- What is ADHD? In the last couple of decades, ADHD was seen exclusively as a disorder of childhood that disappeared in late adolescence. This had broad implications for those adults with ADHD who were not diagnosed. Many were called lazy, unmotivated, scattered, off task. In 1902 it was called “Moral Deficit Disorder!” The truth is, with advances in science we have found that ADHD is a neuro-biological disorder.
- For those with ADHD brain scans have shown structural and functional differences in the frontal lobes, basal ganglia, and cerebellum and possibly the anterior cingulated gyrus. There is also difference in the volume of brain matter in the prefrontal cortex, cerebellum and possibly striatum which make for less neural components to do the work of these areas.
- The neuro-chemical difference is found to be in the dopaminergic and adrenergic systems. People with ADHD benefit from stimulants that are dopamine and norepinephrine reuptake inhibitors.
- Gender ratio 4:1 to 9:1 in favor of males. This difference could be that women are diagnosed as anxious. They also have the inattentive type more often.
- Biologically about 25 % of first degree relatives (parents, siblings and children) have ADHD.
- Adults with ADHD actually work very hard at being organized but have little to show for it, in terms of results. They move things around but the objects don’t end up in better places because the person doesn’t have a good organizational system into which to put things. This leads to procrastination and hopelessness.
- There has been more than 100 years of research documenting the existence of ADHD.
- What is the prevalence of adult ADHD? Despite claims that ADHD is over diagnosed in children, it is still under diagnosed in adults.
- Approximately 4 percent of adults in the United States have ADHD.
- This disorder impacts every aspect of their lives: work, home, and social life.
- One myth that has been out there for a long time is that children outgrow ADHD. The fact is that approximately 2/3 of children with ADHD continue to suffer from it when they are adults.
What are some of the signs that I might have ADHD or be married to someone who has it?
- Frequent work errors despite “knowing better.”
- Detailed and tedious tasks such as doing the taxes are very stressful for someone with ADHD.
- The person chooses speed over accuracy and does not recheck the work.
- Difficulty staying on task until completion before switching to something else.
- The person is a great starter – but a bad finisher at tasks.
- Frequently receives complaints about not listening, not being able to get their attention, or forget things that have been heard.
- Difficulty with accurately following others’ verbal or written instructions.
- Does not follow through on commitments made at home or work.
- Has a hard time paying bills on time.
- Long delays in responding to emails, organizing papers, due to procrastination.
- Frequently late, miss’s appointments and deadlines.
- Does not plan ahead.
- Poor sense of time, inefficient.
- Frequently looses keys, cell phone, purse, wallets, and work assignments, parked cars.
- Puts a lot of effort into decreasing distractibility. May work in off hours so there are not so many distractions.
- Memory problems: can go to store with a mental list of things to pick up but forgets half of them. Can’t remember where they put things such as keys.
- Fidgety: picks at fingers, shakes knees, taps hands or feel, talks with hands, or changes position frequently. Feels restless at long dinners or conversations.
- Doesn’t want to wait for others.
- Feels like they always need to be on the go or doing more stimulating activities.
- Internal restlessness. Hard to stay home for a quiet evening. Might be a workaholic.
- Has difficulty moderating speech volume.
- Others complain about the frenetic pace the person sets. Little time to rest and difficulty to relax.
- Excessive talking resulting in others not feeling heard due to frequent interruptions.
- Clowning around, dominates conversations, can’t get point across, and goes on tangents.
- Blurts out answers before questions have been completed. Might feel that others talk too slowly.
- Says things without thinking.
- Gets irritated when waiting for children or other slow people to finish something or when they have to wait in line.
- Viewed as socially inept in conversations.
- Steps on others toes, doesn’t respect others personal space.
- Told they are not living up to their potential and if they cared or tried harder things would change.
- Can become hyper-focused and be engrossed in an activity to the exclusion of everything else. It may require repeated attempts to get their attention.
- Might miss parts of the conversation or briefly tune out.
- Get a higher than average number of speeding tickets or reckless driving.
- Regrets spontaneous purchases. This tie into not being able to anticipate future needs or budgeting.
- May engage in thrill seeking behavior like motorcycling races.
- High caffeine intake because it helps them focus.
- Feel demoralized about the future and their ability to improve things for themselves.
- Family and co-workers may try to over-function to help the person with ADHD.
- Difficulty with loose structures such as college.
- Mood changes frequently.
- Low self esteem due to experiencing more rejection and failure than their peers.
Are there any positives that people with ADHD have? Yes! And it is important that these be pointed out and remembered by the person with ADHD. Some of the strengths people have:
- An ability to multi-task effectively
- A good sense of humor
- An ability to think “out of the box.”
- The drive to focus on something they are interested in
How can I find out if I have ADHD?
- Find a qualified neuro-psychologist for a complete review.
- This may include Barkley’s ADHD Rating scale
- Brown attention-deficit disorder scale
- Connors adult ADHD rating scales
- Conners continuous performance test (CPT)
- Intermediate visual and auditory (IVA) CPT
- Test of variable attention (TOVA)
Ok, now that I know that I have this disorder, how can I get my life back and get organized?
