be paid - but the circuits that connect to the DMN fail to send the instructions to quiet down. When the DMN notices a new magazine lying next to the pile of bills, emotional interest centers light up and overwhelm the weak voice of the cognitive centers.

We have come a long way from our earliest concepts of ADHD as hyperactivity to a dysfunction in the control pathways, but much remains to be studied. Finding which therapies strengthen control centers, which ones improve communication between control centers and action centers, and which ones bypass typical pathways will help adults with the disorder become more productive and confident.

Treating ADHD: What Really Works Best?

"Just tell me one thing so I can get this straight: How much of treating ADHD is medications, and how much is everything else? Is it 50-50? 80-20? Give me a number, so I can wrap my mind around it." Alex wanted Oren Mason, M.D., a family physician in Grand Rapids, Michigan, to cut to the chase. Alex's ADHD treatment plan was complex. He was overwhelmed by the recommendations to exercise daily, hire a coach, listen to some ADHD audio books, get more sleep, and start some supplements. The idea of medication sounded promising to him, but the trials needed to find the right dose of the right medication could take months.

"How much bang for the buck do these treatments give?" is a fair question. People with ADHD have already tried dozens of strategies to improve attention and efficiency that, over time, fizzled out.

On one hand, if non-medication therapies were going to successfully treat Alex's ADHD, they would have done that. He had worked with tutors, therapists, and nutritionist, and read self-help books, but he still had inattention and self-control issues. Medication response can be remarkable, but it isn't the whole story. Physicians can't prescribe pills and assume a patient's ADHD will get better.

Many doctors lack personal experience with ADHD, and don't understand how much more rigorous the treatment is than the oft-heard "just pop a pill." Investigators define successful treatment in scientifically accurate terms such as "a 40 percent or better reduction of investigator-rated DSM-V symptomatology, along with a CGI-I score of at least +2."

Patients, bless them, don't talk like that. They tend to have goals for successful treatment, such as "get more organized," "study," "work to my potential," and "be more thoughtful" or "be less frustrated with my children." These goals are hard to express in numbers. They have an "It's hard to describe, but I'll know it when I see it" endpoint.

Alex wasn't asking Dr. Mason to quote studies, just to help him reach some of his goals. Dr. Mason was about to say "50-50," to emphasize that the effects of medication and non-medication therapies are both important, but what came out was, "They're both essential. It's 100-100. Neither of them matters much without the other."

Researchers have worked on that question and have tried to give us more accurate numbers, even if they aren't exact. It turns out that you get about 30 percent of what researchers call "the potential response" with medications alone, and about the same from evidence-based non-medication therapies. Using only one therapy alone misses 70 percent of the potential improvement. In other words, if your ADHD were a pie, one evidence-based therapy would eat about one third of it. Use another therapy and 30 percent more would be gone, and so on.

Which is best: medication or the non-medication therapies? The answer is not the scientifically accurate one, but the one that spilled out intuitively that day: 100-100. The best responses come with both therapies done at full-court-press levels.
[Free Resource: Stimulant Medications Chart for the Treatment of ADHD]

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Face It - People with ADHD Are Wired Differently

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On a hot summer day in my new office, my client and I were shivering cold. "The air conditioning is hyperactive, maybe?" I jokingly wondered as we pulled on sweaters. I turned the thermostat up to 76 degrees, then 80, but the cold air wouldn't stop.

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A surprising thing happened when I was evaluating teenagers for ADHD. One by one, the mothers of my patients approached me regarding the age-normed rating scale I had developed to gauge their adolescents' symptoms. The questionnaire, which asked about a variety of problems in daily life associated with ADHD and asked both the patients and their caregivers to rate each problem on a scale of 0 to 3. It was hitting a nerve - but not in the way I expected.

"I never had those problems when I was growing up or when I was in school, but over the past few years I've had increasing trouble with many of the items on that list," the mothers told me regarding problems with working memory, organization, focus and attention. "That scares me! It makes me wonder if I had ADHD all this time and didn't know it. But more than that, I worry that those changes could be early signs of Alzheimer's Disorder."

