News and Views

Holiday Disruption & ADHD: Sloppy Sleep

by Janna, posted in Holidays

Sleep is notoriously difficult for ADHDers. Either we find it hard to fall asleep because our minds are racing or we forget to go to bed until we’re falling asleep sitting/standing up. All the traditional advice to solve these problems revolve around “sleep hygiene” (because hygiene in general is so easy) or bedtime routines.

What really sucks is that sleep is vital for optimal brain function, so when our sleep is messed up our brains don’t work as well as they might otherwise, which means that our symptoms are harder to manage.

Now add in the disruption of the holiday season.

Is it any wonder that we get overwhelmed so much more easily during the holidays?

A pinnable image of a child climbing the stairs to go to bed.

How much sleep do we really need?

When my son was born, I took some time to really look into the question of how much sleep we need. It’s definitely more than we think!

In general, if you’re getting less than 7 hours a night, you’re sleep deprived. How sleep deprived depends on your age:

Age groupRecommended amount of sleep
Infants 4 months to 12 months12 to 16 hours per 24 hours, including naps
1 to 2 years11 to 14 hours per 24 hours, including naps
3 to 5 years10 to 13 hours per 24 hours, including naps
6 to 12 years9 to 12 hours per 24 hours
13 to 18 years8 to 10 hours per 24 hours
Adults7 or more hours a night
Chart from The Mayo Clinic, at link given above.

Of course, there are other things that impact your sleep. Interruptions (like when you have small children) and hormonal changes (like with pregnancy or menopause) affect your sleep quality, age affects how well you sleep, and sleep deprivation increases your sleep needs.

What’s the point of sleep?

We actually don’t know all of the reasons we need sleep, but we do know a few things.

Perhaps the biggest reason is that our brains build up toxins during the day–all that thinking and firing neurons and so on creates a bunch of waste–and those toxins can’t be disposed of while we’re awake and creating more.

We also know that a lack of sleep contributes to a number of health conditions, including obesity, diabetes, and mood disorders. On top of that, sleep deprivation can often look a lot like ADHD because it affects the frontal lobe (where executive functions are managed). That’s why a sleep study may be part of the assessment process. (It is important that the professionals involved understand that ADHDers tend to have difficulty sleeping properly anyway.)

Sleep Problems and ADHD

The biggest issue ADHDers tend to have with sleep is struggling with actually falling asleep because our minds are racing. We just can’t turn that off.

Other problems ADHDers seem to experience more often than non-ADHDers include:

  • forgetting to go to bed due to hyperfocus;
  • not getting tired due to messed up melatonin production; and
  • non-24 sleep-wake disorder (N24–your circadian rhythm isn’t on a 24-hour schedule).

That Racing Thoughts Problem

Some good ways to get your brain to finally shut off and go to sleep include putting your imagination to good use and telling yourself a story; reading a book until you’re actually sleepy; and doing some kind of puzzle book until you’re sleepy. All of these things can be done in bed with the lights off, using a bedside lamp to illuminate your book if necessary.

That Hyperfocus Problem

The biggest problem I’ve found here is that it’s difficult to predict what is going to trigger hyperfocus. Setting alarms to remind yourself that it’s bedtime can be helpful with that, as long as they’re alarms you won’t ignore. Creating an evening routine that will get you to bed at a good hour (based on when you need to be up in the morning) can also help with this, particularly if your routine doesn’t include activities that you tend to hyperfocus on. For example, including reading in my evening routine would be foolish, as I’m likely to simply stay up all night reading!

That Melatonin Problem

Melatonin tends to be the first thing people suggest whenever someone says they’re having sleep issues. And it can certainly help you get to sleep and stay asleep, as long as you follow the guidelines. However, it’s important to know that you may need a very small amount (smaller than the pills sold in-store are, so you’ll have to cut them), and that there can be weird side effects. Remember, “natural” doesn’t mean “totally safe”!

When you’re taking melatonin (or any sleep-related medication), you need to take it around half an hour before you want to be asleep, and then you need to be in bed ready to sleep before you hit that mark. If you miss it, you might as well have not even bothered taking it. If your dose is too high or too low, you may wake up multiple times in the night or you may have disturbing dreams.

