If we’re always in action – or inaction, without taking a conscious pause to step back, observe, reflect and perhaps redirect, we’re doing ourselves an injustice. All pauses are not the same. Check these out:
PLANNING Pause – I often talk about Planning Time vs. Doing Time – how important it is to set aside specific time to focus on deciding what you need to do and how you’ll get it done (Clarity) along with when you’ll do it (Priority). When you pause to plan, your efficiency quota can increase exponentially! See my blog “TheTwo Magic Words for Productivity: Clarity and Priority.”
REFLECTION Pause – Another helpful distinction is Reflection Time vs. Action Time. The idea here is to make the time, while working on a project (preferably one task at a time!), to pause and think about the efficacy of your actions. Ask yourself if what you are doing now (task, project, direction, etc.) is the best thing for you to be doing at this point in time. Consciously consider whether your actions will help you to finish the project, attain a goal or, on a broader scale, live a life you love! If so, continue; if not, redirect your efforts.
HABIT Pause – One of the benefits of Reflection Time is seeing patterns you might have overlooked,or known but ignored. You can’t fix what you don’t realize is broken, so take a pause to think about it. Members of my online Action/Accountability group, The TUIT Project, are asked to consider not just what they’ve accomplished, but what worked and what got in the way. How can you build on that? What habits/patterns support your efforts, and which ones hold you back?Here’s an example: Annie is a TUIT group member who identified chronic perfectionism as getting in the way of her productivity. While helpful to a certain extent (especially knowing how easy it is to get distracted and careless), it’s also easy to have too much of an otherwise helpful thing – ever hear of ‘paralysis by analysis, or ruin something that was working by overthinking or over correcting, or miss a deadline because you wanted to fix ‘one more thing’? Awareness helps, and awareness begins with a pause.
DOING Pause: Redirect – I don’t believe you can just stop doing – or thinking – about something. There will be a void and you have to fill that void with a different ‘something.’ So, telling yourself to be less of a perfectionist is not going to be very helpful unless you then substitute another conceptor behavior. In Annie’s case, an internal bell now rings when she’s caught up in perfectionism, and she reminds herself, “Go with Good ‘Nough!” as a replacement mantra for perfectionistic behavior. Successful people don’t constantly second guess themselves – they get into action and move forward towards completion, pushing through the obstacles instead of getting stuck in finding a perfect solution. See my blog “Ready – Fire – Aim.”
ACTION Pause – Sometimes, an Action Pause is the best way to get something done. Temporarily walk away from it – avoids the law of diminishing returns. Shift to another task or recharge with exercise, an outdoor break, play break or even a quick nap.
PROCESSING Pause – Many people with ADHD also have a degree of ‘slow processing.’ This has nothing to do with intelligence, nor the ability to understand concepts (which we often get quicker than many people). It does, I think, reflect the way many of us understand things. We need to relate new information to something we’ve already processed, whether consciously or not. Facts in a vacuum don’t work. So it may take a bit of time to absorb the new info and tie it together with something we already have stored in our atypical brain. That is partially our genius – we make links that many others will not. It’s also our challenge, because we may not easily get stuff that others pick up without pause. Allow yourself the gift of the pause. Take time, without guilt, to absorb things, whether it’s a conversation, a lecture or a scenic view. Don’t apologize for that blank stare when someone is talking, or feel pressured into a quick response, but do have a response ready, “Hmmm… I’m thinking about that.”
SPEAKING Pause – People with ADHD tend to be impulsive, which can mean blurting out what they think without thinking it through. Poor short-term memory can also contribute to the rush to get a thought out before we forget it. Sometimes we are so focused on what we want to say that we’re not in full listening mode. This can by annoying to others, and then some. A great idea that is poorly communicated is doomed. So, recognizing this tendency, pause to consider if what you want to say is appropriate, helpful, timely and succinct. If not, remain on ‘pause.’
THINKING Pause – Therapists, coaches and some teachers are trained to ask a question, then pause, giving the recipient time to reflect and respond. We have so much going on in our lives that it takes time to think, so that we can pull out what is most pertinent, relevant or important. It’s easier to discuss things at a superficial level, but when we pause to really think about something, that’s when we open the door for those ‘Ah Ha!’ moments. What do you think about the PAUSE? What are some Pauses that work for you? Share them in the comments section below.