Most of those mothers were well-educated and successful in various businesses or professions. They were also roughly 45 to 55 years old, the typical age of menopause.

Research the Interplay Between Menopause and Dopamine

As I began researching this phenomenon, I was reminded that estrogen is one of the primary modulators for dopamine in the female brain. I began to wonder if the natural reduction of estrogen that comes during menopause might be related to some of the ADHD-like problems that some of those mothers were reporting.

I consulted with Dr. C. Neill Epperson, a colleague of mine when we were both teaching at Yale; she is a psychiatrist specializing in research related to women's issues. She advised me that several studies had reported that many women report mid-life onset of decline in cognitive functions, particularly short-term memory, sustaining attention, and activating/organizing for work tasks.
[Get This Free Download: Focus Your ADHD Brain With 5 Helpful Hacks]
Those discussions led to our collaboration on three research studies about mid-life cognitive problems of menopausal women who did not have ADHD but did have cognitive problems with ADHD-like symptoms that appeared at the time of menopause. We were curious about whether medications used to treat ADHD might be helpful for menopausal women who suffer with mid-life onset of ADHD-like symptoms. Results of those studies were published in peer-reviewed medical journals in medical journals in 2011, 2015, and 2017, but results of that research have not yet been widely recognized.

All of those three studies utilized the adult version of my normed Brown Attention-Deficit Disorder Scale (BADDS), which had been tested not only for evaluating persons for ADHD, but also for testing the effectiveness of several different medications developed and approved for treatment of ADHD.

A Foundation in Executive Functions

Below is a diagram that illustrates the model on which the Brown Attention-Deficit Rating Scale and its more recent successor, the Brown Executive Function/Attention Rating Scale (BEFARS) are based.

The BADDS and BEFARS scales are based on a model that sees ADHD not as a simple behavior problem, but as a complex problem in the development and functioning of the brain's self-management system, its executive functions. This model sees ADHD as a problem that usually is inherited and generally develops during childhood, though, for some, it is not recognized until the person enters teen years or later. More details explaining this model are available on my website.
[Read: The Adult ADHD Mind: Executive Function Connections]
Menopause Research Protocol

The first study done by Dr. Epperson's team involved 15 healthy women who were evaluated to confirm that they did not have ADHD. All were complaining of problems with memory and attention that had started in mid-life after their monthly menstrual periods had stopped. After baseline administration of the BADDS scale, each woman participated in a crossover trial in which they were treated for six weeks with the non-stimulant medication atomoxetine (ATX) or with placebo, followed by a four-week washout period and a six-week trial of whichever of those two treatments they had not previously been given.

After each treatment phase, the BADDS was readministered. Neither the women nor the researchers knew who was on medication or on placebo until the study ended.

Results from the BADDS showed that treatment with ATX significantly improved scores for working memory; focus scores showed improvement in the BADDS when the women were on ATX as well. No such improvements were found when the women were taking placebo.

The second study in this series involved 32 healthy women aged 45 to 60 who reported mid-life onset of executive function symptoms as measured by the BADDS. All of the women were required to have had irregular menstrual cycles for at least the previous 12 months and no menstrual period for at least 3 months. None had a history of ADHD. Those women were treated for 4 weeks with the stimulant medication lisdexamphetamine (LDX) (i.e. Vyvanse), a washout period, and four weeks with placebo; medication and placebo treatments were in randomized sequence.

Results showed that LDX in doses from 20 to 60 mg daily significantly improved total scores on the BADDS, and subscale scores related to organization and motivation to work, focus and attention, effort and processing speed, and working memory and accessing recall. LDX also improved an objective measure of short-term working memory in that sample of healthy menopausal women. Women taking LDX reported improved sleep quality much more than did women taking the placebo.

Using Neuroimaging to Confirm Findings

This was the first study to provide evidence that a stimulant medication can be well-tolerated and improve executive functions in healthy menopausal women without ADHD who report subjective decline in executive functions that were unprecedented for them prior to their menopause.