When I tried melatonin, I found that I couldn’t get the dose to where it helped me fall asleep but didn’t give me weird dreams. (When I say “weird” or “disturbing” dreams, I don’t mean nightmares, though some people have had that experience. Mine weren’t nightmares, but they did tend to be gory–just not scary.) When the dose was too high, I woke up in the night but did find it easy to fall back asleep.

That N24 Problem

N24 sleep disorders require consultation with a sleep specialist. I am definitely not able to provide assistance with this beyond recommending you keep track of your sleep as best you can if you think you have an N24 sleep disorder, so you have lots of data to present to your doctor.

What About the Holidays?

I don’t know about you, but during the holidays I have more trouble than usual following a sleep schedule. There are fewer demands during the day, and more fun things to do with family and friends in the evening. When my whole family is together, my brothers and I are prone to talking until the wee hours, solving world hunger and all that; when I was a kid, if I was sharing a room with a cousin, we’d stay up and talk all night.

What I’ve noticed is that my in-laws prefer an earlier bedtime, and I am considering trying to take my cue from them next time we’re all together. Other than that, the best thing to do is to get a solid routine in place and then create a contingency plan (as per two weeks ago) to follow as needed.

This week’s printable is meant to help you keep track of your sleep and figure out what helps you get enough sleep. There is a tracking chart included, as well as a worksheet to use for developing a functional bedtime routine for yourself. You’ll also find some information about good sleep hygiene, such as when to shut off your devices and what to drink before bed. I hope it’s useful for you and for your doctor, should you decide to seek help with your sleep issues!

Holiday Disruption & ADHD: Messy Mealtimes

by Janna, posted in Holidays

Remember those four things that heavily impact how difficult your ADHD symptoms are to manage? Diet, sleep, exercise, and stress. This series as a whole is about lowering your holiday-related stress levels, which should help somewhat. Part of lowering your stress levels, like we discussed last week, is maintaining your routines.

This week, we’re going to talk about diet.

About Diet & ADHD

First, my disclaimer: I am not any kind of medical or nutrition professional. I am not offering advice regarding the actual content of your diet beyond general suggestions based on the nutritional guidelines adopted by most food and health related services in Canada and the United States. Always consult your doctor and/or a dietician before making any big changes to your overall diet. And of course, eat what you enjoy eating that fits within whatever dietary constraints you may have (e.g., food allergies, food intolerances, food sensitivities).

Now that’s out of the way…

You’ll find lots of information online about dietary intervention for ADHD. Some of it is supported by science, but a lot of it isn’t. The problem is that a lot of the unsupported ADHD-related diet stuff tends to be offered up as a way to cure ADHD. Which it isn’t, because ADHD isn’t caused by food allergies or sensitivities. But dealing with those food allergies or sensitivities, if you have any, can make your ADHD easier to manage. For example, studies have shown that people with food allergies or something like celiac disease may have some cognitive problems similar to those seen in ADHD. However, those problems disappear once their diets have been adjusted, and they obviously do not actually have ADHD. Of course, if you do have ADHD and one of those food-related issues that causes brain fog (etc.), then adjusting your diet will help with the food-related symptoms, but you will still have executive dysfunction.

In general, the best diet for ADHD is a healthy diet with lots of fruits and vegetables and a little extra protein. Not a low-carb diet necessarily–your brain actually requires glucose in order to function–but protein actually provides more energy over a longer period of time, and it has other nutrients that ADHDers can need more of, such as iron. And yes, you can eat extra protein if you’re vegetarian or vegan; meat is not required.

If you’re really confused about what will be best for you and your health, find a registered dietician and discuss your diet with them. This can be pricy, but it’s worth it for your overall health and functioning. I do recommend a dietician over a nutritionist, though a nutritionist may be cheaper, because dieticians have professional guiding bodies that ensure ethical practice and give you somewhere to go if you think your dietician has done something they shouldn’t. Meanwhile, in a lot of places the term “nutritionist” isn’t regulated at all, so someone may not have any food science education whatsoever.

