SUMMARY: There is a delicate balance between taking care of yourself and the giving of self that is integral to any real relationship with another person. Whether it is your partner, family of origin, friends, co-workers or children, relationships require certain boundaries to stay healthy. Learn to recognize and respect yours.
Boundaries are Limits that YOU Have and Will Not Cross
Personal boundaries are internal limits. They may not be obvious to you, but they exist and influence your actions. Boundaries are important and should be recognized and appreciated. Most of our boundaries are healthy, and to ignore them is detrimental to our physical, mental, emotional or spiritual well being. Such limits are developed for many reasons, and stem from different sources which may include:
Family or moral values
Self-knowledge and an understanding of your personal needs
Awareness of the consequences of going beyond these boundaries
Boundaries are Limits that Others May Not Cross:
Violence, physical or mental cruelty
Insulting behavior (vs. supportive behavior):
“MAKE-WRONGS” – Turn your comments, ideas or thoughts into negative feedback, often subtly and insidiously: Example: You say:“I lost 5 pounds this week.” Make-wrong response: “Great, but how are you doing on the 50 pounds you still have to lose?” Supportive response: “That’s terrific! I know this is tough and I’ll help in any way I can!”
“PUT-DOWNS” – Convey a lack of faith in your ability to do something and/or to do it correctly: Example: You say: “I’ll finish the project this evening.” Make-wrong/Put-down response:“Sure, like you said you would yesterday?” Supportive response:“Okay, but if you forget, do you want me to remind you?”
GLOBAL COMMENTS/CRITICISMS – Turns previous disappointments into general character statements that trap, hurt and prevent moving forward in a relationship: Examples: ”You never get anything done.” “You always do that!” “It’s always what you want!”
Pushing The Limits
Sometimes, the personal boundaries we set are overly protective and limiting. This is not healthy. While they serve a purpose, they keep us from reaching for a higher rung. We are comfortable where we are, and unwilling to make the effort (emotional, physical, intellectual, etc.) to push our limits and risk the possibility of growth – or failure.
Personal boundaries are meant to protect our values, not to stifle our growth. Limits imposed from fear are often cages. Beliefs should be looked at from a position of honesty and humility:
“Am I a better person because of my internal limits or am I protecting myself from the challenges of self-growth or the intimacy of a relationship?”
Personal Limits Include:
SPACE – Physical, emotional, thoughts… Everyone needs some privacy. We have a right to private thoughts and solitary activities.
Not sharing everything doesn’t mean a lack of trust in another person, nor does it mean you’re cutting the other person out of your life (or being cut out of his or her life).
If you feel compelled to always be with others, question why… What is it about your own company that is so unappealing? If you are just bored, develop some interests! You can’t always count on others, but you are always around, so learn to enjoy – and appreciate – yourself. Do you need others to constantly validate you? What can you do to build your sense of self-worth and learn to respect your wonderful, unique self?
Be together, but separate – practice parallel play.
Some people are more extroverted, in the sense that they get energy from being with others, while some are more introverted, and recharge by doing solitary activities or having ‘quiet time.’ It can be helpful to know what you – and your partner – need.
TIME – There is rarely enough time in our lives to do everything we would like to do, let alone everything others want us to do. Give yourself permission to take time… to make time… for self-care: quiet time, sleep, relaxation, healthy eating, grooming, personal interests or hobbies, enjoyable activities, etc.
Interfering with or intruding on this time is actually counter-productive and can even be detrimental to productivity.
It’s easy to criticize someone for “doing nothing” when there’s much left undone, but time to unwind is NOT selfish or do-nothing time. It helps us to decompress, recharge and build up the ability to attack projects, go places or just “do something.”
There can be justification in expressing concern at “too much” personal time. If both partners agree there is an excess of time spent “vegetating,” then provisions should be made to SCHEDULE certain activities at specified times. This avoids conflict as to what was agreed upon.