I have mixed feelings about the New Year. I can fantasize that my deepest desires will materialize this year. I can feel in control, as I haven’t yet failed to accomplish my goals, nor have I disappointed myself (or anyone else). But I will… Fortunately, I will also succeed at a lot of things, and it is important that I acknowledge my successes, because…
We’re really good at reinforcing our perceived failures. Sometimes it seems that most of our thinking involves berating ourselves for what we haven’t done, or feeling anxious about what we need, or want, to accomplish. It’s rare that we congratulate ourselves. Even here, in the opening paragraph, I debated whether I should write that I’ll succeed at ‘a lot’ of things, or scale it down to succeeding at just ‘some’ things.
It is important to be self-aware (Step #1 in my 7-Step PowerPlan to Success™), and that means realistically recognizing our strengths, along with our challenges. To do this we can’t listen to our inner Judgmental Critic that constantly tells us we aren’t ‘good enough.’
So how can we set ourselves up for real success?
Accept yourself for who you are. (#2 in the 7-Steps) Take a neutral position – “Yep, I do some good stuff but I’m also good at screwing things up.” The year will have its ups, but also downs. You can’t have good without bad, success without failure, or there is no discernible distinction. So stop beating yourself up for your challenges, and work from your strengths. Expect a roller coaster approach to success, and shoot for improvement, not perfection!
Appreciate micro change.Focus on making small changes that eventually add up, instead of going for the big ones that may never happen. Commit to losing 5 pounds, not 50 (do-able, rather than intimidating or frustrating and thus easily avoided). Clear one drawer or file, instead of feeling you have to rearrange the entire room or file cabinet (so you don’t even start the clean-out). Get that done and you can go for more. Write 15 minutes a day, instead of waiting for that rare combination of available time and energy to spit out your masterpiece. This is the premise of the TUIT Project, my online Action/Accountability group – join us for the next session, beginning January 3rd, www.OvercomeOverwhelm.com.
Get excited by progress, not perfection. Congratulate yourself on your baby-steps. Feel good that you made dinner, even if it was food-assembly of a store-bought roasted chicken and frozen veggies and not a cookbook classic… or that you managed a 10-minute walk, if not the 50-minute work-out… or you organized your tax-related receipts, even if you’ve yet to file from last year. We don’t give ourselves enough credit for the things we do – especially considering how difficult it is to do things that don’t trigger our ‘I wanna’ brains.
Prepare. Make life less confusing by setting aside time for weekly and daily Planning (vs. Doing) sessions… track events on a calendar and use alarm reminders… create project sheets to break down projects into do-able tasks… have the right tools and information on hand so jobs go quicker… know exactly what it is you want to accomplish so you don’t drift… practice difficult conversations so you get your point across in a win-win way… acknowledge when you need help and get it. (Click here to schedule a free initial Coaching Conversation with me.)
Put on the blinders.There will always be more to do. If we let it all in at once, it can be paralyzing. So focus on what you can (or choose) to do at a given time, ignore the rest and save yourself unnecessary and defeatist guilt-trips.
Honor your needs and desires. Get enough sleep. Take time to eat right and be active. Chill out in front of the TV, with a book or video game. Enjoy a hobby. Make time for vacations. Play with your pets. Spend fun time with friends and family.You’ll have less time to accomplish work, but more time for a successful, satisfying life!
Yes, it’s about to be a New Year. Take advantage of this major calendar holiday as an incentive to think about what you really want, then set a realistic (for YOU) plan for making progress towards your goals. Remember to stay grateful for what you have and appreciative of who you are. Give yourself credit for even tiny steps – success breeds success!
Some people consider their birthday as the start of a New Year. The Jewish New Year is usually in September or October, and the Chinese New Year is celebrated in late January or February. But isn’t every day the beginning of a new year? This means we can hit reset and get a fresh start at any time. Good to know!
On a personal note, I am so grateful for those of you I know as clients and friends, and I’m full of caring and compassion for all of my readers. I understand how challenging life can be, and I’m in awe of, and inspired by, your efforts.
It’s tough enough that many of us have challenges with ADHD/Executive Functions (organization, time management, prioritization, activation, short-term memory, etc.). But we compound the problems when we add guilt to the mix.
I may not be happy that I’m not checking off all my To-Do’s
– even when I’ve realistically created a theoretically do-able Daily Action Plan. Feeling a degree of
anxiety about accomplishing things can be helpful as an impetus to action, but dwelling on my failures is totally
unproductive – and unfair!