Okay, let’s talk holidays and food.

Meal Messiness

I don’t know about you, but I forget to eat. There are a bunch of reasons for this, all related to my ADHD:

  1. I might get hungry but be hyperfocused and forget to get food.
  2. I might make food and forget about it until there’s no time to eat.
  3. I might not get hungry at all (sometimes due to medication, sometimes my body is just weird).
  4. I might be hungry but unable to find anything I actually want to eat.

On top of that, I also tend to overeat. Again, there are a bunch of reasons for this, all related to my ADHD:

  1. I might seek out high-carb food like chips and candy for a quick hit of glucose for my brain.
  2. I might snack absentmindedly while watching TV/YouTube, reading, or doing something creative.
  3. I might have extra helpings of something that tastes really good.
  4. I might be extra hungry after not eating all day (see above).

I’m also notoriously bad at figuring out what to make for lunch. Breakfast is easy, and I’m good at supper, but I’m not a sandwich person and need things to be easy in the middle of the day.

Basically, food is already chaotic for me, and I bet it is for a lot of other ADHDers. Add in holiday disruption, and you’re going to struggle even more.

So how to handle holiday disruption and food?

Set Alarms

Those little hand-held computers we all carry in our pockets these days can be fantastic for reminding us to eat. I even found this great little app called EatWise (not sponsored, not affiliated) that will remind me to eat at specified intervals. It’s free and available for both iOS and Android.

Carry Snacks

Keep snacks nearby. Things like granola bars, trail mix, fresh fruit, cheese strings, and yogurt cups can be great options. Eating something that combines carbs, fat, and protein will help keep you going when you’re hungry but not able to have a full meal.

Drink Meal Replacement Shakes

If you’re struggling with eating actual food, a high-protein meal replacement shake (e.g., Boost) can be a decent option. This should really be a once in a while kind of thing, but it’s worth keeping some around just in case.

Plan Your Meals

Meal planning sounds hard, but it’s probably not as hard as you think it is. In fact, I’m going to suggest you keep it as simple as possible. There’s a bit of work to do to get it set up, but then it’ll be easy to maintain. There are a few different ways to make this work for you, depending on whether you’re hosting others or visiting. So let’s look at the general set up first.

Set Yourself up for Success

In general, you probably have food that you like to eat. You also have meals that you’re good at making. Start there. Write everything down. Don’t worry about anything except writing down the food you like to eat and like to make. Microwave dinners are absolutely an option.

If you’re responsible for feeding more people than just yourself (e.g., you have children, you’re the primary meal-maker in your family), do the same for each person you need to feed.

Once you have your list, you’re going to sort it. For whole foods like potatoes, carrots, steak, etc. you’ll divide them into proteins (include dairy products here), fruits & vegetables, and carbohydrates (grains & potatoes). Put candy, chocolate, chips, and other “junk food” in their own group. Your final grouping will be for full meals, like casseroles and microwave dinners. Full meals are things you can’t really separate into the individual components. Meal replacement shakes go here.

If you’re feeding more people, sort their lists of food as well. Then compare the sorted lists and create a master list of all of the foods that appear on everyone’s lists. You’re going to want to use this master list for any meals that you will all be eating. Be sure to note any food allergies or sensitivities; you don’t want to make anyone sick.

You now have what you need for meal planning.

everyday meal planning

I don’t think it makes sense for ADHDers to make strict meal plans. Life is way too unpredictable for that! Instead, use the components on your master list as your basic grocery list. These are the staples–basic meal building blocks you want to keep on hand, so you can easily feed yourself (and others) based on what you feel like eating and what you’re up to cooking. Doing things this way also lets you shop the sales at your local grocery store. Stock up on your staples when they’re on sale, and that way you’ll always be able to make food you like without spending too much.

when you go to make a meal

When you are going to make something to eat, you can look at your list to see what your options are. Choose something that sounds like it will taste good and fits your current cooking ability. For a meal that isn’t from your full meals category, you want to choose a protein, at least one vegetable or fruit, and a carbohydrate. The “balanced plate” illustration most government sources use suggests half your plate should be vegetables, a quarter should be protein, and a quarter should be carbohydrates. I agree with this, though a little more than a quarter of your plate being protein is also good.

