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.
But I Don’t Feel Like it! …
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 power of 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 want to 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?
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.”
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.
- 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?
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.
There is often a collapse in our understanding when it comes to getting things done. We’re taught to believe that if we were really motivated, we would get started on that work project, organize the closet or declutter the entry. We’re told that if we really cared about our family’s health, we would consistently prepare tasty, nutritious meals. We tell ourselves that if we’re not exercising or finishing the online course we started, lack of willpower and poor self-image is to blame. If only we tried harder… Maybe, but not likely.
Activation, unlike motivation, is an executive function skill, also known as Initiation. That means it is brain-based in an area of our brain (the frontal lobes) that may not be as consistently high-performing as we’d like. Especially so for people with ADD / ADHD. This is the area of our brain that is largely responsible for things like organization, time management, prioritization and activation (the ability to get started on something). It is easily overwhelmed by too much to do, confusion as to how to do things, or the dread that comes when a project seems too big or boring to be easily accomplished.
That’s when the protective amygdala— the part of our brain that helps us to manage stress— steps in with its fight, flight or freeze response. So we go into avoidance mode. OK, this is an oversimplification, but it helps us to understand WHY we find that doing some things becomes so challenging that we continually procrastinate, even if we are motivated to get them done.
Just because we’ve decided to do something, doesn’t mean we will actually get it done – despite motivation by desire, rewards or dire consequences. This lack of ability to get going can be both frustrating and scary!Here are eight strategies to help you overcome overwhelm, minimize the avoidance factor, get activated and successfully accomplish your goals.
Stop Identifying Yourself by Failure. Procrastinator. Lack of willpower. Lazy. Unmotivated. Selfish. Inconsiderate. Untrustworthy. These are words that make me want to quit, not put in the effort needed to overcome a brain-based executive function challenge. So recognize that despite the widespread ‘Just do it’ mentality, it’s often necessary to find work-arounds. Let go of the negative self-talk. Accept that you’re having difficulty beginning a task, and instead of being self-critical and judgmental (which accomplishes nothing), be gentle with yourself. You may be anxious about the task, uncertain about how to get it done, uncomfortable about doing it (like calling a company to complain about something), or stuck because you might ‘do it wrong.’ Avoid paralysis by analysis. Often all that’s needed is that first step, which is what activation is about. Identifying what is getting in the way is part of the solution. It’s important to take action despite your feelings, but it helps to understand them. Studies show that you’re 50% more effective if you first get clarity as to why it’s tough to get going, than you’d be if you just push through and try to get it done.
Set Aside Planning Time and Action Time. They are not the same. Planning time is for deciding exactly WHAT you are going to do, and HOW you’ll get it done. It’s the time to determine your priorities and decide WHEN you’ll actually work on your tasks (your Action times). It’s the time to make DECISIONS, so they don’t hold up your progress once you start working. Sometimes we plan to do something without being realistic about how much available time we actually have (the ‘white space’ in our calendars). So when planning, take all of your time commitments into account. And don’t overplan. Activation takes effort, so leave space for recharging, along with time to deal with interruptions, unexpected tasks or spill-overs from tasks that take longer than planned. If you skip Planning time and go directly to Action time, it’s easy to lose focus on what is most important and spend that Action time pursuing any new bright and shiny object (or checking emails, Facebook, Instagram, Twitter, Pinterest, etc.). If you haven’t planned very specific tasks for your Action time, it’s easy to get overwhelmed by all of the options when you are ready to work.
Use your Planning time to gain CLARITY. What are the specific tasks that will enable you to make progress towards your goal? A project is too big to ‘do’ in one sitting, so the thought of ‘doing’ an entire project is overwhelming, resulting in avoidance rather than clarity. It’s easier to activate when there’s something very specific to do, with no conflicting priorities and a set time for starting –and ending– your efforts. It’s the way you solve that proverbial question, “How do you eat an elephant?” (the project you tend to avoid because it’s just too big, scary or unappetizing). How? One bite at a time! Begin by breaking the project into do-able tasks, or individual bites that aren’t too painful to swallow. The smaller you make them, the easier they’ll fit into your busy schedule. Prioritize those tasks (what has to be done before you can move on to the next task?). WRITE DOWN THE STEPS! Then, when you are in Action time, put on your blinders to stay focused on the designated task.