ADHD and EF
challenges are neurobiological, which means they exist, like it or not. It
isn’t a question of morality, intelligence or willpower. I can find strategies
to compensate and even excel, but without them, I will struggle with even
simple tasks. And there are days when even my best strategies will go unheeded.
I can write this blog and feel energized, but before I
began, I shut my eyes to avoid looking at the kitchen counter that needs
straightening, saying ‘later.’ As a productivity/ADHD/organization coach (ah, the irony!), I tell myself to just
take 10 minutes on the counter (which would totally be enough time), but my
brain cries out that I might lose the train of thought that inspired me to
write this. So, the kitchen counter waits.
My brain works in a
way that is sometimes quite incredibly wonderful, but won’t usually win awards for straightening up, making calls I’d rather avoid or working on tasks that
don’t light up my engagement button. Activation, or getting started on
something, has little to do with motivation. I may really want to lower my
cable bill, but initiating a call to the cable company to complain meets brain
resistance and is easily postponed (it’s important, but not urgent, and has now
been on my list for several months!).
I can choose to feel
shame and guilt, or I can choose self-acceptance. My challenges aren’t
excuses, but they are explanations. I choose to not spend my life focusing on
what I don’t do/haven’t done, because that would be a sad way to live. Instead,
I look at what I do accomplish (often things that were not on my Action list)
and appreciate my efforts. I look at
where I’m struggling, and focus on compensatory strategies to help me do
Here’s an example: My natural tendency is to be late for just about anything. When I was honest
about this, and the negative affects it had on both myself and others (my PowerPlan to Success™ Step #1,
Self-Awareness), I accepted responsibility, tempered by knowing I have
brain-based challenges that contribute to lateness (Step #2, Self-Acceptance).
HOWEVER, I decided I could still improve (Step #3, Belief in Possibility, and
that You Always Have a Choice). So, I
developed a load of compensatory strategies, both practical and mindset. Now
I’m late only occasionally, but if I didn’t use these strategies, I’d be back
to old habits.
It’s a waste of energy and a drain on your spirit to mourn the person you are not. Yesterday morning I spoke with a client, Annie who felt shame when she used a timer to remind her of things. It reminded her that she “was a failure, because I can’t do it myself.” We discussed this, and Annie was able to reframe her thinking from one of failure and self-blame to a positive take. She focused on how terrific it was to proactively compensate for a brain-based challenge that she could not control by willpower alone. She shifted from feeling defeated by her perceived failure to feeling empowered by her decision to let a tool (the timer) create a successful outcome.
That same afternoon I spoke with Paul, who was berating himself for not having done something on a timely basis that resulted in some really negative consequences. We spoke about systems that could make a difference going forward, but the real issue was one of Self-Acceptance. For any system to be effective, it must be used. So he needed to understand and accept that he has executive function deficits that require conscious compensation:
He can’t rely on his memory. There has to be an independent trigger to take action. (Although Paul’s need was for a long-term reminder, accepting, and finding a strategy to compensate for his poor working memory was similar to Annie’s realization that using a timer was smart, necessary and nothing to feel ashamed about.)
He can’t depend on getting something done immediately, even when remembered on a timely basis. This can be a struggle for anyone, but is particularly tough for those with ADHD. (Research shows we are less motivated by Importance than those with neurotypical brains.) Build white space, or open-time cushions, into your calendar, in case you need to delay a scheduled To-Do, then have a can’t-miss way to remind yourself when you’ve run out of avoidance time.
When Paul accepted the reality of how he worked (or didn’t!), he also let go of the shame he had attached to his failure to take timely action. And we came up with some nifty strategies to avoid this in the future.
We always have a choice. We can be the 5-foot tall person who spends her life bemoaning the fact (totally out of her control) that she isn’t 5’10”, or the woman who is 5’10” and wishes she was more petite, or we can focus on our reality and make the most out of it. We can be the person who refuses to wear glasses because he doesn’t think they look good, or we can buy funky glasses that mirror our personality or mood and have fun with it. We can want to lose weight and keep feeling guilty about our lack of willpower, or we can find a program with strategies (not willpower!) that work for us. We can take charge of our efforts, instead of being ruled by inadequacy and self-judgment. Will we always succeed, no. But there’s a lot less stress, and less time wasted wallowing in self-blame and guilt.
Please, stop beating yourself up for struggling. Accept that your wonderful, creative and capable brain has some challenges. Find strategies to help and give yourself credit for workarounds. When things don’t go the way you’d like, refuse to define yourself by your struggles – and don’t let others erode your self-esteem.