Remember that a snack is just a really small meal.

when you have guests

If you’re hosting people, you may be responsible for keeping them fed. If so, get them to make lists of their favourite foods and meals before they come, so you can compare their lists with your master list and adjust your staples for the time they’re there. It’s also a really good idea to check if anyone needs to eat at particular times, such as if they have diabetes, so that you can figure out how to make sure that happens for them.

when you’re the visitor

Now that you have your master list, you can pass a copy along to your hosts so they can plan meals more easily. It’s also a good idea to ask if there is a set schedule for meal times, since that will help you know if you’re going to need snacks.

hosting a festive meal

If you’re going to host, ask your guests to bring side dishes, and you provide the protein. If you have to provide all of the food yourself, figure out the timing early so that on the day you know what to do when, and make some things ahead of time so you don’t have to worry about them on the day of the meal.

This week’s printable is all about meal planning. The first two pages will guide you through the process of creating your master list of meals and meal components (print these two pages for every person you need to feed). The rest of the document is about planning a festive meal. I hope this will help lower your stress!

Holiday Disruption & ADHD: Broken Routines

by Janna, posted in Holidays

Something I don’t see discussed often enough is how much we ADHDers can get thrown off by a disruption to our routines, even when the disruption is fun or positive. Since the USA has Thanksgiving later this month (Canada had Thanksgiving in October) and Christmas will be a month after that, I thought this would be a great time to talk about strategies to deal with the many ways in which the holidays can screw us over.

Let’s start with routines.

Pinnable image for this post. A picture of a checklist on a clipboard with a cracked egg on it.

yes, you have routines!

Routines seem like the impossible dream a lot of the time, but I’m here to tell you that you have some, even if you think you don’t.

Do you always brush your teeth after you shower in the morning? That’s a really simple routine.

Do you always have spaghetti for supper on Wednesdays? Also a basic routine.

What typically happens is that we fall into routines almost by accident. Most people talk about routines as being these intentional things, but for us they’re more like magic, and they can poof really easily.

The easiest way I know to find out what your routines are is to actually write down what you do, in order, every day for a while. You don’t need to keep track of the time or anything, just the stuff you do. When you have at least three weekdays, you can compare the days and see what things you do in the same order every day.

Those are your routines.

Because a real routine is a collection of habits that are chained together, it’s not something we think about when we do it. It’s just what we do. The thing is, routines give us structure, which is something we struggle with. (See last month’s posts for why that’s hard. Executive dysfunction sucks.)

So when holidays come–or anything that disrupts our usual lives–those routines get disrupted, and it can be really hard to recover from that disruption. And the resulting lack of structure is stressful, which can make our ADHD symptoms harder to manage.

routine disruption

Routines can be disrupted in a lot of different ways during the holidays. Work and school are often cancelled, or if you work in retail you have extra hours. You might have houseguests. You may travel to visit family or friends. In some instances, your routines can continue as usual. In others, things are so out of the ordinary that you can’t maintain them at all.

So how do you mitigate this disruption?

figure out a minimal version

Try looking at your established routine and pull out the activities that feel most important to complete. That’s your minimal version of your routine. It can function as your alternate routine when time is short.

pick a different time

Maybe you can’t do your routine at its usual time, but maybe you can do it at a different time of day. Figure out whether that routine needs to be done when you currently complete it or if it can be moved.

do something else to get the same result

What is the point of the routine in question? Is there another way you can get that result? For example, if your morning routine isn’t going to work in full when you’re visiting your family because you can’t shower due to how many people are competing for the bathroom at that time, maybe you can break up the routine and move showering to a different time of day (see previous heading), or maybe you can clean yourself using wipes or a washcloth instead.

Do you have any other suggestions for ways to manage when your routines are disrupted? Please share in the comments!

