Back to Basics III – Treatments for ADHD

So far this month, we’ve talked about what ADHD is and looked at executive dysfunction—both the good and the bad.

Obviously, we’re looking at more bad than good. One clearly-defined criterion for psych diagnoses is the requirement that symptoms cause distress/make it hard or impossible to accomplish necessary activities of daily living.

But once you have the diagnosis, or once you think you might have ADHD, what can you do about these challenges? Russell Barkley says that ADHD is the most treatable disorder, but what does that really mean?

Pinnable image for this post, with illustrations of a bunch of different types of treatment for various medical conditions.

The Big Four

The first things to look at when considering your ADHD symptoms are diet, exercise, sleep, and stress. Keeping these within healthy ranges will generally help your brain and body function at their best, and that will give whatever treatments you attempt the best chance at helping you manage your symptoms.

diet

A good diet that has lots of protein (not like ridiculously high, just higher than average) is important for good brain function. Other important components here include Omega-3 fatty acids (found in eggs and fish, for the most part; vegans can find it in walnuts, flax seeds, chia seeds, and edamame) and plenty of vegetables, as well as complex carbohydrates (e.g., whole wheat bread and pasta, beans, potatoes).

Exercise

Regular exercise (especially cardio) is amazingly good for your brain! It wakes up your entire body and keeps dopamine in your system, which is great since dopamine is one of the primary neurotransmitters involved in ADHD. When you exercise regularly, you also make it easier for those dopamine levels to remain higher for longer periods of time.

Sleep

When we sleep, our bodies do a bunch of things like healing and rejuvenating. Our brains do that, but they also work through all of the events of the day, committing things to long-term memory and stuff like that. We need to make sure we’re getting at least eight hours of sleep per night to make sure our brains are functioning at their best.

Stress

Stress, even positive stress, increases cortisol in the body and makes it harder to function normally. Keeping yourself on an even keel can actually help your symptoms a lot, as long as you don’t let things also get boring!

formal diagnosis required

Most of the things you can do to help you manage your ADHD symptoms don’t require a formal diagnosis, but some things do. Namely, accommodations at work or school, and medication.

Medication

Medication is still the first (and sometimes only) place people turn. It’s very well-researched, and its effects are fairly well-known. There are many different types of medication available for ADHD treatment, so don’t stop after one failure. There is a fantastic chart linked in the sidebar that outlines the different applicable medications, their typical doses, and expected side effects. It doesn’t go in-depth, but it does give a solid base to work from. I recommend you share it with your doctor.

A good treatment plan will not involve medication only. If you ever have to stop taking medication, you will require strategies to help you maintain your lifestyle. It’s better to establish those strategies while you’re taking effective medication than to wait until you don’t have that support.

Accommodations

Accommodations are things that help you succeed. For example, wearing noise-cancelling headphones if you work in a cubicle so that you can focus on your work; having extensions for school assignment due dates; writing exams in a private room; or bringing a Tangle (quiet fidget toy) to work meetings. You do need a formal diagnosis of ADHD to access accommodations, and you will need to register with your school’s resource teacher (for grade school) or disability centre (for post-secondary), or discuss needed accommodations with HR. None of this guarantees you accommodations, but it is more likely.

Neurofeedback

Neurofeedback needs to be individualized and administered by a trained practitioner. It uses a variety of computer-based activities to retrain your brain in specific areas of functioning. I do not have personal experience with it yet, but I know a few people who have had good results and hope to finally get the paperwork in so that I can do it soon.

No Diagnosis Needed

The rest of your options can be accessed without a formal diagnosis. I’ve listed them here with what my experience has shown is most effective at the top. That doesn’t mean that the options lower on the list won’t be helpful for you, it just means that I didn’t find them useful.

ADHD Coaching

ADHD coaches help you learn, develop, and implement strategies that work for you, so that you can better manage your ADHD symptoms and be able to do well if you have to stop taking medication. Do be careful about who you hire; coaching is not a regulated profession, so look for someone who has a good track record and has done training in life coaching as well as education in ADHD.

Talk Therapy

Sometimes you have a lot of stuff you need to work through, so this can be very helpful, whether you see a counselor, social worker, psychologist, or psychiatrist. Many professionals in this field will use elements of Cognitive Behavioural Therapy (CBT), which is a type of behavioural therapy where the practitioner (a psychologist or social worker with training in CBT) helps you think through your behaviours and come up with better ways to react to different situations.

Meditation

If you’re able to meditate, this can be really helpful in getting your mind centred and teaching your brain to actually concentrate or focus on what you want it to.