Tools to Use to get organized
When a person has ADHD their environment can impact if they deal better with life or worse. The clutter and disorganization can cause the person “visual stress.”
Nadeau and Kolberg suggest the 3 “S”
- Avoid procrastination by setting reasonable goals.
- Replace negative self talk with encouraging positive self talk
- Ask for support and help
- Don’t rely solely on a “mental structure” by sorting things out in your head. You will get better results with an “externalizing structure.”
- Create a visual organization system such as using a shadow mark tool. Trace the white side around the tool, cut out and stick the black underside to where the tool is suppose to go.
- Breakdown an overwhelming task into concrete do-able bits.
- Make specific strategies
- Organize for reasons that matter to you i.e. less anxiety, help relationship
- Get energized! Pick some music that makes you feel good!
In his book “Taking Charge of Adult ADHD” Russell Barkley suggests 8 things:
- Externalize information. For ADHD information is held in the mind in a visual form. To remember things you must put the information into some physical form. Always carry a small journal and pen to write down tasks, steps, and deadlines. Take pictures of how something is suppose to look. Then match the work to the picture.
- Make time physical: Use kitchen timers, clocks, computers, PDA alarms that can break time down by the hour.
- Use external incentives: Break a project up into small steps and give yourself a small reward after completing one hour i.e. listen to a song, stretch, get the score on your sports team.
- Balance out the neurological deficits by taking the task at hand. Use physical prompts to keep your mind focused. Medication.
- Replace distractions with reinforces to focus on.
- Turn rules into physical lists and post them.
- Breakdown large projects into small chunks of time spaced closely together.
- Stay flexible and be prepared to change your plan.
Reduce the clutter in your home and office.
I know easier said than done! Remember to pace yourself and not take on everything at once. Think of this project as little sprints versus a marathon. Break up projects into small pieces that can be completed start to finish in one dash. Some ways you can do this are:
- Work with an organization buddy. This can be a friend, co-worker or a professional. The buddy can just be present in the room and help you stay focused; they can help but not give advice, or actively participate in the process.
- Go through your closet and first take out everything you have not worn in the past year. For these cloths divide them between two garbage bags labeled: throw it out, donate. The clothes that you keep are those you have worn in the past year. Those that you throw away are stained, ripped or those you don’t want to fix. The donate bag is for things someone else will find valuable. If you are keeping the item ask yourself: Does this still fit me? Does it have sentimental value? Will I need it in the future?
- Next take the clothes you have left and group them according to categories: shirts, jackets, blazers, pants, shorts, dresses and skirts.
The next area to focus on is all the papers in your house! Buy a file cart with wheels and hanging folders. Label five folders: Read it, File it, Take action, Give away, and don’t know.
Once a month look in the “Don’t know” file. If you have not used them either file them or throw them out. If there is anything in the “give away” file either mail it or throw it out.
In the” take action” file do it today, file it, or throw it out.
To keep track of important papers purchase two accordion folders:
One pre-printed with the days of the month and another preprinted with the months of the year. The folder with the days of the month is for papers you will need this month. So if you have a meeting on Wednesday and need an email from a colleague, file it under Wednesday. The folder with the months of the year is for papers you will need in the upcoming months. If you receive an invitation to a party or are have registered for a conference, file it under the month of the event. If you have papers left over from that month, transfer them to next month’s pockets or throw them away if you no longer need them.
Now what about general household clutter? Some ideas are:
- Cancel your newspaper delivery. Newspapers create a lot of clutter. With the use of the Internet so prominent you can have current events sent to you or sign up for an online version of the paper (just don’t print it out!)
- Instead of buying books or cds try taking them out of the library. This way if you never read the book, listen to the movie, or watch the DVD you can return it and not have the clutter while saving money!
- Sign up for electronic bills and statements. Some companies offer reduced rates if you pay online or receive only online statements. This will greatly reduce the amount of mail you receive and things may not get lost.
- Go through your mail as soon as you get it with a trashcan next to you. Immediately throw out any catalogs, junk mail, and ads. If you receive bills put them in a separate bill-paying basket.
- Get an old shoebox. When you purchase items or pay a paper bill put the receipt in the box. This will be helpful at tax time when you then throw out the receipts you don’t need and keep the ones you need to use. It is also helpful when returning items.
Keep your brief case and purse organized:
- Find one with several compartments and train yourself to always put the same thing in the same place i.e. car keys, wallet.
- Buy a wallet with a bright color so you can find it more easily.
- Use clear zip-lock bags to separate coupons, pens and pencils, make-up etc. This will also help you get through security more quickly if you travel a lot.
- People with ADHD and those that live with them should try to feel less guilt and shame about their disorder. Bad morals, poor diet, or bad parenting does not cause it. It is a disorder not a disgrace!
- Avoid all or nothing thinking. Do 3 drills versus not going to basketball. Try not to go from under-doing to over-doing.
- Break up tasks into small chunks so you can feel successful.
- Notice the things you did right! It is too easy to focus on what hasn’t been done versus all the things you did get done.
Barkley, Russell, “Taking Charge of Adult ADHD.”
Nadeau and Kolberg, “ADD friendly ways to organize your life.”
Sarkis, Stephanie, “10 Simple Solutions to Adult ADHD