If you need help finding alternative strategies, there are terrific books (I’ve listed a few in www.SusanLasky/Resources), and a wealth of good podcasts, webcasts and articles online. Also, consider the benefits of individual coaching to jump-start change – click here to schedule our no-obligation Initial Conversation. If we’ve worked together and you have some new (or recurring) issues, let’s catch up!
Sometimes it is more difficult to believe in the power of possibility than at other times. So, when we have reminders, hold onto them!
What am I talking about? In my 7-Step PowerPlan to Success™ (you can download the free ebook here), the first Step is Self-Awareness – knowing who you are, and aren’t… what you’re likely to do, and what you probably won’t… what you like, and what you don’t. It’s about accepting your reality, and so Step #2 is Self-Acceptance. This isn’t about giving in or giving up, but about starting from where you are, not where you (or others) wish you were. New studies are showing that Self-Acceptance is fundamental to both happiness and, perhaps surprisingly, productivity. Making better choices that suit you, and planning realistically, helps minimize overwhelm, which then makes it easier to get things done.
Knowing… and accepting… yourself doesn’t mean you can’t change or improve. That’s why Step #3 is Belief in Possibility – that you always have a choice in the matter. You can’t always control a situation, but how you choose to react can change your life (and often the lives of others, as have those people who began movements or charities after being affected by negative events in their personal lives).
But I’m writing this to talk about the inner power we have that is sooo easy to overlook. Sometimes we’re reminded, and that helps. Today I had an old post of mine pop up on Facebook. It was about an event that happened three years ago, and I’m thankful for the reminder that I have the inner power to do things that I may not intellectually or emotionally believe possible.
I was at an energy workshop. The presenter was Dr. Gene Ang, a Yale-trained neurobiologist. He spoke about the power we have to heal, ourselves and others. To prove that our minds (and spirit) can do things that science would scoff at, we were all given heavy-weight metal utensils (forks and spoons). He walked us through an exercise that ended with being able to bend these thick and solid utensils with thought and energy, not strength. Of course we tried to bend them in every way (including using double fisted grip strength) before the exercise, with no success (ok, no WWE members in the group).
Then we did the energy exercise, and those spoons started bending – I mean really bending. It wasn’t our physical strength that did it, but our focus and will, channeling stronger forces as we loosely held these store-bought utensils by their handles. I admit – I was totally frustrated, being one of the last non-benders in the room. I let out a healthy expletive, directed towards my recalcitrant spoon, and let go of trying. The spoon immediately ‘softened’ in my hand and bent totally in half (see the picture – it’s a cell photo of my handiwork). Wow!
So when you’re running low on positive possibility, remember the spoons – change is within you! Apparently, the Universe wants us to succeed, when we’re really clear about what we want, and willing to put in targeted effort.
I especially like this spoon story at this time of year, bringing the focus from shopping and stress back to miracles and possibility.
How ADD/ADHD Diagnostic Terminology (and Thinking) Has Changed
ADHD is NOT a new or made-up disorder, contrary to what the skeptics have been saying for the 25+ years that I’ve been an ADD coach, diagnosed ADDult and parent of a now-grown child with ADHD. So respond to the critics by showing them more than 240 years of ADHD history!
Let’s start with some clarity: ADHD refers to Attention-Deficit/ Hyperactivity Disorder. There are three primary subtypes, or presentations – Primarily Inattentive (often referred to as ADD), Primarily Hyperactive-Impulsive and Combined type. An individual can have symptoms that are mild, moderate or severe, and this may change over time or depending on the situation.
Current figures vary, but the CDC says that approximately 9-11% of school-aged children have been diagnosed with ADHD. It is estimated that 4-7% of adults have the disorder.While almost everyone experiences some of the symptoms some of the time, an actual diagnosis is based on several factors. For more on this see the CHADD Fact Sheet. For a free adult screener, go to www.SusanLasky.com/resources/ and scroll down to Free Evaluations & Screeners.
With so much attention on ADHD, there are those who say it doesn’t exist. So here is some historic perspective that will put to rest any thoughts that ADD/ADHD is a NEW or MADE-UP Disorder. (You may not like everything you read, but ADHD can be debilitating!)