Mindfulness

Mindfulness is about getting us to focus on the actual now and the immediate future, rather than dwelling on the past or thinking really far into the future. Being truly present in the moment instead of jumping ahead in conversations or tuning out because something else caught our attention.

Supplements

Krill oil (or other fish oil), rhodiola, reishi, and other supplements can be helpful in promoting optimum functioning. Dr Amen also has some suggestions in his book Healing ADHD. (This is the only thing I would suggest Dr Amen for. Many of his ideas, including the many types of ADHD, are fringe.)

Disclaimer: I am not a medical or other type of health care professional. This post is meant to serve as an overview of the different treatments available to ADHDers, not a recommendation or endorsement of any one course of treatment in particular.

There are probably other treatments that I’m not aware of yet. Please comment with anything you’re aware of that isn’t covered in this post.

This week’s printable is a long one, but it’s designed to help you keep track of your various treatment attempts and how they affect your symptoms. It’s fillable, so I recommend saving it before you start filling it out, and name it whatever treatment you’re going to be tracking. You can also print it and keep it in a binder, and bring it with you to your appointments.

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Back to Basics II – Types of ADHD

There are three types of ADHD: Inattentive Type (ADHD-I), Hyperactive/Impulsive Type (ADHD-HI), and Combined Type (ADHD-C). Is it really as simple as this, though? Well, sort of. Let’s talk about it.

Pinnable image for this post, featuring a person running up a flight of stairs towards a light bulb.

The first thing to remember is that ADHD is diagnosed based on observed behaviours. The second thing to remember is that the division between the types is really kind of arbitrary. The third thing to remember is that which kind you’re diagnosed with has nothing to do with what treatments will or will not be helpful for you, because regardless of what type you have, it’s still all caused by a problem with your executive functioning.

ADHD-I Symptoms

  • Makes careless mistakes/lacks attention to detail
  • Difficulty sustaining attention
  • Does not seem to listen when spoken to directly
  • Fails to follow through on tasks and instructions
  • Exhibits poor organization
  • Avoids/dislikes tasks requiring sustained mental effort
  • Loses things necessary for tasks/activities
  • Easily distracted (including unrelated thoughts)
  • Is forgetful in daily activities

ADHD-HI Symptoms

  • Fidgets with or taps hands or feet, squirms in seat
  • Leaves seat in situations when remaining seated is expected
  • Experiences feelings of restlessness
  • Has difficulty engaging in quiet, leisurely activities
  • Is “on-the-go” or acts as if “driven by a motor”
  • Talks excessively
  • Blurts out answers
  • Has difficulty waiting their turn

If you are a child, you need to show at least six of the symptoms of a given type for at least six months, in multiple settings; if you are an adult, you need five. They also need to be evident prior to age 12. For ADHD-C, you need to meet the criteria for both ADHD-I and ADHD-HI.

But what if we look at these again, through the lens of executive dysfunction?

ADHD-I is then characterized by difficulties with:

  • Attentional Control;
  • Cognitive Flexibility;
  • Cognitive Inhibition;
  • Goal-Directed Behaviour;
  • Organizational Skills;
  • Planning;
  • Self-Monitoring; and
  • Working Memory.

Meanwhile, ADHD-HI is characterized by difficulties with:

  • Cognitive Flexibility;
  • Goal-Directed Behaviour;
  • Inhibitory Control; and
  • Self-Monitoring.

ADHD-C, then, is characterized by difficulties with everything.

But, well, I don’t know about you, but I see an awful lot of overlap on the executive functioning issues. In fact, what I see is that the thing that distinguishes ADHD-I from ADHD-HI is that ADHD-I has trouble with Attentional Control, Cognitive Inhibition, Organizational Skills, Planning, and Working Memory, while ADHD-HI has trouble with Inhibitory Control. Both types have difficulty with Cognitive Flexibility, Goal-Directed Behaviour, and Self-Monitoring.

This means that it would be incredibly strange for someone to have “pure” ADHD-I; some of the criteria for ADHD-HI are likely to show up at least some of the time (and more often than they would for someone who doesn’t have ADHD) since they’re caused by issues with the same executive functions. Same goes for “pure” ADHD-HI.

Okay, this post is getting a touch maudlin, so I’m going to take us in a new direction.

Last week’s printable was about identifying areas where you need supports. That’s important to know as you’re looking to develop systems and materials to help you manage your symptoms and your life; the thing is, nobody is made up of only deficits. We all have some strengths, and it’s really important to know what yours are.