Encouraged by these results, the team undertook a third study, which used neuroimaging to study the effects of LDX on brain functioning of 14 women who had no history of ADHD, but did report cognitive difficulties with working memory, organization, focus, and attention that had begun during their menopause transition.

The study used multimodal neuroimaging to test the hypothesis that LDX would be associated with increased activation of dopaminergic circuits and would reduce glutamate in regions of the brain often impaired in ADHD. Researchers predicted that LDX would increase brain activation during a working memory task and decrease glutamate and glutamine levels in specific portions of the prefrontal cortex at rest.

Participants in that third study were 14 women aged 45 to 60 who reported executive function difficulty that had started during menopause. All were within 5 years of their last menstrual period. Each was tested with the BADDS scale at starting point and after a 4-week trial of LDX and a 4-week trial of placebo, during which researchers and the women were all blinded as to who was on medication or placebo.

Results showed that LDX significantly improved total BADDS scores and the subscales for focus, effort, emotion, and memory. As predicted, neuroimaging data showed that LDX activated executive networks in specific areas of the brain. Those data also showed that LDX's effect on specific brain regions was associated with improved BADDS scores overall, and with BADDS scores for activation and alertness/effort. Imaging data indicated that improvements in brain activation were significantly larger when women were on LDX than when they were on placebo.

Implications of Menopause Research

It should be noted that these studies do not claim that the women involved had ADHD or developed ADHD during menopause. All participants were carefully studied to make certain that they had not met ADHD diagnostic criteria prior to the study and did not meet those criteria during or after menopause.

What these studies showed is that some women report mid-life onset of some executive functions similar to ADHD symptoms during menopause and/or in their post-menopausal functioning and that those symptoms may respond to treatment with medications approved for treatment of ADHD, specifically ATX and LDX. Treatment response in these studies was stronger after treatment with LDX than after treatment with ATX.

These three studies do not provide information about why some women experience the onset of these cognitive impairments during menopause while other women do not experience such difficulties. However, the studies do provide evidence that, for some women who are impacted by the cognitive impairments described in these studies, there is evidence that medications used to treat ADHD may be helpful.

More detailed information about selecting, prescribing, and monitoring medications approved for treatment of ADHD is available in my book, Outside the Box: Rethinking ADHD in Children and Adults-A Practical Guide, published by American Psychiatric Publishing.

Menopause, Memory, and ADHD Medication: Next Steps

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¹Epperson, C. N., Pittman, B., Czarkowski, K. A., Bradley, J., Quinlan, D. M., & Brown, T. E. (2011). Impact of atomoxetine on subjective attention and memory difficulties in perimenopausal and postmenopausal women. Menopause (New York, N.Y.), 18(5), 542-548. https://doi.org/10.1097/gme.0b013e3181fcafd6 ²Epperson, C. N., Shanmugan, S., Kim, D. R., Mathews, S., Czarkowski, K. A., Bradley, J., Appleby, D. H., Iannelli, C., Sammel, M. D., & Brown, T. E. (2015). New onset executive function difficulties at menopause: a possible role for lisdexamfetamine. Psychopharmacology, 232(16), 3091-3100. https://doi.org/10.1007/s00213-015-3953-7 ³Shanmugan, S., Loughead, J., Nanga, R. P., Elliott, M., Hariharan, H., Appleby, D., Kim, D., Ruparel, K., Reddy, R., Brown, T. E., & Epperson, C. N. (2017). Lisdexamfetamine Effects on Executive Activation and Neurochemistry in Menopausal Women with Executive Function Difficulties. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 42(2), 437-445. https://doi.org/10.1038/npp.2016.162

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Could ADHD Medications Improve Memory, Focus & Organization in Menopausal Women? The Research Says Yes

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An overview of the first studies providing evidence that a stimulant medication can be well-tolerated and improve executive functions in healthy menopausal women without ADHD who report subjective decline in working memory, organization, focus and attention that were unprecedented for them prior to menopause.