1775 – Dr. Melchior Adam published the textbook Der Philosophische Arzt that contained a description of the inattentive and impulsive behaviors associated with ADHD. This is probably the first textbook ‘description’ of this syndrome. It is also notable for not focusing strictly on the hyperactive symptoms, where most emphasis has historically been placed.
“He studies his matters only superficially; his judgments are erroneous and he misconceives the worth of things because he does not spend enough time and patience to search a matter individually or by the piece with the adequate accuracy. Such people only hear half of everything; they memorize or inform only half of it or do it in a messy manner. According to a proverb, they generally know a little bit of all and nothing of the whole… They are mostly reckless, often copious considering imprudent projects, but they are also most inconstant in execution.”
BEST OF ALL: Dr. Adam’s treatment recommendations from over 240 years ago included massage and exercise!
Inconsistency is a major problem for people with ADHD – if they can do something sometimes, why not always? Although people with ADHD can be VERY detail oriented and focused, it isn’t always possible – especially when the subject isn’t of particular interest. (One of the main reasons people dispute this diagnosis is that, when interested, children and adults with ADHD can be attentive, to the point of hyperfocus, yet staying focused at other times can be very difficult. This isn’t intentional – it’s brain-based, frustrating and at the heart of this disorder.)
1798 – Sir Alexander Crichton, MD, published a book An Inquiry into the Nature and Origin of Mental Derangementwherein he said:
“In this disease of attention, if it can with propriety be called so, every impression seems to agitate the person, and gives him, or her, an unnatural degree of mental restlessness. People walking up and down the room, a slight noise in the same, the moving of a table, the shutting a door suddenly, a slight excess of heat or of cold, too much light, or too little light, all destroy constant attention in such patients, inasmuch as it is easily excited by every impression… they have a particular name for the state of their nerves, which is expressive enough of their feelings. They say they have the fidgets.” (p.272).
Dr. Crichton suggested that these children needed special educational intervention (in 1798!) and noted that it was obvious that they had a problem attending “even how hard they did try.”
“Every public teacher must have observed that there are many to whom the dryness and difficulties of the Latin and Greek grammars are so disgusting that neither the terrors of the rod, nor the indulgence of kind entreaty can cause them to give their attention to them.” (p.278).
I LOVE THIS – discussing the need for educational interventions more than 200 years ago!
1844 – Heinrich Hoffman was a progressive psychiatrist who rejected the common beliefs of his time that psychiatric patients were obsessed or criminal, and instead considered mental disorders as medical issues. He published an illustrated children’s book with a poem called ‘Fidgety Phil,’ a classic description of a hyperactive child. An 1847 edition of the book also had a story about “Johnny Look-in-the-Air,” about an inattentive child. WHY DO PEOPLE continue to insist that ADD/ADHD is a NEW disorder!?!
1902 – Sir George Frederick Still, MD (the father of British pediatrics) introduced the concept of a Defect of Moral Character during a series of lectures to the Royal College of Physicians in the U.K. on ‘some abnormal psychical conditions in children,’ published later that year in The Lancet.“There is a defect of moral consciousness which cannot be accounted for by any fault of the environment.” He described 43 children who had serious problems with sustained attention and self-regulation, who were often aggressive, defiant, resistant to discipline, excessively emotional or passionate, showed little inhibitory volition, had serious problems with sustained attention and could not learn from the consequences of their actions, though their intellect was normal. Describing a 6 year old boy:
“…with marked moral defect, was unable to keep his attention even to a game for more than a very short time, and as might be expected, the failure of attention was very noticeable at school, with the result that in some cases the child was backward in school attainments, although in manner and ordinary conversation he appeared as bright and intelligent as any child could be.
Dr. Still proposed a biological predisposition to this behavioral condition that was probably hereditary in some children and the result of pre- or postnatal injury in others.
Following the 1917-1928 Encephalitis lethargica worldwide outbreaks and the 1919-1920 Influenza pandemic, the behavioral symptoms in many surviving children led to the speculation that there is a causal relationship between brain damage and behavior. Children often became:
“… hyperactive, distractible, irritable, antisocial, destructive, unruly, and unmanageable in school. They frequently disturbed the whole class and were regarded as quarrelsome and impulsive, often leaving the school building during class time without permission.” (Ross and Ross 1976 p.15).
This was called Postencephalitic Behavior Disorder or the Brain-Injured Child Syndrome.