For example, I was diagnosed with severe ADHD-C, and I honestly do struggle with an awful lot of things I “should” be good at as a stay-at-home-mother. At the same time, I have some strengths that help me get by, and I’m hoping I can find ways to harness them moving forward.

Executive FunctionDefinitionExample of Strengths
Attentional ControlThe ability to control what you pay attention to. It’s basically being able to concentrate.Hyperfocusing on important projects or topics.
Cognitive FlexibilityThe ability to change your behaviour and thought processes based on changes in your situation or gaining information.Understanding different points of view.
Cognitive InhibitionThe ability to tune out unrelated stimuli and stay on task or follow a train of thought.Hyperfocusing on a special interest to the exclusion of all else.
Goal-Directed BehaviourThe ability to control your behaviour so that you’re working towards achieving goals.Hyperfixating on a topic or activity such that you become an expert in a short amount of time.
Inhibitory ControlThe ability to stop before you act so you can choose the most appropriate way to behave in a given situation. It’s got a lot to do with self-control.Recognizing which fidgets or stims are inappropriate in certain settings, and choosing alternatives that are more appropriate.
Organizational SkillsAll that sorting, putting things away, etc.Setting up solid organizational systems.
PlanningThe ability to think ahead and to break goals down into smaller steps.Breaking down large tasks or projects into small steps.
Self-MonitoringThe ability to keep track of what you’re doing and how you’re coming across, as well as notice things like hunger, thirst, fatigue, pain, the need to use the bathroom, etc.Realizing that you always get hungry or thirsty at a particular time of day, and making sure you have a water bottle and snacks on hand.
Working MemoryThe ability to hold information in your mind so you can use it to make decisions and complete tasks.Keeping a notebook and pen on hand so you can write stuff down instead of having to remember it.

Note that these examples of strengths aren’t necessarily strengths in executive functioning; often we develop solid coping mechanisms in response to our struggles, and we should absolutely consider those mechanisms strengths that we have in those areas.

This week’s printable is a reproduction of this chart, with the example column blank. This is your opportunity to think about what you’re good at in each area of executive functioning, including ways you’re dealing effectively with your deficits.

You’re good at stuff, it’s just hard to see sometimes.

Back to Basics I – What is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that primarily affects executive functioning. In simpler terms, the brain of a person with ADHD develops differently from that of a typically-developing brain, and those differences make it harder to control our attention and our behaviour. I recently had a bit of hyperfocus on ADHD-related stuff, so this post is going to explain why, as a result of what I learned, I’m more convinced than ever that ADHD is primarily a disorder of executive functions, just like Russell Barkley says.

A pinnable image of a cartoon therapist talking to a child. Text in the bottom right corner reads “Back to Basics: What is ADHD?”

 * Most of this information came from Wikipedia or the Canadian Oxford English Dictionary, 2nd ed.

The diagnostic criteria for ADHD in the DSM-5 are categorized as either inattention or hyperactivity/impulsivity.

INATTENTION AND EXECUTIVE DYSFUNCTION

Inattentive SymptomsRelated Executive FunctionsExamples
Makes careless mistakes/lacks attention to detailAttentional Control Self-MonitoringUncorrected typos in essays and reports
Difficulty sustaining attentionAttentional Control Cognitive InhibitionDaydreaming during meetings or class
Does not seem to listen when spoken to directlyCognitive Inhibition Cognitive FlexibilitySpacing out during conversations
Fails to follow through on tasks and instructionsWorking Memory Planning Goal-Directed BehaviourStarting a task and leaving it unfinished
Exhibits poor organizationOrganizational SkillsMaintaining a chaotic living space, desk, locker, etc.
Avoids/dislikes tasks requiring sustained mental effortAttentional Control Goal-Directed BehaviourPostponing homework as long as possible
Loses things necessary for tasks/activitiesOrganizational Skills Goal-Directed BehaviourSearching daily for shoes, toys, keys, etc., often multiple times a day
Easily distracted (including unrelated thoughts)Attentional Control Cognitive InhibitionGoing off on tangents during conversations and in written work
Is forgetful in daily activitiesWorking Memory Planning Goal-Directed BehaviourWalking into a room and not knowing why

Attentional Control is the ability to control what you pay attention to. It’s basically being able to concentrate.

Cognitive Flexibility is the ability to change your behaviour and thought processes based on changes in your situation or gaining information.

Cognitive Inhibition is the ability to tune out unrelated stimuli and stay on task or follow a train of thought.

Goal-Directed Behaviour is about controlling your behaviour so that you’re working towards achieving goals.

Organizational Skills are all that sorting, putting things away, etc.

Planning is the ability to think ahead and to break goals down into smaller steps.

