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.
CHANGE…Often we avoid it, preferring to stay in our comfort zone. Or maybe we just lack the energy to explore new options. This can work for us, but it will keep us stuck. If we want things to be different, we have to dosomething differently.
Other times we seek out change as a remedy for boredom. Those of us with an active impulsivity trait tend to keep our radar focused on new opportunities (always attracted to that bright and shiny object). It’s probably a good idea to hit the pause button before jumping in.
Mostly, we look towards change to fulfill a desire for something more in our lives.This is a good thing – without it we wouldn’t risk a career change, buy a new house, adopt a pet, go on a date or start a family. Change can be less dramatic, like starting a new health routine, switching to a more helpful day planner or deciding to clear clutter.
When we try something new, it may not work out, but at least we won’t stagnate. We’re also a step ahead, having a better idea of what will work, when we can rule out what didn’t.
Triggers for Change: There are certain times of the year when we’re more inclined to think about making changes, like on New Year’s or a birthday. Why wait? Today is the first day of the rest of your life. For many of us, summer is coming to an end – a perfect time for a new beginning; your trigger for change.
What do you wantto be different?
What can you do to help make that happen?
Whatsupport will make change easier?
Believe in the magic of possibility. Attitude matters. It is so sad that when people are caught in negative emotions they can’t muster the attitude and energy to try something new. Don’t let feeling hopeless, or like a victim, prevent you from doing something new, or changing the way you do it. Start small. Success breeds success. Limit your goals – less is more; better to accomplish one thing successfully than to work towards multiple goals only to give up, feeling overwhelmed.
An effective way to create positive change is to declare your intent, verbally and in writing. It forces you to be clear as to your specific goals. Say it with conviction (even if you find that difficult), as something you’ve already accomplished: “I am wearing that size 10 dress and looking terrific.” … “I’m sitting at my organized desk and doing great at my new job.” … “I have a special relationship with a wonderful, supportive, smart and sexy person.” Print it out and post it where you’ll see it. If you can, include a photo that illustrates your accomplished goal.
There’s science behind it. Our brains are quick to see the negative; not so much the positive. Some studies declare we think up to 60,000 thoughts a day, and that 80% of them are mostly negative – that’s 48,000 negative thoughtsa day. That’s a lot to overcome, and we need all the reminders and reinforcements that we can muster. When we speak in the positive, it changes our expectations. When we say we will, instead of we’ll try, we reinforce our internal belief that change is possible.
So choose a goal to celebrate your new possibilities. Be realistic but positive – this time you can. I invite you to state your possibility and commitment in the comments section below.
I would love to help you turn your goals into realities. Just click here to schedule a time to talk about individual coaching or click here to learn more about my action/accountability group, The TUIT Project.
I’m laughing (okay, smiling to myself) as I write this, since it is so much the opposite of what I began to write!
It started with a decision to compile some of my favorite quotes about some of my favorite topics – ADHD, Executive Function, Attitude, Organization, Parenting, Time Management, Relationships, Self-Care, Self-Fulfillment, etc. These well-phrased gems are often perfect for creating perspective on situations with which my clients (and myself) struggle.
I know that some of these ‘words of wisdom’ are originally mine (not surprising when I’ve been writing and speaking on these topics since 1989, when Hal Meyer and I published the first CHADD of NYC Newsletter). However, I know that most are not, and so I went online to seek out sources.
I began with one quote that I know wasn’t my original, although it may have been Hal’s, or more likely Hallowell’s.
This is a great way to describe the tendency to act without thinking something through. It helps to understand some of the challenges created by the impulsive ADHD mind, and how actions taken without thinking can lead to unexpected, often negative consequences.
I thought I’d write about how important it is to be very clear about your target and goal before taking action (“Ready, Aim, Fire”), so you don’t waste or misdirect your efforts, but when I put “Ready, Fire, Aim” into a search engine, I wound up reframing my thinking about this phrase! Now I think that it can often be a better plan, since it puts the emphasis on action.
Taking action is a major challenge for many people, especially those who are very busy, cautious, or those who might have ADHD, but with a lower dose of the ‘H.’ Wanting to get it ‘perfect’ often leads to not getting it done at all… or to long hours, paralysis by analysis and missed deadlines. It’s the opposite approach to those who rush to just get something done and out of the way. Yet now I’m advocating for better balance, which can mean to just ‘FIRE’ in order to get going!