Make the Task more Appealing. How can you turn a need-to, should-do or must-do into a want-to? Same task, different attitude. Even then activation may be difficult, but it’s easier when you see a positive reason for accomplishing a task (even if it’s just to get it over with so it no longer gives you angst!). How can you add a fun element to the task? Some ideas: Do it with a friend, working together or just in parallel play… get out of your home or office and work in a coffee shop or park… upgrade your writing tools with a special pen and appealing notebook… promise yourself a reward for getting the task accomplished (even if it’s just some guilt-free ‘me’ time)… make finishing the task a game… have a giant check-off list, etc. Or try one of my favorites: get to work on it to avoid doing a task that’s even less appealing! Remember the benefit. Write down what you will gain from finishing the task. Keeping the goal in mind can make the work that goes into accomplishing it less onerous.
Think Progress, not Perfection. It’s easier to eat the elephant (work on that task or project) when you feel like it, or when you’re really hungry (deadline anyone?). But that’s a less effective way of ensuring you successfully accomplish your business or personal goals than if you were to commit to taking small, palatable bites every day (consistent effort). Prioritize the bites and keep them small, triumphing over your perfectionistic avoidance tendencies. Consistent small bites get things done!
Take a Short Detour to Gain Momentum. Sitting and staring at a blank screen won’t get that blog written. First, try doing a tiny action, like writing one sentence. This small action will often get you over the inertia hump, so you can continue. But if you find yourself unable to initiate action, take a detour. Do something physical (energizes your body and your mind). Take a short nature break (relaxes the anxiety and provides a feeling of well-being you can take back to your desk). Call a positive friend and make plans to do something fun. Listen to music that energizes and helps you stay focused. Make sure you eat and drink (dehydration contributes to brain fog). If you take medication, check that you’ve taken it. If you need ten minutes of down time, take it – even if it’s to check your social media or email (be safe and set a STOP alarm!). Remind yourself of your commitment to get to your Action task, and then, refreshed, get back to work.
Be Aware of Transition Trauma. Sometimes it’s hard to stop one activity to begin another. Our brains just don’t want to make the switch. Be clear as to what you plan to do when. Write it on your Daily Action List. Put it in your calendar as a Task-Appointment. Use alarms to define your Action times and alert you that it’s time to begin (activate). Get up and move between activities so you can clear the Zombie-like focus, or hyperfocus, from a previous task (or from that computer solitaire marathon session).
Find an Accountability Partner. When someone else cares whether we’ve accomplished what we said we would, we’re more likely to get it done. This is often difficult when you work alone. Just as it’s easier to get to the gym when you go with a friend, it’s easier to get activated and work towards your goals when there are others who are supportive of your efforts and cheerleaders for overcoming your challenges. Share with a non-judgmental friend, join a mastermind group, consider the benefits of individual coaching, or join a group like my TUIT Project, which is designed to provide support and accountability. A new online group begins each month—visit OvercomeOverwhelm.com.
Also consider the benefits of individual coaching. Contact Susan Lasky Productivity Solutions to discuss how coaching could help you move forward and have a less stressful, more fulfilling life. Susan is based in Westchester, but works virtually anywhere. She can be reached at 914-373-4787 or Susan@SusanLasky.com. You can schedule a convenient, no-cost or obligation Initial Consult at https://SusanLasky.AcuityScheduling.com.