Self-Monitoring is the ability to keep track of what you’re doing and how you’re coming across, as well as notice things like hunger, thirst, fatigue, pain, the need to use the bathroom, etc.

Working Memory is the ability to hold information in your mind so you can use it to make decisions and complete tasks.

HYPERACTIVITY/IMPULSIVITY AND EXECUTIVE DYSFUNCTION

Hyperactive/Impulsive SymptomsRelated Executive FunctionsExamples
Fidgets with or taps hands or feet, squirms in seatInhibitory Control Self-MonitoringClicking a pen, chewing on a pencil, constantly adjusting sitting position
Leaves seat in situations when remaining seated is expectedInhibitory Control Cognitive Flexibility Goal-Directed Behaviour Self-MonitoringPacing while thinking or talking through an idea
Experiences feelings of restlessnessSelf-MonitoringAlways wanting to be in motion or to move on to a new job or living situation
Has difficulty engaging in quiet, leisurely activitiesGoal-Directed Behaviour Self-MonitoringPlaying loud games, talking loudly when indoors
Is “on-the-go” or acts as if “driven by a motor”Inhibitory Control Self-MonitoringMoving constantly, particularly the whole body
Talks excessivelyInhibitory Control Self-MonitoringTalking more than others in a group
Blurts out answersInhibitory Control Cognitive Flexibility Self-MonitoringAnswering questions in class without raising hand first
Has difficulty waiting their turnCognitive Flexibility Goal-Directed Behaviour Self-MonitoringGoing straight to the head of the line without being invited
Interrupts or intrudes on othersInhibitory Control Cognitive Flexibility Goal-Directed Behaviour Self-MonitoringStarting to talk during a conversation before someone else is finished saying their piece

Cognitive Flexibility is the ability to change your behaviour and thought processes based on changes in your situation or gaining information.

Goal-Directed Behaviour is about controlling your behaviour so that you’re working towards achieving goals.

Inhibitory Control is the ability to stop before you act so you can choose the most appropriate way to behave in a given situation. It’s got a lot to do with self-control.

Self-Monitoring is the ability to keep track of what you’re doing and how you’re coming across, as well as notice things like hunger, thirst, fatigue, pain, the need to use the bathroom, etc.

Obviously some executive functions interact with each other more than others, and that is probably what makes the difference between what type and how impaired we are. Granted, this is just conjecture, but it makes logical sense to me.

Of course, to the general public, ADHD is still just hyperactive little boys, and all of these issues we have are just signs of poor parenting, laziness, etc.

The printable for this post can be found here. It’s a copy of the symptom/executive function charts with definitions and examples, plus a blank version you can use to write down examples of your own executive dysfunction. I hope it’s helpful for you in figuring out just where you’re struggling, since knowing that can help you figure out supports.

Long-Term Planning: Goals Revisited.

Let’s talk goals.

I know, I know, we spent all of January talking about goals. But April is about planning, and the best planning starts with goals.

One benefit of ADHD, when it comes to long-term planning, is the tendency towards big-picture thinking. We have big ideas and big ambitions.

Unfortunately, ADHD also gets in the way of our long-term planning. It doesn’t matter how awesome our ideas and ambitions are if we can’t work out the best way to make them happen.

In keeping with what I talked about in January, we’re going to look at our big-picture goals this week. We won’t break them down into steps, but we will be talking about goals and how to create good ones.

Pinnable image for this blog post.

Now, time isn’t real and we’re definitely prone to struggling with how long things are going to take (not to mention how long ago things happened). As such, our long-term goals aren’t going to be really detailed in terms of deadlines.

The first thing I want you to do is daydream about your ideal life. Think about your career, your home, your family and pets, and your health. Write down everything you can think of that would contribute to contentment and a great life.

Once you’ve got all of your ideas written down, group them by category. Mine are: Home, Personal, and Work. You can have more, but I wouldn’t go higher than 5 categories and 3 is definitely the lowest.

Next, you’re going to write 1-3 goals for each category, using these ideas as the basis for each of them. Rather than writing SMART goals, we’re going to drop the “T” and use the 4 “A”s to guide us. The 4 “A”s (synonyms for SMAR) are Accurate, Assessable, Attainable, and Applicable.

Accurate goals describe exactly what you want to achieve.

Assessable goals are written positively, and you can measure your progress.

Attainable goals are within your power to achieve, usually through hard work.

Applicable goals make sense for you and your individual desires, preferences, skills, etc.

These are your goals. They should be broad enough that you aren’t stuck in one route to achieve them, but detailed enough that you’ll know when you’re done.