My online search led me to a blog on a fitness website that explains this really well. I know nothing about his program or the author, Keith Lai, but I loved his approach. He talks about this concept as it applies to fitness, but I see how it affects every aspect of life where we postpone taking action because we are too caught up in researching/thinking about exactly what action to take, or because we think we need to know the exact outcome of our actions. And as much as we may fantasize about it being otherwise, we can only control our actions, not the outcome.
So here’s a slightly edited version of what Keith Lai had to say – www.fitmole.org/ready-fire-aim
How to Use The “Ready, Fire, Aim” Technique to Crush Any Goal
One of the best books I’ve read recently is called Ready, Fire, Aim by Michael Masterson. It’s more of a business book on how to grow a wildly successful business than anything else (it really has nothing to do with fitness), but the lessons taught are applicable to anyone with ambitious goals, including those who want to transform their physique.
The premise of the book revolves around a concept called “Ready, Fire, Aim” which basically states: Anytime you want to reach a goal quickly, you simply need to act first, then make any necessary adjustments and correct for any mistakes later.
Let’s break it down into the 3 separate stages:
Stage 1 – “Ready”
This is the research phase where you begin researching the ins and outs of what’s necessary to reach your goal. In fitness, it might mean reading up on what’s needed for your workout or diet.
If you bought a fitness course (like my Superhero Shredding course), the “Ready” phrase means going through the course and absorbing the information.
But the secret to being successful in the “Ready” phase is to not obsess about understanding things 100%. I’ll go into more detail on Stage 1 later in this article.
Stage 2 – “Fire”
This is where you charge straight in and take immediate action (“Fire”). Even if you don’t fully understand the nitty gritty technical details of the workout or diet plan you’re on… JUST DO IT.
Inaction and doing nothing are the worst possible things in the world – there will never be a better time than now so pull the trigger ASAP.
Stage 3 – “Aim”
Now that you’ve taken action, you can gradually fix any mistakes you’ve made in the beginning, but because you’ve already taken action, making micro-adjustments will be easy.
Maybe you screwed up the first 2 weeks and just realized you weren’t getting enough protein, that’s fine, you can make that change now. You’re already light years ahead of the guy who’s still reading the diet manual, so pat yourself on the back.
Getting stuck in the “Ready” phase – The #1 reason for failure
Being stuck in the “Ready” phase is like reading 20 different dating books before ever dating a girl…
Most guys are stuck in the “Ready” phase. They spend too much time researching and not enough time doing. Why? Because it’s a lot easier to read about eating healthy than it is to actually eat healthy.
One of the biggest mistakes I made in the beginning of my fitness journey was spending months and months reading about diet information. I just kept reading and reading because I thought there was some “secret ingredient” that was missing. I thought there was something out there that I needed to know in order to get started.
But in reality, the only reason I kept reading was because I wanted to avoid putting in the hard work. Reading is a lot easier than doing as I’m sure you’ll agree.
Trust me, you know enough. There’s no secret sauce. I need to make a statement – YOU KNOW ENOUGH.
Most people know they need to eat in a calorie deficit to lose fat… Most people know they need to get stronger and eat in a surplus to gain weight… Most people know that fruits and veggies are good for you and you shouldn’t eat doughnuts in excessive amounts.
The basic premise of losing fat and building muscle is VERY VERY simple. And yet, people always want to complicate this shit. For some reason they want it to be complicated. Why?
Hell if I know, but if I had to guess it’s because making something more difficult rationalizes their decision to continue “researching” and stay in the “Ready” phase.
More and more people these days are getting caught up in the “science” of fitness (e.g. the best scientifically proven upper chest exercise for hypertrophy), but spending all day going through exercise research reports doesn’t do shit for you. Don’t know what hypertrophy means? Awesome, you don’t need to know.
This why a lot of the gym “bros” who seem a lot less educated, statistically, have superior physiques to the guys who just read and read and read. It’s because they just take action without overanalyzing everything. You have to admit that it’s pretty funny when the people who get the greatest results are the ones who don’t much care about all the science and theory behind fitness.