Frustrated by the gap between knowing what you should/want/need to get done and the reality of what you are actually accomplishing? For many people, this is a chronic struggle – especially those with ADD/ADHD/EF (executive function) challenges, myself included! Even when we are at the top of our game there’s still a backlog that can approach critical mass. Do you wonder what the top of your game would be if you could be more Nike™-like and ‘Just Do It.’ Fortunately, there ARE strategies that help, and here are a few:
Begin with Clarity – Know exactly what you plan to do AND why you want to do it. Maybe it’s because you need to get something done, but by phrasing it as something you want (even if the reason is to keep your job, pass a course or stay on speaking terms with your partner), it becomes your CHOICE, and our motivational circuits work a lot better when we choose to do something. So convert your ‘have-to’s’ ‘must-do’s’ and ‘need-to’s’ to ‘WANT-TO’s.’
Confusion by Susan Lasky
Think ‘Task’ NOT ‘Project’ – Often, what we want to do is too big to accomplish in a single sitting, leading to a feeling of overwhelm. For many of us, overwhelm is a trigger to shutting down and doing less, rather than ‘attacking’ the project to successfully accomplish it. Our brain perceives the situation as threatening, and shifts into the protective ‘fight, flight or freeze’ mode, which doesn’t help with getting things done.
Avoid overwhelm by identifying the PROJECT (it might be to redo the files, create a newsletter, plan a vacation, organize the closet, write the thesis, ‘do’ the taxes). Whatever it is, break it down into the multiple small steps (TASKS) that are needed to complete the project.
The first task of any project is to create a written Project Sheet that specifies everything you’ll need to get it done, from resources needed (information, people, money, tools) to a step-by-step breakdown of each action, with approximations of the time you’ll need for each step – then double it (or more). Reinforce the steps by writing them down and saying them out loud. Keep the Project Sheet where you can easily refer back to it. (Think weekly and daily planning/review sessions, which take time but totally save you hours!)
Set a Conscious Intention (Commitment) – Once you are clear about WHAT you will do, decide WHEN you’ll get it done – PRIORITIZE. Put each step in your calendar or planner as a Task-Appointment, which is an appointment with yourself to work on a specific task at a specific time.
Saying ‘yes’ without saying ‘when’ is a typical precursor to not getting things done. Consider posting a reminder with the specific task you have prioritized, in a place that will draw your attention back to it when it begins to wander (and accept that it will wander!). You might want to expand your declared focus to prioritize an entire day or a week, “This week I will finish …” This doesn’t mean you won’t do other things, but it helps to swing you back to your key priority when your attention drifts or your interest wanes.
Make it Do-Able – It often helps to set a timer for a short amount of time so you don’t feel ‘trapped.’ It is easier to start something if you know you only have to stay focused on it for 20 minutes (or 15… or 10!). If you don’t complete the task within the time you’ve allotted, that’s okay. Congratulate yourself for having done what you said you would, then set additional Task-Appointments to finish what you’ve successfully begun. Take breaks between scheduled appointments. Some people find background music makes it easier to stay focused (volume and genre do matter!).
Minimize Distractions – Put on your blinders and resist temptation by making it less intrusive. Turn off email notifications, and even the phone if possible. Put a sign on your door that you will be available at 3:30 (or whenever), to minimize interruptions. Use a chalk or white board so visitors can leave messages. Give yourself permission to let go of the guilt from the other projects that need your attention, so you can successfully focus on one at a time. (I’m a brilliant multi-tasker, as long as I only work on one task at a time!)
We can’t quite turn off our brain (although a few minutes of mindful focus before you begin the work can help), so keep a ‘parking lot’ handy – a place to write down the thoughts that pop up and can compromise your focus. You don’t want to forget to make that call, send an email, pick up the dry cleaning, order a replacement phone charger, etc., and these are the things that will often pop into your mind while doing something else. You will think about it, so capture these thoughts in writing or tell it to Siri, OK Google, Alexa or your phone companion. Then you don’t need to shift your attention away from your project in order to remember to do it.
Start Small – When you are REALLY stuck, just open the notebook or computer file and look at the page or screen. Then put your pen to paper or fingers to keypad. They may start moving of their own volition. If not, commit to writing just one sentence, which often opens the gateway to moving forward. Or pull out a folder and skim the papers. Or make a list of what you think you should be doing. It’s the ACTIVATION that’s so difficult. Sometimes, all it takes is a minimal start to trigger our brains to become involved with something we’ve been avoiding. And remember how good it feels to get something done!