I recommend keeping these somewhere that you’ll be able to find them easily. Revisit them every 3-6 months and assess whether they are still applicable or attainable. They aren’t written in stone, after all: goals need to be adaptable to life situations—we aren’t static, and our goals shouldn’t be either.

Also, you’re going to need your goals as we work through this month of planning, so there’s that.

Goal-Setting for ADHDers, Part 4

So you’ve done all the work, and you have a to-do list made of small steps/tasks. But that list is kinda long, and it’s hard to get through. Some days, you can’t even get started on the first thing, because the whole list is just too much.

I’ve got you, don’t worry! There are a few ways to cut down the overwhelm, and that’s what we’re going to get into today.

Pinnable image for this post. Illustration of a man holding a long sheet of paper, looking stressed out. The paper says "What should I do?" on it..

Method the First: Use Categories

Remember how I suggested categorizing your life into different areas? Well, apply those categories to your to-do list. I highly recommend colour-coding your categories and using highlighters on the list.

Once you have everything categorized, you can split the list into multiple smaller lists instead. These smaller lists will be less overwhelming. Then you can have set times each day when you work on tasks from specific categories.

If these category lists are still too much, fear not! We have more options to cover.

Method the Second: Prioritization

Prioritizing can be pretty hard, but here are a couple of ways you can assign priorities to your tasks.

  • Order by due date. The tasks that are due soonest are higher priority than things that are due later on.
  • Order by how much you want to do things. I recommend alternating between things you don’t want to do and things you do want to do, just to make sure you get the unfun stuff done.

Method the Third: Triplets

Start with categories and prioritization, then group everything by what you need or where you need to do the different tasks. Then do the tasks in what I call “triplets”: groups of three tasks with a break after the third task.

Method the Fourth: Goals & gravy

When I’m having a Bad Brain Day, it can really help to set myself “Goals & gravy.”

Goals are important things that I need to get done, and I choose three.

Meanwhile, gravy is made of three tasks that I would like to get done but that aren’t vital.

I like to do a Goal and then a gravy, so gravy is like a reward for doing Goals. The best part is that if I do any of the other things on my list, it’s extra!

So there you have it: four ways to manage to-do list overwhelm! And that concludes our month of goal-setting. I hope some of the information has been helpful for you this month. Join me next week as I introduce February’s focus!

Goal-Setting for ADHDers, Part 3

The last two parts of this series were probably daunting. Makes sense; all this stuff is hard! I mean, I enjoy doing all the planning part, but I have a tendency to over-complicate everything, which naturally makes it easier for it to break down, fall apart, explode in my face.

So how do we set goals, and how do we achieve them, or at least make decent progress on them?

That’s what I’m going to talk about today.

It’s all about simplicity and making things habits.

“But J!” I hear you say, “I have ADHD! I can’t be consistent enough to make something a habit! I chafe at the rigidity of routines! I need variety in my life!”

What if I told you that it’s possible for ADHDers to:

  • Create new habits and
  • Enjoy following routines, all while
  • Incorporating the novelty and variety that our brains crave?

Sounds too good to be true, doesn’t it? Well, it kind of is. Because doing all of this, getting a system in place and maintaining it, isn’t easy. It’s hard work. But it’s worth the effort.

Pinnable image for this post.

Over the last couple of years, I’ve read both Tiny Habits (BJ Fogg) and Atomic Habits (James Clear). Neither book contained new information, but both provided a reframe on how we form habits and why stuff is hard.

First things first, let’s talk about behaviour. There’s a whole branch of psychology that studies behaviour and how people (and animals) learn to do or not do things. Behaviourism as a discipline isn’t awful, but some of the ways this knowledge is applied certainly are. Happily, what we’re going to discuss here is pretty neutral.

The basics of behaviour are pretty simple.

  1. Antecedent—The “trigger” for the behaviour.
  2. Behaviour—What you do in response to the antecedent.
  3. Consequence—What happens as a result of the behaviour.

When you’re trying to figure out how to change a behaviour, it helps a lot if you can figure out what’s going on when you do it and how you feel during or afterwards. That’s where your “why” is hiding.

The other part that’s most important to understand is how the interplay of motivation and ability affect your ability to change your behaviour. Here’s a really simple graph to illustrate.

Illustration of a graph where motivation is on the left vertical axis, with low at the bottom and high at the top; ability is on the bottom horizontal axis, with hard to do on the left and easy to do on the right. The line of the graph starts at the top left (high motivation) and moves toward the bottom right (easy to do), travelling mostly vertically for two-thirds of the height and then slowly curving so that it begins to travel almost horizontally for the right two-thirds of the graph. The space below this line is teal, and it contains the words "Prompts don't work"; the space above the line is white and contains the words "Prompts work."