1932 – Drs. Franz Kramer and Hans Pollnow described a Hyperkinetic Disease of Infancy. The most distinguishing characteristic was daytime motor restlessness, unlike the postencephalitic motor drive that also affected sleep. They also noted:
“…distractibility by new and intensive stimuli, inability to concentrate on difficult tasks, refusing to answer questions and appearing not to listen when spoken to directly.”
Noting that symptoms, especially motor restlessness, decline in intensity by age 7, they called it Hyperkinesis of Childhood.
1937 – Psychiatrist Charles Bradley administered Benzedrine sulfate, an amphetamine, to “problem” children at the Emma Pendleton Bradley Home in Providence, Rhode Island, in an attempt to alleviate headaches. However, Bradley noticed an unexpected effect upon the behavior of the children: improved school performance, social interactions, and emotional responses.
“The most striking change in behavior occurred in the school activities of many of these patients. There appeared a definite ‘drive’ to accomplish as much as possible. Fifteen of the 30 children responded to Benzedrine by becoming distinctly subdued in their emotional responses. Clinically in all cases, this was an improvement from the social viewpoint.”
This was probably the first documented use of stimulants in children with ADHD behaviors. Although an inadvertent side effect of treatment or headaches, Dr Charles Bradley saw noticeable improvement in behavior.
1930’s and 1940’s – Further research supported the idea of a causal connection between brain damage and ‘deviant’ behavior, referred to as Minimal Brain Damage.
1956 – Although scientists could not identify the biological mechanism, Dr. Bradley’s Benzedrine experiments created a scientific model for further research on stimulant drugs to treat hyperactivity. In 1956, psychiatrists began to prescribe Ritalin (methylphenidate, or MPH), a stimulant drug similar to Benzedrine with known benefits for children’s behavior and few side effects. PROTESTS THAT MPH IS UNTESTED?After more than 60 years? It may not be right for everyone, but it HAS been vetted.
1957 – Studies by Laufer et al addressed the possibility that children with the Hyperkinetic Impulse Disordermay not have brain damage, but rather a functional disturbance of the brain. So the idea that every child presenting with abnormal behavior had Minimal Brain Damage was disputed. (Birth of the neuro-atypical brain concept?)
1963 – The Oxford International Study Group of Child Neurology held a conference and stated that brain damage should not be inferred from problematic behavior signs alone. They advocated for a shift to the term Minimal Brain Dysfunction.I KIND OF BUY INTO THIS ONE– or maybe just Minimal (or Variable) Brain Difference or the Neuro-Atypical Brain!
1968 – Considering the term Minimal Brain Dysfunction as too general and heterogeneous, the term Hyperkinetic Impulse Disorder evolved into the diagnostic term (as defined in the Diagnostic and Statistical Manual published by the American Psychiatric Association) DSM-II: Hyperkinetic Reaction of Childhood– “The disorder is characterized by overactivity, restlessness, distractibility, and short attention span, especially in young children; the behavior usually diminishes by adolescence.” (1968, p.50)
1972 – Psychologist Virginia Douglas presented a paper to the Canadian Psychological Association, arguing that deficits in sustained attention and impulse control were more significant features of the disorder than hyperactivity, resulting in a change in the conceptualization of the Hyperkinetic Reaction of Childhood.
1980 – The disorder was given a new diagnostic label in DSM-III: Attention Deficit Disorder (ADD), with or without Hyperactivity. The three separate symptom lists were for inattention, impulsivity and hyperactivity, along with an explicit numerical cutoff score, specific guidelines for age of onset, duration of symptoms and a requirement of exclusion of other childhood psychiatric conditions. Note: This was a departure from the International Classification of Diseases (ICD-9) published by the World Health Organization, which continued to focus on hyperactivity as the primary indicator of the disorder.
1987 – The two subtypes were removed and the disorder was renamed, in DSM-IIIR: Attention Deficit Hyperactivity Disorder (ADHD), in an effort to further improve the criteria, in particular with respect to empirical validation (largely based on Russell Barkley’s concerns about qualitative similarities, or whether the two types had to be considered as two separate psychiatric disorders). The subtype “ADD without hyperactivity” was removed and assigned to a residual category named “undifferentiated ADD.”