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Does menopause exacerbate symptoms of ADHD (or vice versa)? ADDitude posed this question to more than 1,500 women with diagnosed and undiagnosed ADHD earlier this year in a reader survey. The finding: A whopping 94 percent said yes - their ADHD symptoms grew more severe during perimenopause and menopause.

For more than half of the women, ADHD symptoms grew so severe during their 40s and 50s that they called menopause the period in which "ADHD had the greatest overall impact on their lives." Only 17 percent said the same about ADHD symptoms in their 20s and 30s, and even fewer before then.

MENOPAUSE & ADHD SURVEY
Please click to complete the ADDitude survey on the impact of menopause on ADHD symptoms among women. Thank you!

"Perimenopause and the pandemic were an awful combination," wrote one survey respondent. "Everything fell apart. I couldn't cope, sought diagnosis, and realize now I struggled all along, but particularly when estrogen was surging and declining."

Memory & Overwhelm are Primary ADHD Problems

Mid-life hormonal fluctuations began, on average, at age 45 with perimenopause and continued with the onset of menopause at age 49 for ADDitude survey respondents. During this stage, the most impactful ADHD symptoms were brain fog or memory issues, and overwhelm, both of which 70 percent of women said had a "life-altering impact" in their 40s and 50s. By contrast, only 11 percent of women called memory problems life-altering during their 20s and 30s; half said the same of overwhelm earlier in life.

" I was good at masking and worked really hard to stay on top of things as a child, teenager, young adult, and young mother and in my working life - and I managed to cope," wrote one mother of four who entered perimenopause at 50 and is now 64. "In my late 40s, no amount of hard work could cover up the struggles and everything got on top of me, increasing anxiety, leading to overwhelm and emotional dysregulation, and exacerbating all the struggles I had all my life."
[Take This Self-Test: ADHD Symptoms in Women]
Some women said they worried that brain fog and memory problems - symptoms of both ADHD and menopause - would affect their job performance. Others said new and worsened ADHD symptoms, namely emotional dysregulation, affected their relationships during perimenopause and menopause. One ADDitude reader said her symptoms were so abrupt and disruptive that she feared she might have early-onset dementia.

"Brain fog became unmanageable," wrote one 45-year-old mother of two who entered perimenopause at age 41. "Distractibility increased and my inability to complete work tasks in an appropriate amount of time decreased. I began spending all night working just to keep up. Things that I used to have unconscious strategies to deal with were no longer manageable."

Given this common experience, it's not hard to imagine why overwhelm was cited by 70 percent of women as life-altering. The next most debilitating symptoms in menopause were time-management difficulties (called life-altering by 63 percent of women in their 40s and 50s), procrastination (also 63 percent), and distractibility (59 percent). Emotional dysregulation was called life-altering by 56 percent of women during perimenopause and menopause.

"I never experienced rage or brain fog before perimenopause," wrote one woman. "Overwhelm has been more frequent in recent years, and depression began in my 40s. I definitely attribute some of this to hormonal changes."
[Get the Free ADDitude Newsletter for Women with ADHD]
"Motherhood has been a struggle as I try and fail to manage time within daily flow and weekly schedules," wrote one mother of two who recently entered perimenopause at age 40. "Entering perimenopause, I'm feeling depleted of my own hormones, which is physically and mentally draining me, and exacerbating my brain fog, fatigue, emotional dysregulation, sensory overload, lack of sleep, heightened anxiety, and inability to exercise."

The Dangers of Missed ADHD Symptoms

Many women reported receiving an ADHD diagnosis later in life. Of those, the average age of diagnosis was 43. Half of women said they had combined-type ADHD with both inattentive and hyperactive/impulsive symptoms, while 40 percent said they had inattentive ADHD. Comorbidities were the rule, not the exception; 89 percent reported at least one diagnosis in addition to ADHD. Of those, 73 percent reported anxiety and 64 percent cited depression. Many other women reported misdiagnosis or incomplete diagnosis as a significant barrier to health and happiness.