Scheduling also allows the person taking personal time to do so without guilt, but since the “assigned” personal time isn’t open-ended, scheduling it helps to limit over-indulgence. Guilt-free personal time is also an excellent reward/incentive for accomplishing scheduled Task-Appointments. See “The Task-Appointment.”
When working, interruptions will slow you down and destroy the ‘flow.’ Some estimates say it takes an average of 26 minutes to get back on track, and that’s if you don’t get distracted by something else! And it is even more frustrating if it took major effort to get activated in the first place. You have a right to minimize interruptions – especially when you are working at a task that requires concentrated effort. If possible, turn off the computer and phone notifications for a set time. Let others know you’ll be in temporary seclusion. Consider a phone message that tells others when you will, once again, be available. Put a sign or count-down timer on your desk or office door that says when you will be free (people are more likely to wait if they have a specific time when they can speak to you).
Learn to say ‘NO” so you have more time to say “YES” to what really matters. Our time banks are limited, and everything you do is a withdrawal. So, choose wisely. Decide what is important and set your boundaries accordingly.
PERSONAL GOALS, DREAMS, and INTERESTS – We all need dreams to strive and hope for, but it’s important to objectively evaluate them, discard the unrealistic and work towards actually achieving goals that are truly meaningful. See “How to Accomplish Goals.” We also need to accept and enjoy our interests without judging them according to someone else’s barometer.
Expressing realistic concern about another’s goals or desires is okay, as long it’s done constructively.
To be critical in a negative way (“make-wrongs” or “put-downs”) of another’s goals and desires is to take away something precious from that person. The same is true for being totally non-supportive.
If your needs strongly conflict with another’s goal (e.g., your partner wants to buy a vacation home and you don’t want the stress, financial outlay and additional demands on your time), you can still express an understanding of the need, even if you are not supportive of the action. Perhaps you can both work out some compromise, such as buying into a time-share.
The reverse is also true. We can be supportive without fully understanding another’s dreams. Sometimes we haven’t a clue as to why something is important for someone else (e.g., running a marathon), but we can still support them in their quest.
Be careful that you don’t impose your dreams, or interests, on others. If you want to go bird-watching and your friends find it boring, it is unfair to force them to join you. However, don’t give up your interest, just find others who share it. Or suggest that while you birdwatch, your friend can use the time for his photography hobby, so you are both doing what you enjoy.
Don’t allow others to impose their interests on you. You can decline to share an activity and still be a good friend. You can appreciate that your spouse likes to watch sports on TV but choose to watch your favorite sitcom in another room. Not wanting to watch the news or go to an opera doesn’t mean you are superficial. (Beware the hidden make-wrong!)
If you know something will be difficult for the other person, even if you don’t think it should be, accept their limitations (real or perceived) and lend your moral support, without being controlling, indirectly insulting or withdrawing.
Limits Must Be Communicated
Know and understand your own limits. It is unreasonable to expect compliance or understanding from others if you’re not clear on your own needs.
Make sure others know your limits before you criticize them for going too far, or not far enough. It is unfair to expect something of someone else unless you’ve clearly explained to them what it is you want or need. Too often we get upset with someone because we think they should just know what we want, need, etc.
Relationships consist of more than one person. While it is important to get what you need and to strive for what you want, it’s unhealthy (to a relationship) not to also take into account the other person’s needs and wants.
Reclarify as needed. Sometimes we think we said something or made something clear and the other person says we didn’t. Instead of accusing the other, accept that either one of you may be responsible for the misunderstanding and restate your needs and expectations. Remember that conversations disappear, and no one is to blame. Communication is critical. And it always helps to write down things that you want to remember, and if they relate to an event, put them on a calendar and set an alarm!
Ask for feedback. To be sure major points are understood and to avoid miscommunication, ask the other person to tell you what they’ve heard, and what they think you mean. (Ask nicely, not with an attitude.)
Be flexible. Boundaries can be expanded at times. Stay somewhat flexible and try to see things from the other’s point of view without losing your integrity or perspective.
Examples: If your partner is ill or “down,” you may do more than your share of chores or provide greater emotional support.