But what if “it” doesn’t work?
Last December I had a reader email me. To keep the reader anonymous, I’ll be calling him Captain Korea from this point on. Like a lot of my readers, he asked what’s the best workout to lose weight. I pointed him to one of the free workouts on my site and told him to do that.
One day later, Captain Korea emailed me back saying “This looks good, but can I add in 2 extra sets of side lateral raises? I feel like it will work better.”
*!X*#!!!*Z@!%*
The workout I gave him was a simple yet very effective 3-day split. Yet in Captain Korea’s mind, he was trying to make what was a great workout plan much more complicated than it needed to be.
Adding an extra couple of sets wouldn’t have killed him, but it’s the fact that he thought about it before even doing the workout once is what drives me insane. If Captain Korea decided to add the 2 extra sets of lateral raises after doing the workout for 4-6 weeks and decided that his shoulders were lagging a bit, then that’s totally fine.
Because by then, Captain Korea has already passed Stage 1 (Ready) and Stage 2 (Fire). Adding in the extra lateral raises is the intelligent Stage 3 (Aim) move.
“READY, AIM, FIRE” – The most common path to mediocrity
The majority of guys follow a “Ready, Aim, Fire” approach to fitness and life.
For example:
They decide they want to do something such as workout, and begin researching and buying workout products. (Ready)
They make sure every aspect of the workout is “perfect” by reading forums, blogs, and research reports. (Aim)
They finally take action after weeks/months of “fine tuning” their workout plan to perfection (Fire) only to jump back into the “Ready” or “Aim” phase after a week because they don’t think their plan was perfect enough.
As you can see, this approach to fitness, and to pretty much anything in life, almost always leads to disaster and at best, mediocre short-term results.
But once you “Fire” before “Aim,” you’ll discover that your entire life changes, and achieving any goal becomes a piece of cake.
How do you approach your goals? Do you follow the Ready-Aim-Fire or the Ready-Fire-Aim model?
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Keith Lai talks about the Ready-Fire-Aim model as it applies to diet and fitness (BTW, sound familiar?) but it applies to so many aspects of our lives. I remember working with a web designer on my first website. I got so caught up in obsessing over what colors to highlight that I gave up on working with the designer, created my own ‘temporary’ two-page site and only got back on track five years later! How many possible clients did I lose because I didn’t give enough info on my laundry-list of a two-page site? Compare that to how many would have been turned off if my color scheme (easily remedied later) wasn’t fully expressive of my personality?
Sometimes, the best course is to reasonably prepare (get READY), then jump in and act (FIRE), knowing you can fine-tune the adjustments later (AIM). Besides, by then you might have a clearer target!
I’d love to hear what you think. Join the conversation by commenting below.
FREE WEBINAR! I recently gave a webinar for ADDitude Magazine: “How to Get More Done… With a Lot Less Stress.” If you weren’t on the call, you can listen to a replay by clicking here – it’s free until July 4, 2018! (I was blown away that almost 9,000 people signed up!) I’d love to hear your feedback.
The following challenges were brought up during a recent TUIT Project Group Webinar. I think the topics (dealing with piles of paper and getting to delayed projects) are concerns for many people, so I’d like to share the strategies we discussed.
How do I deal with avoidance, when it comes to tacking my piles of paper?
Work on one pile at a time. Start with the more recent ones, as you’re more likely to find some time-sensitive discoveries.
Don’t tackle a big pile – just the thought of it is overwhelming, which automatically creates an avoidance response. So, take a handful of papers at a time, and bring them somewhere else if you need to separate yourself so you don’t have to look at the intimidating ‘master pile’ (or piles).
The goal isn’t to shuffle the piles (which is what often happens), but to create workable units of related items that can be reviewed more efficiently than if the categories were intermingled. Remember, your goal is to process the papers, not just organize them! However, organization is the first step.