"I feel like doctors aren't listening to me when I bring up ADHD, and they don't seem concerned," wrote one 44-year-old mother of three. "They keep trying to say it's depression and anxiety, but it's not. I've been depressed and anxious in the past - and this isn't that."

It is not uncommon for women who have ADHD to be misdiagnosed or undiagnosed - and the hormonal fluctuations that result in brain fog and memory problems during perimenopause and menopause may only complicate the potential for an accurate diagnosis. Do these symptoms point to ADHD or are they simply typical signs of this life transition? It's often difficult to answer that question.

The fact is that ADHD symptoms fluctuate significantly during a lifetime, with impulsivity and hyperactivity often giving way to disorganization and emotional dysregulation over time. According to the women who answered ADDitude's survey, the most problematic ADHD symptoms during each stage of life are as follows (in order of severity):

Ages 0-9: Emotional dysregulation, inattention/distractibility, and social struggles

Ages: 10-19: Procrastination, emotional dysregulation, and time-management difficulties

Ages 20-39: Procrastination, overwhelm, and time-management difficulties

40-59: Overwhelm, brain fog and memory issues, and time-management difficulties

60+: Brain fog and memory issues, procrastination, and overwhelm

"Age 40 was when I dropped all the plates I'd been struggling to keep spinning; the overwhelm and inability to cope reached a breaking point," wrote the 44-year-old mother of two who was diagnosed late in life. "Having the responsibility of young children and a stressful job pushed me beyond being able to cope and quit my 20-year career."

"I was diagnosed with premenstrual dysphoric disorder in my early 30s. Then perimenopause hit around age 40, which started the 10-year emotional roller coaster from hell," wrote one woman diagnosed with ADHD at age 54. "I only looked into an ADHD diagnosis by chance, but I can now see how and why I had a much harder time than anyone else I know."

Diagnosis Unlocks Effective Treatment

Diagnosis is a critical factor for managing the most impairing symptoms of ADHD during menopause, according to the 40 percent of respondents who said stimulant medication is effective or very effective in treating their ADHD symptoms. Without a diagnosis, a prescription is not possible.

"Stimulant medication was life-altering for me," wrote one woman diagnosed with ADHD at age 55.

"I would absolutely recommend ADHD medication to anyone," wrote one 54-year-old mother of three. "All the other factors like diet, exercise, and improved wellbeing have an impact, but if I go two days without medication, I feel it all start to fall apart."

Exercise was deemed effective or very effective by 37 percent of respondents; nutrition was similarly labeled by 27 percent; and mindfulness was favored by nearly 30 percent. More than 60 percent of women said they changed their diet, fitness, and health routine during perimenopause and menopause to better manage flaring ADHD symptoms. Many women said they ate more healthfully, some said they exercised more regularly, and others said they cut back on drinking alcohol as they became more sensitive to its effects.

"Meditation and yoga are very helpful when I practice consistently," wrote one woman. "Meditation was a lifesaver in helping me overcome sleep issues. I've been on methylphenidate and it helps as well. Regularly scheduled appointments with friends and family keep me sane. I have a friend with ADD and we try to have daily accountability check-ins. It makes a huge difference."

Roughly 35 percent of survey respondents also said they take or have taken hormone replacement therapy (HRT), most to address both cognitive and physical symptoms of menopause. Of those, 26 percent said HRT helped with their ADHD symptoms.

"I didn't have an ADHD diagnosis when I was on HRT," wrote one woman diagnosed with ADHD at age 61. "On reflection, I was pretty productive during that time, and relatively stable but still had old problems of sleep disturbance, anxiety, grief reactions, and depression. I did make friends, though - and that was unusual."

Menopause Symptoms and ADHD: Next Steps

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

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ADHD Impairment Peaks in Menopause, According to ADDitude Reader Survey

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Does menopause exacerbate symptoms of ADHD (or vice versa)? ADDitude posed this question to more than 1,500 women with diagnosed and undiagnosed ADHD earlier this year in a reader survey. The finding: A whopping 94 percent said yes - their ADHD symptoms grew more severe during perimenopause and menopause.