Motivation is on the left, and ability is across the bottom. The curvy diagonal line is the “sweet spot” where the behaviour is most likely to occur. You’ll notice that when motivation is low, then it needs to be easy to do or it won’t happen. If you’re really motivated to do it, then it’s okay if it’s more difficult.

We’ll, that’s how it works for neurotypical people, at least. Executive dysfunction means our graph is way messier and not so straightforward. But! If we make things as easy as possible, then often we can sidestep our executive dysfunction and actually get stuff done.

In Tiny Habits, BJ Fogg gives a really simple “recipe” for building a habit.

“After I [Antecedent] I will [Smallest first step possible] and I will celebrate by [something that makes you feel great when you do it].”

Tiny Habits, BJ Fogg

There are two things that are really important with the Tiny Habits method. First is the Antecedent, or trigger. Another way to think of this is as a prompt. That’s why the recipe begins with “after…”: the new behaviour is something you’re going to do after something you already do all the time. It’s important to note that if you have low motivation to do something and it is really difficult, then that prompt isn’t going to work.

The other important part of this method is to celebrate immediately after you complete the new behaviour. This ties the excited feeling and burst of dopamine to doing that thing, which will help you remember to do it again next time. Remember, the ADHD brain has trouble with dopamine; most of us either don’t have enough or we don’t use it effectively. That means we are always looking for more. So anything that gives us that surge is something we’re going to want to do more often.

James Clear talks a bit about this (he’s done some studying under Dr Fogg), but his book takes things further and smaller (hence “atomic”—he’s going smaller than tiny). I’ve incorporated both books into my current approach to life and seen some success. So I’m going to explain it now.

The first thing is to figure out what you already do. It doesn’t have to be precise, just make a list of what you do every day, in order. You can do this for several days in a row and then see where things repeat—for example, I get up every morning and use the bathroom, then I make the bed and get dressed, and then I do my hair.

Now that you know what you do, it’s time to decide what you’re going to add.

Just like last week, we begin by dividing our lives into 5 or 6 different categories. This is important because we don’t want to take on too much. The point here is to make stuff easier, not to make it all as complicated as possible!

Now you get to daydream a little. Think about the things you value about each life category, and think about people you know or characters from TV, movies, or books (etc.) who exhibit those values and qualities. The idea is to think about what kinds of things those people do that reflect their values, because that’s going to get you to the next step.

Write down the things those people do and the values and qualities they exhibit. Then write yourself a positive statement that attributes all of these things to you. Start this sentence with “I am the kind of person who…”

You’re probably feeling a bit weird about writing something like “I am the kind of person who puts things away and does the dishes every day” if your house is a perpetual disaster. The thing is, this isn’t lying, it’s stating your values in a positive way, to remind you what’s important to you and why you’re doing the things you’re doing. It’s an aspirational message: you aren’t there yet, but you’re working on it and you’re doing your best.

Once you have a statement for each life category, you get to pick one thing in each that you’re going to start doing. Except you’re going to make that one thing the absolute smallest thing you can possibly think of.

Let’s say that you have a life category for physical health, and your statement is “I am the kind of person who eats well and exercises regularly.”

Thinking about people who eat well, you decide that you want to start eating more vegetables. But that’s pretty vague, and vegetables can be time-consuming to prepare, and they can be expensive.

So you decide to have fresh vegetables for an afternoon snack every day, and that you will get bags of baby carrots or snap peas, or a prepared veggie tray for this purpose every week when you get groceries.

You decide to keep these snacks on the top shelf of the fridge so you see them when you go looking for something to eat.

Your “recipe” reads as follows: “After I feel hungry in the afternoon, I will eat one fresh vegetable as a snack, and I will celebrate by clapping my hands.”

Most things you’re going to consider doing will require a bit of prep work, as with the example of eating more vegetables. The key is to keep the prep simple (e.g., by buying vegetables that are ready to eat and don’t need to be cut up or anything) and set yourself up for success by making whatever you need easily accessible (e.g., by putting the vegetables in a visible location in the fridge). Oh, and you definitely need to choose vegetables that you like and will want to eat!

So I think we’ve covered all of the important bits here. We’ve tied eating vegetables to afternoon hunger and made it easy to remember to eat the vegetables and to actually eat them. We want to be healthy, and we like the vegetables we’ve chosen. We’re celebrating as soon as we’ve eaten the vegetables. All of these things will help us turn eating vegetables into a habit.