1994 – Realizing that ADHD was not exclusively a childhood disorder, but a chronic, persistent disorder remaining into adulthood in many cases, and based on additional research, in DSM-IV: Attention Deficit Hyperactivity Disorder (ADHD)recognized the three subtypes of ADHD, along with the possibility of diagnosing a purely inattentive form of the disorder. The subtypes: Predominantly Inattentive Type, Predominantly Hyperactive-Impulsive Type and Combined Type, with symptoms of both. It also accredited the diagnosis of ADHD in adulthood by including examples of workplace difficulties in the depiction of symptoms. Note: There was now more similarity between definitions of the diagnosis with the International Classification of Diseases (ICD-10), although the ICD-10 was more demanding about cross-situational pervasiveness of symptoms.
2000 – A text revision, DSM-IV –TR, did not change the definition of ADHD, but was more descriptive of the symptoms.
2013 – DSM-5: Attention Deficit Hyperactivity Disorder (ADHD) now distinguishes ADHD as a ‘Neurodevelopmental Disorder.’ It is truly no longer solely a disorder of childhood, but one that reflects brain developmental issues throughout the life span. (See factsheet.)
There are still 18 primary symptoms divided into two major groupings: inattention and hyperactivity/impulsivity.
The subtypes have been replaced with presentation specifiers that correlate to the prior subtype. Presentation can change over a lifespan.
New descriptions are more age-appropriate (a child might run about or climb, an adolescent or adult might feel restless).
The age of onset has been raised from age 7 to 12, and now multiple symptoms are required to be present in more than one setting (home, school, work, social). Note: Future DSM’s may include Adult Onset ADHD.
The required number of symptoms for ages 17+ is reduced from 6 to 5 in either the inattentive or hyperactive/impulsive categories.
The DSM-5 recognizes that ADHD and autism spectrum disorder may coexist.
So that’s it… for now. I still do not like the term ‘Attention Deficit Hyperactivity Disorder.’ I relate more to ones like ‘Attention Surplus Disorder’ (Ned Hallowell) or ‘Information Processing Disorder‘ (I’ve heard this from several people, initially from the psychiatrist William Koch), or even ‘Behavioral Inhibition Disorder’* (I believe Russell Barkley coined this term),
*This theoretical model links inhibition to 4 executive neuropsychological functions: (a) working memory, (b) self-regulation of affect-motivation-arousal, (c) internalization of speech, and (d) reconstitution (behavioral analysis and synthesis). Extended to ADHD, Barkley especially see deficits in behavioral inhibition, working memory, regulation of motivation, and motor control in those with ADHD.
I believe there is a greater difference between subtypes (indicators) that will ultimately result in several different diagnoses. Nor should the importance of Executive Function challenges in ADD/ADHD be underrated. Dr. Thomas E Brown has been instrumental in supporting the relevance of Executive Functions and Emotions in relation to ADHD.
The DSM-listed diagnostic symptoms are not comprehensive by any means. The symptoms now mention organization, which is often a major problem. Still, there isn’t enough awareness of time and energy-related challenges… transitions… time blips… activation/procrastination… completion… hyperfocus (which is why I’ve been writing this for hours and ignoring the other things, like sleep, that are essential)… short term memory issues and future-blindness… and the overwhelming ADD ‘fog’…
I’ve been working with ADHD issues since 1989, and as a Productivity & ADHD coach/ consultant, professional organizer, ADDult and mom of a now-grown son with ADHD, I see patterns, and they differ within the umbrella ‘ADHD diagnosis.’ For instance, I don’t see any diagnostic symptoms having to do with decision-making. Yet, in general, many people with ‘ADD’ tend to be less decisive than someone with ‘ADHD’ (although making the right decision is another story, especially when impulsivity is involved!).
My work with clients primarily focuses on developing compensatory strategies for Executive Function (EF) challenges, which can include planning, prioritization, activation, time and project management, organization, sustaining focus and effort, utilizing working memory, self-awareness and acceptance, etc. There are many people with ADHD who haven’t been diagnosed because they think of ADHD in terms of an 8-year old boy running around in circles and disturbing their classmates – not the quiet daydreamer, the academically hi-achieving Ph.D. or the successful entrepreneur.
So the saga of the ADD / ADHD diagnosis continues to develop. It is clearly NOT a new or ‘made-up’ disorder. The ADHD brain is neuro-atypical and does operate differently. While under certain circumstances this can be beneficial (just check out the vast number of entrepreneurs, inventors, creatives, athletes, politicians, professionals and celebrities who have it), there are definite challenges that negatively affect performance, judgment, relationships and self-esteem.
The more we know about ADHD, its history, impact and treatments, the better the lives of those who have it and those who teach, love, live or work with them.