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Adults with ADHD sometimes blow in the wind - directionless due to difficulties with long-term planning and decision-making. To devise an authentic life plan, ask yourself these questions to reveal your values, strengths, and passions.

What should I do with my life?

I grappled with this question for decades as an adult with attention deficit hyperactivity disorder ( ADHD or ADD). I read self-help books, took personality tests, hired career counselors and a life coach, but I couldn't connect the dots. Though I am ambitious and driven (drive, after all, is a form of hyperactivity), I was secretly terrified that I wouldn't live up to my potential. I'd create a plan and get distracted by something brighter and shinier.

I needed a life plan to spark and focus my scattered ADHD brain. You probably need one, too. To that end, I'm sharing the following six questions - ones that I found particularly revealing and helpful as I worked to create a life plan that centers on my values and passions.

ADHD Life Plan Question 1: What Do You Value?

Values are the principles and ideas that drive your personal and professional decisions and influence your relationships. Sometimes we adopt values that are ours alone, but often we adopt the values of our family, friends, or community.

Rachel was raised in a family that rejected science, but when she started examining her values, Rachel realized she loved science. She remembered how good it had felt to look up at the stars for hours. This clarity gave her the confidence to go back to college to study astronomy and stop making decisions based on her parents' values.

When we live other people's values, we live other people's lives - and we wonder why we're unhappy. This is especially true for adults with ADHD. We know what we should do, but after years of being told that our way is the wrong way, we don't trust ourselves.
[How-To: Find Your Feel and Make It Real]
ADHD Life Plan Question 2: What's Your Life's Theme?

Your core values drive and make sense of all your other values. Choose one of them as the overall theme for your ADHD life plan. My top value is to challenge the status quo. I'm always attracted to the option that challenges the norm for the better. If I need to make a decision, I ask myself, "Which option shakes things up more?" Since that option will be more aligned with who I am, I know that it will hold my interest longer and bring more satisfaction.

ADHD Life Plan Question 3: What Are Your Strengths?

Many of us can identify our weaknesses, but have trouble listing our strengths. The VIA Character Strengths Survey ( viastrengths.org) helps uncover the personality traits that represent the essence of who you are. These traits drive us and give us energy. Values live in our head, but if we don't act on them, they never evolve into pillars of an ADHD life plan or character strengths. Character strengths integrate who we are and how we act, not just what we think and feel.

Carol was raised to value security. Her parents preached caution, citing her uncle's failed business as proof. She discovered that caution was not one of her values and became an entrepreneur anyway, using her strengths - creativity, humor, love of learning - in her business. Living her values sparked positive feelings, which further motivated her ADHD brain.

ADHD Life Plan Question 4: What Are Your Superpowers?

When you nurture your natural-born talents, they become your superpowers. What are you better at than most people? If you're not sure, ask your best friend. Many of us can't see our superpowers at all.
[Great Job! A Career Happiness Formula for Adults with ADHD]
Alicia was the perfect example. When I talked to her, she described herself as "mediocre." So I asked her to make a list of the things she had done that made her feel positive emotion. Her list included publishing four novels. She was also on track to complete her psychology degree and made the dean's list every semester.

When you write down your superpowers, they are harder to ignore.

ADHD Life Plan Question 5: What Are Your Passions?

Everyone needs to recognize their passions, but for those of us with ADHD, it's imperative. Our brains are wired for interest. What can you do for hours while time flies by? Passions are the things you could do all day.

Katelyn Mabry is the author of the children's book, Hi, It's Me! I Have ADHD. As a child, Katelyn knew she was smart, but she struggled in school. Somehow she got into college. The first two years were hard, but in her third year, Katelyn decided to study special education. She wanted to crack her own reading and learning code, so she could help other students avoid what she went through. Katelyn found a passion that gave meaning to her past. She went on to earn a master's degree and graduated at the top of her class.

ADHD Life Plan Question 6: What Are Your Strongest Passions?