Start by separating the papers, by category, into smaller piles as you go through them. It is a waste of time and energy to transition your thinking from issues concerning the house… to kids… to work… to finances, etc. The same applies to sorting piles of paper at work. The popular OHIO method (only handle it once) doesn’t make sense if it means having to constantly shift focus to deal with different categories and different priorities. Stack all papers relating to a category in one pile or folder (put a blank paper at the top with the category name, so you’ll remember). Then, either go through and process all of the papers in a specific category (do now, do later, do whenever, delegate, discard or file), or continue adding to your sorted categories by taking additional handfuls from the master pile.
Don’t think you’ll just get around to this. Knowing you have or want to do something has little to do with getting it done. (Especially for ADDers, who are less motivated by reward, consequence or even importance.) Create a Task-Appointment (time on your calendar to do a specific task) for sorting the master pile, sorting the category piles, acting on the category sorts or filing (if you don’t set a time for filing, it’s unlikely to happen, which will just add to the future piles).
You can do this for just 15 minutes a day. You won’t get it all done, but the piles will decrease. A good idea is to make it part of an existing routine. Eat lunch, then sort/process for 15 minutes while the food digests.
If there are important items in the master pile, then you might want to focus on pulling those out so they ‘go to the top of the list.’ Systems are designed to help us achieve goals, but don’t overlook what is urgent while working on whatever is more interesting.
What is a good approach for getting to a long-desired but delayed project?
Realize that even when you aren’t in action on a project, if it’s something you’ve been thinking about, you have made some progress. The problem is that, without putting your thoughts down in writing – in one designated and labeled place/folder, you are ‘reinventing’ the wheel every time you think about it, instead of moving forward. So get your thoughts in writing to solidify and remember them. Consider that you aren’t starting fresh; you have the benefit of the thinking you’ve been doing. The difference is that when you get it out of your head and onto paper (or computer file), it clears your head and frees you up for action.
Define the project – create a Project Sheet. This is the difference between Planning Time and Doing Time (Taking Action). Without clearly planning out your actions, you’ll be less efficient and perhaps less successful at reaching your goal. You have probably spent an incredible amount of time over the years thinking about that project, so you’ve made progress, but haven’t yet taken concrete action towards getting it done, other than maybe a few false starts. Use just the one master folder (or file) where you’ve consolidated your thoughts. If it’s a big project, you may have subfolders or files. If you have old notes you’ve accumulated over the years, but aren’t sure where you put them, decide whether it’s worth the time and energy to find them, or just start fresh. (The ‘looking’ is often an unconscious way to delay beginning.)
Think through the sometimes hidden factors that have contributed to the delay in getting started. In this example, Jane Doe had spent a great deal of money on window treatments that never looked right. A major factor delaying replacement was her fear of making another expensive mistake by once again choosing the wrong items. What can you do differently to help ensure success? For Jane, hiring a consultant (a good interior designer) for a quick review would be well worth the expense, as it would alleviate her fear of re-doing it ‘wrong.’
Look at the benefits of proceeding (or not). In this case, Jane has to look at her ‘mistake’ every day, so it is a constant reminder of her poor, and costly, choice. That’s a negative impact statement and reason enough to make a change, if it is financially feasible. Note: This is only important because it was affecting the person who was looking at her perceived ‘mistake’ for 10 years – someone else might not even have noticed, so it would be a non-issue.
Get specific about those issues that have complicated making a change. Jane wasn’t sure as to which style, materials or colors to use for the replacement window treatments, whether they needed to be custom made, and if so, by whom. There are more resources available now than 10 years ago when she made her original purchase, and it’s easier to explore options on the web (even showing possible window treatments as they would look in the actual room).
To help narrow down the choices when making a complicated decision, use basic Decision-Making strategies, like a Decision Matrix, where you create a grid. Across the top, list the factors that affect your decision-making (these are your criteria), which in this case would include things like cost, appearance, quality, availability, maintenance, etc. Down the left side list the options. Then weigh each box by assigning a number. I like to use -3 to +3, with 0 being neutral. So one option, silk drapes, would get a +3 for looks, but a -3 for affordability/cost. Another option, wood blinds, would get a +1 for looks, but a -1 for maintenance. You get the idea. Some factors, like cost, might carry more weight than others. Maybe not. When you total the numbers, it helps determine your best choice, given your criteria and options.
By getting your thoughts out of your head, and creating a plan of action with specifics, you can get that long-desired, but not urgent, project accomplished without too much intrusion (time and energy) into your already busy life.