Take Breaks & Make Time for Self-Care – Avoid ‘overbooking.’ Often, less IS more. Leave ‘white space’ in your day. Especially when you have things to do in the evening or over the weekend. Leave time between Task-Appointments (if you work for 20 minutes, take a 5-10 minute break, then a longer break every two hours or so). Get up and MOVE (keeps the energy flowing). This is easy to forget when in hyper-focus mode, where we can work for hours on something because we are so caught up in it. Try to remember the law of diminishing returns (and ask yourself what is not getting done that is also important.
Take care of yourself! SELF-CARE is often the first thing to go when we feel there is too much to do.
Stop and Smell the Flowers by Susan Lasky
Yet self-care provides the physical AND mental energy to accomplish more. Think about it – how much more cognitively alert and productive are you after a good night’s SLEEP? Multiple studies are showing that our body and brain use sleep as a time to recharge, including eliminating toxins, so it isn’t, as many feel, a ‘necessary evil,’ but part of the productive process.
We know that EXERCISE boosts our body chemistry so we are more functional (and ofter a lot less ‘hyper’ or ‘antsy’). So fit some version of it into your schedule (again, less is often more if it means you’ll actually do it – sometimes our exercise goals may be somewhat unrealistic). DRINK a lot of water (hydrate). SNACK on fruit or have a protein shake. A quick NAP or MEDITATION can be super-restorative. Science is proving that time spent OUTSIDE in greenery can dramatically enhance our mood. (The Japanese even have a concept for this called ‘Forest Bathing.’) Yet when we feel ‘behind,’ as is so typical, we deny ourselves these self-care actions that boost our brain chemistry and pay us back with increased focus and productivity.
We NEED and DESERVE to ENJOY ourselves. Take a break to play with your kids or your dog (laughter totally energizes). Pet the cat and let the purring calm your brainwaves. Allow yourself time to garden, paint, create music or anything that comforts your soul. Have lunch with friends or make some private time with your partner, and you’ll usually get MORE done – and feel less deprived or annoyed by having to do the work in the first place!
Accountability Helps – Don’t try to go it alone. Report your progress to a non-judgmental accountability-partner, whether a friend, family member or coach, or consider joining an Accountability Group. (Check out my Get Around TUIT online action group at www.OvercomeOverwhelm.com)
Here’s an accountability strategy that is especially appealing to the tech-savvy. I ask some of my coaching clients to take a photo of their progress and text it to me. It might be a completed page in their planner, homework assignment or business plan, an organized desktop, newly labeled files or an emptied suitcase from last month’s trip – whatever supports their intention at the end of our last coaching session. If they said they would join a study group, go to the library or attend a networking event, I ask for an on-location ‘selfie.’ The photo is fun, helps them to feel more motivated and gives ‘instant’ feedback as to a job well done – not from me, but from their camera 🙂 It is a testament to their success! You can use this accountability strategy with yourself or a friend.
Commit to a Daily Action Plan, which is different than your 50-page ‘To-Do’ list. It has space for just your 3 primary actions and, if you finish those, 3 secondary activities. If you want to check out my Daily Focus form, you can download it here.
Be a Detective – The best strategies may not work for you, or may work for only a short time (so frustrating, but that’s reality). It is okay to acknowledge you are stuck. Maybe you need new tools, techniques or strategies, or just to tweak the ones you’ve been using. Perhaps you would benefit from a greater understanding of how to do something – a workable office requires an understanding of functional organization, and systems that work with the way YOU think – especially for those of us who are ‘out of sight, out of mind’ thinkers. Maybe you’ve been struggling with writing papers because you never really mastered the process from a technical perspective (organization, time and project management and keeping a check on perfectionism!). Perhaps you would benefit from a better system for managing your emails or running meetings.
So now, imagine that you’re solving your problem, but for a friend or colleague. When we take the emotional component out of the equation, it’s often easier to come up with a workable solution. Things can be different, but how to effect successful change? (Step #3 in my PowerPlan to Success: Believe in Possibility, and that you always have a Choice.) Sometimes we just don’t know what we don’t know, and help is needed.