Adults with ADHD have lots of ideas. We keep running them through our brain, but never wind up acting on most of them. Sometimes we act and get pulled in a new direction until something more interesting comes along. Instead, we need to look for the overlap. Ask yourself, where do your values, life theme, signature strengths, superpowers, and strongest passions intersect? This sweet spot is where you connect who you are with what you're doing.
[Read This Next: What Should I Do With My Life? Capture Your ADD Passions in a Smile File!]
SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Updated on July 23, 2020

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"What Should I Do with My Life?" 6 Revealing Questions for Adults with ADHD

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Adults with ADHD sometimes blow in the wind - directionless due to difficulties with long-term planning and decision-making. To devise an authentic life plan, ask yourself these questions to reveal your values, strengths, and passions. What should I do with my life?

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My father called me a Chatty Cathy, even though my name is Janet. I guess I talked a lot when I was little. I had a lot to say and wanted to be heard.

As I grew up, I didn't know what was wrong with me. I thought that I wasn't smart. I struggled to figure out what teachers were lecturing about. I didn't get it. It was as if I spent my school years wearing earmuffs, always missing out on important information.

My earliest recollection of school challenges came in the first grade, when my teacher moved my desk away from my friends and the classroom windows. Those "windows to the world" called to me often. I stared and daydreamed. It was easier than getting in trouble.

This pattern continued through high school. I studied, but remembered nothing. Teachers talked, but I comprehended little. Distractions filled my mind. I cried a lot and developed severe stomachaches.

College was wonderfully awful. The professor's words did not stick. The material went over my head. It was then that I realized that if I were going to succeed, I would need to study differently.
[Quiz: Can You Distinguish Between ADHD and Learning Disabilities?]
I planted myself in the farthest corner of the school library in a study carrel. There were no visual distractions. Instead of just reading and highlighting the material, I memorized the book. I read a few pages of the chapter, closed the book, and tried to rewrite the pages, word for word. I checked my work against what was written in the text, closed the book, and rewrote it again until I got it all down.

I continued these memorization drills until I could rewrite the chapter almost word for word. This is how I learned. This is how I got through college and earned two masters' degrees, along with my Fellow-level membership in the Academy of Orton-Gillingham Practitioners and Educators (AOGPE). I was motivated to prove to myself, and to others, that I was smart.

It wasn't until I was in my 40s that I learned that my difficulties were due to ADHD and dyslexia. The two conditions have not gone away, but I view them differently now. My attention deficit disorder ( ADHD or ADD) fuels my determination and resourcefulness. I enjoy finding solutions to things that people think can't work.

When I worked as a reading instructor in a private school, an idea came to me. I thought, It shouldn't be like this for these kids. There is a better way. I would start a school for them. Why not me? I could do it. I could see it in my mind, and I knew I'd found my passion. Fortune Academy - a school that helps kids with language learning differences and dyslexia succeed - was born.

Finding a passion is critical for those with ADHD. Without it, we feel trapped, bored, and restless at the same time. We zone out, and we feel underutilized, like a cog in a wheel. When we tap into our passion, we are unstoppable.

These days I see my learning differences as strengths. I can hold many tasks in my brain at once and visualize their completion. I love to problem-solve, and the freedom to try new things without the red tape. I especially love seeing children experience a new way of "doing school."
[Does My Child Have Dyslexia?]

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I Found My Passion and Now I'm Unstoppable

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My father called me a Chatty Cathy, even though my name is Janet. I guess I talked a lot when I was little. I had a lot to say and wanted to be heard. As I grew up, I didn't know what was wrong with me. I thought that I wasn't smart.

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What makes certain careers a good fit for adults with attention deficit hyperactivity disorder? What separates people who feel fulfilled from those who suffer regret? There are five steps to igniting peak performance in the workplace, which I outline in my latest book, Shine: Using Brain Science to Get the Best from Your People (Harvard Business Review Press; 2011)(#CommissionsEarned). The first and most important step is "select" - to make sure that you are in a job well-suited to you and your ADHD.