A well-meaning grandparent may be allowed to ask questions or do certain things that you wouldn’t permit someone else. (But even here, there should be a limit!)
You may allow a partner or a good friend certain intimacies or criticisms you wouldn’t accept from an acquaintance.
Formulate Consequences for Overstepped Boundaries
Calmly state the situation (the other person may not have realized they were pushing your limits).
Reinforce your boundaries when they are, or might be, violated.
Graciously refuse to accept an over-the-boundary situation. Getting angry, depressed or belligerent doesn’t make it easier for you or the other person.
Allow the other person a backdoor; an easy way to change their mind or offer a compromise that realistically works for you.
Examples: Employer:“I need this report by 9am.” Response: “You may have forgotten, but when we met yesterday, I explained that I had to leave early today. You said it was okay. It’s impossible for me to cancel my plans at this point, but I can either prepare the report when I come in tomorrow and have it by noon, or give the data to Nancy so that she can prepare the report.”
Spouse: “Honey, I’m watching the playoffs… can you please keep the kids quiet?” Response: “We agreed that you take care of the children on Sunday afternoons so I can work on my thesis. I know you really want to see the game, so I can take them to the park now, but if I do, you’ll have to take care of dinner and putting them to bed so I can complete the section I’m working on.”
Partner: “Are you ever going to get that ‘A’ project finished? Response: “I certainly hope so. However, I’m also juggling the ‘B’, ‘C’ and ‘D’ projects. If you can take over the ‘C’ project, I shouldn’t have any difficulty completing the other three on schedule.”
Child: “Mom – you didn’t wash my team jersey! You’re in charge of doing the laundry! I need it by 4:00, so wash it now!” Response: “Everyone in this family is old enough to be responsible for putting their clothes in the laundry hamper. You know that. Since you left the jersey on the floor in your room, it wasn’t washed when I did the family laundry. If you want to wear a clean jersey to team practice, you’ll just have to wash it yourself. If you’re not sure how to do that, I’ll be happy to answer your questions, but I won’t do it for you.”
Child:“I’ve had it with doing chores around here. I’m not your slave! You take out the garbage yourself.” Response: “I won’t force you to take out the garbage. I know it’s not very appealing, but everyone has responsibilities. Since you don’t want to do your share of what must be done, I’ll have to work harder. So, I won’t have the energy or time to take you to dance class on Thursday. It’s your choice.”
Recognizing and reinforcing boundaries makes for more powerful and healthier relationships.
There is no easy answer to this question, for many reasons.
ADHD (Attention-Deficit Hyperactivity Disorder, also known as ADD) is on a continuum, meaning it can be mild, moderate or severe. The less extreme the symptoms, the easier it is to compensate, making it less difficult to live with ADHD. The reverse also applies.
Millions of adults have the symptoms associated with ADHD, but not the diagnosis, possibly because their symptoms, although enough to qualify for a diagnosis, are on the milder end of the spectrum. Or they may have learned to cope, or just accepted the way they are, perhaps (unfairly) attributing some of neurobiological symptoms to moral failings (lazy, inconsiderate, careless, foolish, etc.).
ADHD is a diagnosis based on having checked off a sufficient number of symptoms from a laundry list of age-related options. Each of those symptoms can vary in terms of how problematic they can be, and under what conditions (at home, school, work, leisure). That’s a lot of variability. There is even variation within the ADHD diagnosis, as you can be primarily impulsive/hyperactive, primarily inattentive or combination type.
For some, having ADHD is a strength. Their ADHD-related characteristics (or some of them) are essential to their personal and professional success. Consider the high percentage of ADDers in certain careers, such as entrepreneurs, artists, musicians, first-responders, comedians, sales, etc. While the manifestations of ADHD may not be as helpful for all aspects of their jobs, nor in all areas of their lives, they would find life more difficult without it.