This week’s printable is meant to help you figure out what your routines are, get an idea of what kinds of things might disrupt those routines, and come up with contingency plans for said disruption. As a bonus, I’ve included a worksheet to help you add new habits to your established routines.

Next week we’ll start looking at planning for the holidays. Disruption is easier to handle if you know what to expect, and that’s what planning is good for.

Back to Basics IV – Succeeding with ADHD?

by Janna, posted in ADHD Awareness Month

We’re going to finish this month of ADHD Awareness by talking about success. What is success? Why do some people seem to achieve success while others struggle constantly? Is success really possible with ADHD?

In order, my short answers are: that depends; it’s all about support; and yes, but.

So let’s get into it.

What is success?

suc*cess noun 1 the accomplishment of an aim; a favourable outcome (their efforts met with success). 2 the attainment of wealth, fame, or position (spoiled by success). 3 a thing or person that turns out well. [Latin successus (as succeed)]

The Canadian Oxford English Dictionary, 2nd ed.

Society tends to consider the second definition the only type of success that matters; I would say that the third is the most important, because it is about a person’s character rather than their material gains.

But the reason I say that success doesn’t have a single answer (that’s what I mean by “that depends”) is that first definition. “The accomplishment of an aim” is individual. You decide on what you want to accomplish, and you put in the effort to achieve that goal. Which means you get to define your own success.

I encourage you to think about what kinds of things you truly care about. What does success really look like for you? Maybe it is that second definition, but maybe it isn’t. Maybe “success” for you is having lots of good friends who know they can depend on you and who you can depend on in times of need. Maybe it’s being a good parent and raising children that meet that third definition. Maybe it’s much smaller than any of that and it’s simply about living each day the best you can and treating others with kindness and understanding. That’s the point: success is subjective, and you get to decide what it is for you and your life.

Why do some people achieve success while others struggle?

You know that old saying, “Behind every successful man is a woman?” Well, that’s what I mean when I say that it’s all about support. Not that women need to support men to succeed; rather, I mean that all people require support from others in order to succeed. That’s why we stan rags to riches stories: people who rise above their starting place, especially without lots of support, are our heroes.

The fact that everyone needs support for something is an important one to remember, though. It’s not wrong or bad to need support, it’s human. It’s just that some people need more support than others for specific things, and unfortunately the stuff ADHDers struggle with—executive functions—tend to be things that contribute to success, particularly as the world defines it.

It’s also totally possible that people the world considers to be unsuccessful have actually achieved the success they wanted. You don’t know if you don’t ask.

Can ADHDers succeed?

Yes, ADHDers can be successful in business, in life, in love, etc.

But.

ADHD means we’ll probably have to define success to mean something specific and personal to us, that takes our particular flavour of ADHD into account.

ADHD means we’ll need to adapt our road to success based on our particular interests, skills, challenges, and strengths.

ADHD means we’ll probably need people to support us in our less-than-stellar executive functions.

If you look at the ADHDers touted as successes, you’ll see a few commonalities, and if you really dig you’ll probably realize the following:

  1. They’re successful in a field they reliably hyperfocus on; and
  2. They have people around them who handle the stuff they aren’t good at, from Executive and Personal Assistants to manage schedules and tasks, to cooks and cleaning staff (or a spouse who is good at those things).

So define success for yourself, and then think about ways you might get there. Your path doesn’t need to be linear. It doesn’t need to look like anyone else’s path. Your success also doesn’t need to look like anyone else’s success. Figure out what matters most to you, and make it happen.

This week’s printable has been around for a couple of years at this point; it’s a worksheet designed to help you work on this very thing. It actually goes with a couple of YouTube videos I did on the topic of ADHD and life dreams, so go watch those, too.

I look forward to learning about your definition of success and how you’re going to achieve it!

Back to Basics III – Treatments for ADHD

by Janna, posted in ADHD Awareness Month

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.

Back to Basics II – Types of ADHD

by Janna, posted in ADHD Awareness Month

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?

by Janna, posted in ADHD Awareness Month

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.

by Janna, posted in goal setting

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

by Janna, posted in goal setting

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

by Janna, posted in goal setting

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.”