We know that sleep is critical for effective functioning. Sure, we can get by on almost no sleep if the need is great enough (cram for a major test or deadline report, new baby in the house, binge-watch Game of Thrones, etc.).
However, keep up the sleep-deprivation and there’s no getting around the consequences:
Feeling tired with a lack of physical energy and slower response time (driving hazard).
Low energy, making it harder to activate on tasks (whether work-related, going to the gym or even doing the dishes!)
Mental sluggishness, so its more difficult to make decisions, problem-solve or transition between activities.
Physical, not just cognitive concerns. Research shows that sleep helps repair our cells, tissues, hormonal and immune systems, so lack of it creates links to many chronic diseases and conditions—including diabetes, high blood pressure, heart disease, obesity and depression.
Unfortunately, for many people — especially those with ADHD — sleep can be problematic. Sleep challenges include staying up late to finish the stuff you didn’t get to during the day… or because night is your most productive time… or you crave some ‘down time’ or quiet time… or you find it difficult to fall asleep because your brain keeps working… or your stimulant meds haven’t left your system… or you are tired, go to bed then get a sudden burst of energy… or you have an out-of-sync circadian rhythm, where you get tired later and may really struggle with getting up at the expected time.
You might have sleep-onset insomnia (I’ve read that 50% of adolescents with ADHD have it), or sleep-maintenance insomnia (difficulty getting a restful night’s sleep). There’s even a disorder called Delayed Sleep Phase Syndrome, aka The Night Owl Effect (my term for DSPS, coined as I write this at 2am <g>).
If you live in a bit of a vacuum and can set your own schedule to get up later, sleep variances are not as problematic (although some research shows this still affects health and weight). However, most people need to get to sleep in order to get up by a certain time. Creating healthy sleep hygiene, or rituals, helps create better sleep, with all of the benefits. So here are a bunch of tips and strategies to help.
TIPS & STRATEGIES to Get to Sleep
Start by setting an intention that getting to sleep at a specified time is actually something you want to do. Talk is cheap when weighed against, “I don’t feel like it.” Think about the benefits you’ll gain (from feeling more alert in the morning to time for a comforting nighttime cuddle with your partner), so your focus is positive (gain, not loss).
Decide on a realistic bedtime. If you tend to stay up until 3am, setting a 10pm bedtime is less likely to be successful than gradually weaning down the hours.
Create a consistent bedtime ritual. Figure out what you do to prepare for bed, and standardize the procedure. Make a list to create an SOP (standard operating procedure), so you won’t forget the details. Link new habits to ones you already have (like brushing your teeth then getting into bed and reading for 30 minutes before mandatory lights off).
As part of your bedtime routine, reduce morning stress by making sure you have everything ready for getting out of the house on time (if that’s an issue for you).
Note: Parents need to be firm about enforcing their child’s bedtime, while making time for their nightly bedtime ritual (bath, books, hugs, etc.). If they are young, create a page with illustrated steps and post it where they’ll see it.Try to keep the same bedtime and ritual on weekends, with only occasional exceptions.
Avoid sleep disturbing activities. These include late-day exercise (although some people say that helps them to sleep), heavy meals and screens.
Numerous studies show that, apart from the mental stimulation the activity creates, the blue light emitted by computers, tablets, TVs, phones, etc. is itself stimulating. So turn off the electronics an hour before bedtime. If you can’t, use screen software or glasses with special lenses that eliminate blue light.
Some people believe that eliminating ELF electric fields and magnetic fields during sleep is important to optimize cellular regeneration, so turn off those devices or move them out of the bedroom.
While having an alcoholic drink before bed may help you go to sleep quickly, realize that it is a depressant and affects REM sleep, so you won’t sleep as deeply.
If you think medication is keeping you awake, tell your doctor. Perhaps an adjustment can be made in dosage, timing or type of med. Caffeine can affect sleep for up to six hours. However, for some people with ADHD, a low dose of their stimulant or caffeine can sometimes help them to sleep by slowing down their overactive minds.