Unfortunately, for most people, ADHD also leads to certain struggles. The degree to which those struggles make life difficult will vary. If you struggle with time management but aren’t in a job or life situation where following the clock is critical, then that becomes less of a problem. If you struggle with organization, but have assistants at work and help at home, that challenge is less problematic. If you need to be ‘on the go’ and are a student confined to sitting in a classroom, you might be considered hyperactive, from a negative perspective. But if you have a career where you aren’t confined to your office and you also enjoy an active leisure life, your drive to move shifts to a non-issue, and even an asset.
ADHD symptoms vary – one person could be physically hyperactive, and another hypoactive. High energy, low energy. Some people do well in a chaotic environment (many police, firefighters, EMT’s, ER docs, floor traders, teachers, etc. have ADHD) while others would be totally overwhelmed by the noise and activity. Many people with ADHD thrive in the bustle of a big city, while others seek the peace of a countryside or seashore. So, finding an environment and career that suits you makes a difference in how you’ll view life, and how difficult it is, or isn’t, to have ADHD.
ADHD is inconsistent. Not just from person to person or from child to adult, but from day to day. Sometimes it can feel debilitating or dysfunctional; other times you are on a roll and exceptionally productive. Understanding, and accepting yourself (instead of letting your inner Judgmental Critic be in charge) makes those unproductive times less frustrating.
Other factors contribute. If you are surrounded by critical people, whether at work, socially or at home, you’ll obviously find life more challenging than if you have support and understanding. The more you are juggling (work, school, home, partner, children, aging parents, etc.), the harder it is – for anyone. The hormonal changes of aging or the stress of illness will also exacerbate the ADHD symptoms.
Having ADHD can be really frustrating. It’s tough when you struggle with things that ‘should’ be simple (although you may excel when tackling more difficult challenges). It’s sad when you aren’t achieving your potential, even when you might be considered successful (but you know you could be doing much more). It can be extremely stressful when you know you need/want to do something but can’t activate (an executive function), or you are doing something you need to stop, but can’t find the brakes.
Strategies are critical for managing your ADHD symptoms.
There is often a reduction in ADHD-related difficulties when you take time for self-care and stress-reducing activities (exercise, sufficient sleep, outdoor time, mindfulness, journaling, eating well, hobbies, creative, sports and social activities, pets, family fun time and time to nurture relationships, etc.)
Some people benefit from medication, but if you couldn’t play the piano before meds, you can’t play it after – you’re just more available to learning how, which can make a difference.
Some ADHD tendencies are best avoided (or require professional intervention). People with ADHD often have impulsivity control issues and addictive personalities, acting without thinking, whether it’s reckless driving, alcohol, drugs, food, sex, shopping, gambling, internet, etc. They also tend to get caught up in thinking without acting, making it difficult to get things done. Obsessive thinking and perfectionism often come into play, getting in the way of productivity.
When the ADHD brain feels overwhelmed, instead of tackling the issues, it is more likely to shift into the fight, flight or freeze mode – major avoidance. This is an automatic, brain-based reaction to fear, confusion or stress. So, it’s critical to find strategies that will keep you from feeling overwhelmed.
Tools and strategies help to manage ADHD-related challenges. If you struggle to get places on time, meet deadlines, begin or finish tasks and projects, get and stay organized, manage schedules and lists, create and follow routines, prioritize, self-advocate, make decisions, communicate effectively, etc., it isn’t enough to want things to change. You need specific compensatory strategies that work with the way you think – not the way you wish you thought. The right tools make living with your ADHD a lot less difficult. (That’s what Coaching is about!)
ADHD is only part of the mix – we have different personalities, interests, strengths, intellectual and emotional gifts, co-existing diagnoses, etc. Some people with ADHD will excel in school, while many others find it a total challenge. Some will be artistic or creative; others might be athletic or musical, all of the above or none of them. Some will thrive in the limelight; others will avoid it. It isn’t just the ADHD we need to manage; it’s finding a life that supports us on many levels. It’s easier to cope with the difficulties that come from ADHD when we are engaged in activities that play to our strengths.