What about consistency?

Well, James Clear likes to track his habits and he does regular data reviews and stuff. If you like tracking stuff and like data, go ahead. But it’s not necessary. In fact, BJ Fogg says that the common factoid of “it takes 28 days to form a habit” isn’t really true. And if you miss your habit one day, just do your best to do it again the next day.

That’s it. That’s how you do it. Be as consistent as you can, but don’t worry too much about a missed day here and there.

Obviously breaking things down can be hard. Same with figuring out how to set yourself up for success. But that is part of what Actually ADHD (and its sibling Tumblr, “How Do Thing?“) is for. So if you need help with any of that, don’t be afraid of the ask boxes!

Next week we’ll finish up this month of goal-setting by talking about a strategy I find helpful on Bad Brain Days, and we’ll talk about that all-important “immediacy factor.”

Goal-Setting for ADHDers, Part 2

Last week I wrote about neurotypical goal-setting strategies and SMART goals. This week, I’m going to delve into the concept of “objectives” and whether or not they’re really all that different from goals.

I am a strange person in that I really like breaking things down to make them easier to manage and to make it easier to know what to do. Granted, wanting it to be easier is probably normal, but I’m pretty sure that most ADHDers aren’t very interested in breaking projects or tasks down into their individual components or steps.

When I was working in early intervention, we had goals for the children that were quite broad. Within those goals were objectives: smaller goals that would support the child’s growth and development so they would ultimately achieve the big goal.

As I said last week, I don’t really like SMART goals. I prefer to keep my goals broad and to get more specific with my objectives, not long-term and short-term. Maybe that’s just semantics, but sometimes the words you use matter a lot.

Here’s how I do it.

  1. I divide my life into 5 or 6 areas that I want to keep in mind, and I assign each area a colour. The colours match up with some highlighters I have, and this makes it easy to mark things in my planner. My areas are:
    • Home (light blue)
    • Personal (green)
    • Work (pink)
    • Writing (orange)
    • School (purple)
  2. For each area, I think about what I really want things to be like. Some of them get broken down into sub-categories, like Personal (Physical Health, Spirituality, Emotional/Mental Health, Family, Friends) and Work (I have this and I’m a copy editor, among other things).
  3. I create my broad goals, which are really a picture of my ideal life if you put them all together.
  4. I break down each broad goal into its different components.
    • For example, if my broad goal is to have a clean, comfortable home where we can have people visit, the components will be cleaning the house, decorating the house, and having people over.
  5. Each component now gets its own goal, which is what I call a Long-Term Objective (LTO).
    • Sometimes different components for one area can be worked on at the same time, but usually there has to be some delay.
    • For example, I need to clean the house before I can decorate it or invite people over, but I probably don’t need to decorate before having a party.
    • I don’t give myself any deadlines.
  6. Now I break down the LTO’s into their component parts.
    • In the example of cleaning the house, each room will be a component.
  7. And now I write my Short-Term Objectives (STO’s), which are the smaller goals that I want to accomplish and that will help me achieve my ultimate goal.
    • I still don’t give myself any deadlines. Don’t worry, I’ll explain why next week.

Yes, that’s a lot of work. But doing it this way is actually less intensive if you do it every year, because those ultimate goals don’t tend to change in huge ways, and the steps you need to take also don’t change much. You’ll always need to study physics to be an engineer, and you’ll always need to exercise if you want to build muscle.

What do you think of this so far? Does it make sense to you? Do you think I’m being completely ridiculous here, or do you find yourself liking the idea?

Next week I’ll tell you why I don’t give myself deadlines. Hint: it’s related to a book that was really popular last year.

Goal-Setting for ADHDers, Part 1

If you’re like me, you have spent years trying to figure out this “setting goals and achieving them” thing other people seem to be capable of.

The reasons we struggle with this are varied:

  • we forget about our goals.
  • breaking down big goals into smaller steps is hard.
  • maintaining systems and structure is hard.
  • organization is hard.
  • probably other things I can’t think of right now.

I have a couple of videos up on YouTube about ADHD and life goals, and I’ll be adding to that series soon. Today, I want to talk about what I’ll be covering in this month’s blog posts.

It being January, month of new beginnings, I thought goals would be an appropriate theme.

Pinnable image for this post.

Now, I have vast experience with goals. When I worked in early intervention, we had goals to work on with the children. They were usually written up as in an Individualized Education Plan (IEP), and divided into different domains with 1-5 goals each.

And yes, I have written such plans for myself.