Consider natural sleep aids, like certain herbal teas such as chamomile, or blends specifically for bedtime. Some people occasionally take melatonin or valerian root to help them get to sleep, but these are not right for everyone. Most melatonin supplements contain much more than is needed, and a half or third dose is said to be as effective. Tart cherries have similar properties. GABA and CBD (cannabidiol) oil are recommended by some nutritionists to improve deep sleep.
Breathe deeply and stretch before sleep. Dr. Andrew Weil suggests using the “The 4-7-8 Breathing Exercise,” also called “The Relaxing Breath,” to promote better sleep. This is based on pranayama, an ancient Indian practice that means “regulation of breath.”
Comfort your senses. Many people are sensitive to:
Sound. “White noise” can be soothing and block out other sounds. Use a fan or white noise machine. Listen to environmental sounds (available online, but find ones that work for you or they can have the opposite affect!). Try listening to music or guided meditations specifically designed to assist the sleep process.
Light. Consider room-darkening shades and dim LCD displays.
Visual. Think of a few enjoyable and peaceful images you can visualize as you drift off, or buy a calming graphic and hang it near the bed. Associate these with sleep.
Smell. Scents like lavender are very relaxing for some, so experiment with scented oils on your pillow or use a room diffuser.
Touch. Are your sheets comfortable? How about your pillows? Do you prefer a heavier cover (some people find this soothing) or a very light one? Is it time for a new mattress? You spend a lot of time in bed. Make it as welcoming as possible.Temperature. Sometimes an adjustment (heat, air conditioning, fan, open window) makes for a more comfortable night’s sleep.
Environment. People tend to sleep better in an uncluttered, clean environment. Try to keep ‘stuff’ out of the bedroom (think of it as a sanctuary, if possible), and make a quick pick-up part of your evening routine.
Quiet your mind, and the body will follow.
Begin your bedtime routine with conscious relaxation: take a walk… enjoy a bubble bath… read inspirational books or a good romance… practice mindfulness… or whatever works for you.
Use the bed for sleeping (or sex). Avoid working in bed or watching TV (at least not for 60 minutes before bedtime). Try the Pavlovian approach:See bed, go to sleep!
Discourage conversation and engagement. Right before bed isn’t the time for phone calls or text conversations. Certainly not for checking Facebook or any social media. If your child (or spouse) picks lights-out as the time to converse, don’t buy into it (unless there’s some important emotional issue going on that can’t wait). Avoid discussion: just state that you’ll talk about it in the morning, when you can give them your full attention. If mornings aren’t going to work, set a time that will. Then follow-through.
If bedtime is when you tend to obsess about anything negative that happened during the day, take a few minutes to write it all down – then try to let it go, at least for the night. Research shows that when we give brief thought to a problem before sleep, our minds often work through the answer while we get our rest, so a two-for-one benefit! (A good study tip as well.)
Make thinking about things an early part of your bedtime ritual. If bedtime is the first time you have a chance to just think, it can keep you awake. So before you actually get into bed, sit and allow yourself time to review your day and plan for the next day. I highly recommend making a habit of review and planning to increase productivity and decrease forgetfulness! Keep a pad or planner handy to write down your thoughts, or dictate a memo into your phone with the things you have/want to do. Writing things down clears your brain and facilitates getting tasks accomplished. Allow yourself 15 minutes to obsess over them, or over any problems, real or self-generated. Then wave your magic wand (use a back-scratcher in a pinch) and take a page from Gone With the Wind – “I’ll think about it tomorrow.”
End your day on a positive note. After you’ve done your ‘mind dump,’ take the time to write down three things you ‘did good’ that day. It’s easy to remember where you messed up, but it’s worth the effort to remember those things you did well, or at least better than you did in the past. Sometimes, just getting out of bed and taking a shower is an accomplishment. Now, look outside of yourself and add three things to your gratitude journal. Seems minor, but this small action can have a monumental impact on your mood, and lead to better sleep.
Enjoy a restful, energizing sleep tonight!
If you’ve found ways to make sleep your friend, share them in a comment! If you’d like to discuss your specific situation with me, click here to schedule a no-cost or obligation 20-minute coaching consult.
Very best, Susan
Feel free to share this post, with attribution to: Susan Lasky – Productivity, ADHD, Career and Organization Coach – www.SusanLasky.com