There are so many aspects of life that are impacted by ADHD, from relationships to finances, from career to self-care. You can find ways to compensate, and even excel, but it takes effort and self-awareness. The answer to, “How difficult is it to live with ADHD?” largely dependson whether you’ve been able to create a personally ADHD-friendly life!
We’re already in the Holiday buying frenzy season, so step back for a minute to take this Reality Check! (And check out my Time Machine ride, below.)
Some of you are brilliant at earning and managing money. Others have the skill to grow what you’ve earned or have family money to spare. This blog isn’t for you.
Many people with (and without) ADHD have financial issues. The reasons vary, but here are some common ones – can you relate?
It’s Now… or Not Now. When you live in the moment, it’s difficult to plan for the future, whether it’s putting aside money for emergencies or unanticipated events (car repair, best friend’s wedding, new air conditioner, etc.)… OR for non-immediate goals (vacation, new house, newer car, etc.)… OR for longer term needs like retirement planning.
I Want; therefore, I Do. Impulse control isn’t high on the list of ADHD characteristics. If you are lured by items in a store, online or even on a restaurant menu, your first thought may not be whether you can afford – or need – the purchase. You’re less likely to weigh benefit against cost (and even if you do, you’ll more likely decide the value is in the purchase or the cravings, not the savings).
Appeal of the Bright and Shiny Object. It can be a new outfit, despite a bulging closet and emaciated wallet. It might be a new hobby or adventure, regardless of the cost or despite an already maxed out schedule. If it sparks your attention, diverts you from dreaded boredom, sends a dopamine rush of exciting possibility to your brain – well then, money isn’t the major consideration, if considered at all.
FOMO – Fear of Missing Out. It’s too easy to spend money on things we don’t need (the latest phone upgrade?) because if we don’t have the newest and best we’re worried we’ll be out of sync, or ‘less than.’
Did I or Did I Not? If you can’t remember whether you bought something, or if you know you did but forgot where you put it, you’re more likely to purchase it, or something similar, a second (or third) time.
Magical Thinking. The Cambridge English Dictionary defines this as the “belief that thinking about something or wanting it to happen can make it happen.” Sometimes this is a good thing, as evidenced by the benefits of positive thinking and even the Law of Attraction (when coupled with action!). However, when our current financial actions are driven by future income possibilities, it usually means trouble:l can afford this now as I’ll be able to pay for it when I get my new, better-paying job … I’m in line for an inheritance, someday … I’ll marry into money … I will win the lottery … or the horserace. Maybe, but what are the consequences if you don’t?
Difficulty Planning. It’s often a challenge to make decisions that will make a goal so specific and real that you can appropriately budget for it. Let’s say you need additional education or training to change or advance your career. You’ll need to decide on the course, the school and the timing. Only then will you know the expense. Then you’ll need to decide how you’ll pay for it. Do you have the money? Can you save it? Is it worth a loan? Can you get a loan? ALL decisions! Or, you may want to take a vacation, but where to go? With whom? Fly or drive? When? Tour, hotel or house rental? So many decisions! (BTW, mind-mapping can be very helpful for this type of planning.) Do you have money set aside for a vacation? Can you save it? How much you need will depend on the variables, or the variables will depend on how much money you’ve set aside. This required thinking is exhausting for many people with ADHD, who easily suffer from decision-making fatigue. So, the tendency is to postpone making ANY decisions or to make decisions without thinking through financial considerations.
Commitment Phobia. This is a common concern that interferes with making plans. How will I know if I want to do this in six months – or six days – from now? What if something else comes up? You are likely to spend more when you do things last minute, or impulsively, than if you’ve planned in advance.
Boredom. Spending money is often tied in to alleviating boredom. And many of us get bored easily and look for diversions, whether it is a shopping trip, entertainment activity or event, online browsing session, expensive restaurant, bar night out, etc. This can easily negatively impact our budget. Contributing to the drive to spend money is the dopamine rush that comes with the excitement of buying something that attracts us (and might also temporarily help with depression or anxiety). This adds to the appeal for ADDers, making it more difficult to avoid impulsive buying.