Are you in the right job? You can figure that out by answering the 18 questions below. Your answers will help you think clearly about your career choices, skills and preferences, where you fit best in the organization, and under what circumstances you feel most comfortable and motivated.

What do you do best? You should be spending the majority of your workday doing what you do best. Many people spend too much time trying to get good at what they're bad at, instead of getting better at what they're good at.

What do you like to do the most? This does not always have the same answer as #1. Ideally, you can make your favorite activities your career.

What do you wish you were better at? Your answer may suggest that you need a mentor, need to delegate, or need to get training. Many adults with ADHD have difficulty figuring out office politics - a mentor or a coworker could help. Others have difficulty organizing, in which case an ADHD coach can work with you on tidy-up strategies.
[Quit It! The 10 Worst Jobs for Restless Minds and Creative Spirits]
What do others say are your greatest strengths? Friends, coworkers, and performance reviews can identify skills you have but may not value because they seem easy to you.

What are you most proud of in your work life? The answer could be another tip off about what you should be doing.

What have you gotten better at? This will give you an idea of where applying additional effort will pay off.

What are you not getting better at, no matter how hard you try? It's good to know where not to expend effort.
[Free Download: 8 Dream Jobs for Adults with ADHD]
What do you most dislike doing? You might be good enough at something, but still hate it. I know a lawyer with ADHD who hated to do billing. He would procrastinate and then feel guilty because he was always behind. By admitting his dislike of billing, and hiring an assistant to do it, he improved his cash flow and decreased his stress.

Which skills prevent you from excelling in your job? If you lack a skill required for your job and can't delegate it, consider taking a course, finding a mentor, reading a book, or working with a coach.

What regrets do you have about your career? Could you make changes based on those regrets?

What one lesson would you want to pass along to your children about how to manage their careers? Another way to get at your most important views about work.

What was the most important lesson you learned from your mother and father (one each) relating to work? Reflecting on this helps you understand attitudes that have been passed along and how your mind works.

What lesson did your best boss teach you about yourself? Tapping into the insight of others is helpful. Others often know us better than we do.

In what way(s) do you think your time could be better used in your current job to add value to your organization? This may provide valuable insight to your manager and your own perspective about your job.

What sort of people do you work best/worst with? Do you hate to work with highly organized, analytic types, or do you love it? Do creative types drive you crazy, or do you work well with them? Make up your own categories.

What kind of company culture brings out the best in you? Chances are, you will get excited about your job if you feel connected to the company's culture. Are you a top-down person, who thrives with a specific hierarchy, or do you work best in a "no walls allowed" atmosphere?

What are your hopes for the future, in terms of your career? Knowing that fear is the only true learning disability, what stands in your way of reaching those hopes?

What were you doing when you were happiest in your work life? Can you do something like that again? Perhaps you enjoyed the excitement and deadlines in sales work, but are unhappy in the management position you were promoted to. Is it time to move back into sales? That could be the key to career happiness.
[Finding a Career That Works For You]
#CommissionsEarned
As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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18 Questions That Reveal Your Ideal Career

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What makes certain careers a good fit for adults with attention deficit hyperactivity disorder? What separates people who feel fulfilled from those who suffer regret? There are five steps to igniting peak performance in the workplace, which I outline in my latest book, Shine: Using Brain Science to Get the Best from Your People (Harvard Business Review Press; 2011)(#CommissionsEarned).

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Could ADHD Medications Improve Memory, Focus & Organization in Menopausal Women? The Research Says Yes

# data[].attributes.attachment_link.description
An overview of the first studies providing evidence that a stimulant medication can be well-tolerated and improve executive functions in healthy menopausal women without ADHD who report subjective decline in working memory, organization, focus and attention that were unprecedented for them prior to…

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"It took every ounce of physical, mental, emotional, and spiritual strength to live my life - until I finally met someone who listened to my story." Do you recognize your story here? ADDitude readers share their everyday experiences living with undiagnosed ADHD.

A sad woman has undiagnosed ADHD.

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A woman with ADHD in an astronaut suit, covering her face. The condition can make you feel like you're from Mars.

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