What I have found is that I end up with too many goals and I over-complicate everything. So I don’t really do that anymore except for fun (because yes, I think this kind of thing is fun).

If you look up “goal setting” online, you’ll find lots of similar advice. Basically, you’re supposed to “think big” and write SMART goals.

SMART goals are:

  • Specific
  • Measurable
  • Achievable
  • Relevant
  • Time-bound.

Here’s the problem with that when it comes to ADHD:

Let’s say that want to clean. up my house this year. My SMART goal is “I will get my entire house cleaned up and organized by December 31, 2022.” That’s a huge goal, and overwhelming. I can absolutely break it down by room (breaking down big tasks is something I’m good at), and I can even assign the steps to different days in my planner, etc.—I can do all of the things all of these experts say to do—but there’s no flexibility built into the goal, so if life happens or I have a a Bad Brain Day or whatever, my schedule will be thrown off and I won’t be able to complete the goal.

I don’t think that we are completely out of luck when it comes to goals, though. We just have to be prepared to re-jig things in a way that will work better with our brains and symptoms, and that accounts for inconsistency.

How do we do that?

I’ll start explaining next week.

G is for Getting Diagnosed

The diagnostic process can be stressful or simple, and it varies from clinician to clinician.

It can be as simple as an interview or as complicated as complete neuropsychological testing.

It can be as easy as describing your difficulties in detail to the first clinician you see or as difficult as explaining yourself fifty times to as many clinicians.

The reasons you might be denied a diagnosis are many.

  • You might be (or appear to be) female.
  • You might be a person of colour.
  • You might be autistic.
  • You might have other psychiatric diagnoses already.
  • You might get (or have gotten) good grades in school.
  • You might be Predominantly Inattentive, rather than Predominantly Hyperactive/Impulsive.
  • You might be poor.
  • You might have parents who don’t believe in ADHD.
  • You might have parents who don’t want you labelled.
  • You might have parents who don’t want to deal with the stigma of having a child who has “something wrong with them.”

And that is just a partial list (and the most common ones I see).

The choice to try to obtain a diagnosis is not simple. There are a lot of factors to consider, from how the diagnosis might benefit or hinder you, to your history with psychiatric professionals, to your financial means.

It’s okay to get a formal diagnosis if you just want to know for yourself that you aren’t imagining things, and there’s a real reason why you struggle with so many things.

It’s okay to avoid a formal diagnosis if you have a history of trauma at the hands of medical and/or psychiatric professionals.

It’s okay to get a formal diagnosis if you aren’t struggling as much as someone else.

It’s okay to avoid a formal diagnosis if you can’t afford it and can’t access funding to pay for it.

It’s okay to get a formal diagnosis if you think treatment will help you better manage your life.

It’s okay to avoid a formal diagnosis if you think it will negatively affect how people treat you.

What matters is that you make an informed decision and explore your options. Just remember, the label doesn’t change who you are as a person.

It just helps to explain some of why you are who you are.

F is for Fidgeting

The kid who squirms in his seat during class.

The teen who jiggles her leg under her desk while writing a test.

The young adult whose post-secondary lecture notes are covered in doodles.

The working adult who clicks pens during meetings.

The stay-at-home mom whose feet twitch constantly while she’s reading a picture book to her preschooler.

It’s annoying to other people. Sometimes it’s annoying to us. It makes people think we’re nervous. It makes them think we want to be doing something else.

It’s fidgeting.

Fidgeting is the common word for the little things people do to help ground themselves and maintain their focus. Neurotypical people don’t do it as often as neurodiverse people do, but they do it all the same. Sometimes our stuff is more obvious than the neurotypical stuff, is all.

It’s all a type of stimming.

“Stimming” is short for “sensory stimulation” and it refers to the things we do to positively impact our sensory systems. You’ll usually see it used in conjunction with autism, because autistic people do it the most, but all people who have developmental disorders stim, and that means ADHDers stim, too.

Stimming can calm us if we’re feeling overwhelmed.

It can help us focus if we’re struggling.

It can keep our bodies in motion so that our ears and eyes can do their jobs better.

Sometimes a stim or fidget is disruptive, and that’s when we have to find other ways to get the same sensory input. It makes no sense to replace pacing with tapping your knee if what you need is the gross motor vestibular input. Rocking on an inflated rubber seat cushion would probably work much better in such an instance.

The important thing to remember is that we often don’t do these things consciously, and if we do make the conscious decision it’s because we recognize how we’re feeling and have realized that doing this particular thing makes us feel better. So finding ways to accommodate fidgeting/stimming is vital to our success.

How do you fidget or stim, and in what situations?