The Cost of Happiness. Studies show that experiences, including convenience services, contribute more towards feelings of happiness and satisfaction with life (and relationships) than do material purchases. Spending money on a cleaning or meal delivery service, which gives the gift of time (and avoids chores that, for many, are not highly desirable), may increase happiness, but negatively impact bank balances. Even so, these expenses may be worth adding to your budget!
Avoidance of the Reality Check. If we aren’t clear about our income, our savings (or lack of) and our expenses (fixed, variable and discretionary), we don’t have the info we need to weigh a purchase against the reality of whether – or not – we can afford it.
So, what does it take for a Reality Check?
OK, this time machine won’t really transport me to another era (magical thinking to the max!). Sadly, I won’t be able to improve my finances by going back in time to buy IBM, Apple or Google at first offering, or buy into that NYC co-op conversion. (But thanks, Rob Niosi, for the make-believe time travel on your magical work of art!)
Since I have to face the reality of my finances and to understand money and how it affects me, I need to gain clarity about:
My actual income, after taxes. (BTW, if you are entitled to reimbursement for business or medical expenses, and struggle to get in the paperwork, give yourself permission to have someone help you submit those expenses!)
My fixed and variable expenses– the money I need to spend to live (not necessarily to live well…). This includes required expenses related to basic housing, groceries, clothing, electronics, transportation, home and personal care. Also,insurance and medical care along with regular savings for emergencies, unexpected needs, special expenses and retirement. It might include loan and credit card payments (including student loans), plus expenses related to children, dependent parents,pets, etc.
My disposable income– the amount of money I have left AFTER I deduct all of my necessary expenses. The availability (or not) of disposable income also affects the quality and quantity of my choices (Mercedes or Honda… house or studio apartment… Nordstrom or Walmart… exercise DVD or gym membership… luxury hotel or inexpensive hostel).
My discretionary expenses – the things I buy because I want them; not because they are necessities. This category includes entertainment, dining out, vacations, renovations, etc.
So, Reality Check: What is your REAL income after taxes? How much do you need for your fixed and variable expenses? The amount remaining is ALL you have available for your discretionary expenses, unless you want to run up debt that will only compound the problems.
Ouch! Our tendency is to overspend because confronting the reality of how much money we require to live, and how much we have left after those expenses, is something we want to avoid.
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.
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.
I planned to write my next blog post. Great Idea. Gives me joy to share information. Helps me to stay in business so I can keep helping clients. I have the time today… but I don’t feel like it!
The funny/sad thing about “…But I don’t feel like it” – those six short words wield a mighty power, and it’s not for good. We think them frequently, or at least many of us do, and they are the Destroyers of Productivity.
Here are some typical conversations in my head, but I imagine they sound familiar to many of you.
I ought to go to the gym…
I should re-organize my closet…
I need to finish this…
I said I would…
It’s at the top of my ‘Action’ list…
…BUT I DON’T FEEL LIKE IT!
Just six words, but powerful enough to subvert our best intentions. The enemy of getting things done.
What to do?
I coach my clients on the benefits of reframing a ‘should… must… need to… or have to…’ into a ‘want to.’ Why? Because we’re all more inclined to do what we want. But even wanting to do something can lose traction when the ‘but I don’t feel like it’ button is pressed, and it gets pressed very easily – “I’m tired… I have too much to do…. I’m not sure how to… It’s too much work…I just don’t wanna!”
These are powerful feelings. Strong enough to triumph over our already-compromised executive functioning capabilities. So, too often, we don’t take action and our temporary emotions/avoidance tendencies get top billing.
I don’t like giving in. Sometimes, sure. Being self-indulgent can be comforting, and there are times when eating an ice cream sundae or taking a nap should take precedence over staying on a diet or doing the laundry. But other times it feels like the nefarious power of six is in charge, and even my best plans are unwilling hostages. So here’s how I fight back.
I start from my reality. Step #1 of my 7-Step PowerPlan to Success™ is Self-Awareness, which means acknowledging how I really feel. If I don’t feel like it, why deny the obvious? Step #2 is Self-Acceptance. I already know all those shoulds, oughts, musts, etc., and instead of fighting the way I feel or blaming myself, I accept my mood, so I’m not adding incendiary guilt to the challenge of taking action (…or not).
I’ll remind myself I have the powerof choice. Step #3 is to Believe in Possibility – that we always have a choice. It’s easy to forget this when caught up in the moment. Still, despite the way I feel (or think), I can find strategies to do things differently, thus producing different results.
I can take action despite my thoughts and feelings. There is a powerful concept in several therapies, including Morita Therapy, the Japanese psychology of Action, that focuses on our ability to take action regardless of the thoughts and feelings that will always get in the way. The trick is to acknowledge them, including the powerful “I don’t feel like it,’ then choose to ignore them… they don’t have to be in control, even though they seem to be.
Keep that action simple and immediate. If I think about writing a blog, it can be overwhelming. Overwhelm, especially for people with challenged executive functions or ADHD, will allow our fight, flight or freeze reaction to take control, making it even less likely to get anything accomplished. So, maybe I’ll set a timer for 10 minutes and open to a blank page in my notebook or Word file. Maybe I’ll just write a few buzz words (Iike I did when I started this blog by writing, “But I don’t feel like it…”). Maybe I’ll get inspired and continue, or perhaps I won’t, but I’ve done something!
Consider what is actually getting in the way. Sometimes this is a waste of time, but occasionally there’s increased clarity when I explore why “I don’t wanna,” enabling me to move forward. My kneejerk response “But I don’t feel like it” may be a reaction to a concern that, when acknowledged, can be remedied. Perhaps my reluctance to do something might be because I’m not sure how to get it done. Maybe I first need to do some research or create a Project sheet and break it down into small, do-able tasks. Maybe I need to ask for help. Or maybe I have too many things to do and haven’t prioritized. I need clarity.
Look for the options. Sometimes, exploring what’s really getting in the way gives me options.
I don’t wantto re-organize my room because I think it will take up most of my day. OK, how can I power up that action switch? I can set an alarm, put on dance music and work for just 60 minutes. Who knows, I may even complete the job in that time, or at least make good progress.
Or maybe I don’t want to straighten up my clothes closet because there’s no room. So my project shifts to reviewing my clothing with an eye towards donating. As organizing guru Barbara Hemphill says, “You can’t organize clutter.” First, I’ll declutter, then I’ll find it easier to organize.
Look for the motivators. What will encourage activation? For example, people with ADHD are rarely driven by the common motivators of importance, consequences or rewards (unless they are immediate). But if something is interesting or novel, we’re more likely to WANT to pursue it. I know it’s easier for me to unload the dishwasher (boring and repetitive) if I make it a game to get it done quickly: Beat the TV Commercial. I recently discussed this concept with a client, and she decided the best way to clean her kitchen after dinner is to make having her favorite ice cream dessert dependent upon having a cleared counter and sink. The yummy dessert was enough of a motivator to make her want to do it.
So how did I manage to write this blog, despite my immediate reaction of “But I don’t feel like it!”?
I decided to switch my environment (a very helpful strategy) and sit outside to enjoy a gorgeous day (studies show that being in nature resets the brain, so another boost).
My small, portable bluetooth speaker played perfect background music at low volume from my playlist (for me, wearing earbuds or earphones would have made the music my primary brain focus and been distracting, rather than enhancing).
I filled a thermos cup with a tasty drink (self-care). No, it wasn’t wine – not a bad idea, but I was tired and would have drifted off target.
I took along my favorite pen and a pad with smooth, thick conducive-to-writing paper (sometimes hand writing is more inspirational than keyboarding).
I began by writing down those six powerful words, “…But I don’t feel like it.”
Most important – I set a clear intention and decided to put everything else on hold while I write.
There are many ways to fight these Six Powerful Words. Let’s continue this conversation with your comments on my blog, www.SusanLasky/i-dont-wanna. What are some ideas that work for you?