You may benefit from hands-on advice, situational coaching, or exploring the underlying causes that create or compound your challenges. These can include emotional issues, physical problems, learning disabilities, and executive function or attention disorders that can get in the way of success (and here you wasted so much energy blaming yourself for lack of willpower!). Perhaps you struggle with perfectionism, are overly self-critical, feel the work you do isn’t ‘good enough,’ or subconsciously sabotage your success. Remember that it shows strength to work with a consultant, organizer, tutor, coach or therapist to get at the roots of these chronic challenges.
Be Kind to Yourself … Please!!! That’s the most important thing I can leave you with. Studies show that the more you accept yourself, the more productive – and happier – you’ll be!
I’m curious. What do YOU find helps to get things done?
Want to know more?
Most of us feel overwhelmed by the many important, but not always urgent, tasks and projects that we need/want/have to or should do. We’re frustrated and stressed by our failure to get it all done.
What gets in the way? It isn’t necessarily a lack of motivation that’s holding us back, but the challenges that come from a lack of time and/or clarity:
- What to do – conflicting priorities because there are just too many options
- When to do it – lack of time to do it all (we’re not always realistic about our time and energy!)
- How to get it done – confusion about how to accomplish a task or project
Other action-stoppers include:
- Procrastination, due to the lack of a pressing deadline or consequence
- Avoidance of tasks that are particularly difficult or boring
- Inability to activate, or just get started (begin stuck in the ‘off’ position)
- Time blindness that leads to poor planning – it’s either now, or not now
So, How DO We Get Anything Done?
Many people, especially those with ADHD, are ‘burst workers.’ It takes us so long to activate, that when we finally get going on something, we want to get all of the mileage we can. So we wait until the last minute then shift into hyperfocus mode, then get so caught up in what we’re doing that it’s hard to stop. It helps when there’s a deadline, as there are no longer conflicting priorities, and the adrenaline (think stimulant) is naturally flowing, helping with concentration.
But what if there isn’t a deadline? What if it is a project that’s important, but not urgent?
Start by Making the Project Do-Able… and Avoid Overwhelm
Projects can be complicated, and often involve many steps that can take a lot of time to complete. Just thinking about a project (instead of an individual task) can lead to feeling overwhelmed. Our protective brain perceives overwhelm as a threat, triggering the ‘fight, flight or freeze’ response. So instead of the increased clarity and focus we need to get things accomplished, we’re more likely to escape into avoidance mode.
The only way a project becomes do-able is when it’s broken down into tasks (individual components). Tasks allow you to focus on doing just one thing at a time. Yet sometimes, accomplishing even a single task can be challenging.
Think about it: How do you eat an elephant? Bite-by-bite. How does Pac-Man win? Byte-by-byte. How do you tackle a project, bit by bit, step-by-step or task-by-task!
Enter the Tortoise Approach… Slow and Steady Wins the Race
How to Overcome Avoidance, and Cross the Finish Line (Get it Done!)
Start by choosing one very specific task (or mini-project) that will help you accomplish your project or long-term goal.
- If your project is to send out weekly blogs, your task is to write one blog
- If your project is to declutter your office, your task is to organize your desktop.
- If your project is to find a new job, your task is to update your resume.
You can put the task on your calendar as a Task-Appointment (an appointment with yourself to accomplish a specific task at a specific time).
But putting it on the calendar doesn’t mean you’ll get it done.
We’re most likely to complete things when there’s a looming deadline with consequences, when it’s a task we really enjoy, or if we’re trying to avoid something that’s even less appealing! Otherwise, so many things can get in the way, and we wind up with a large number of important tasks that we never seem to get around to completing.
So make the task more do-able by making it even smaller:
- Instead of writing a blog, jot down your ideas for the blog.
- Instead of organizing your desktop, clear the space around your keyboard.
- Instead of updating your resume, make a list of your job responsibilities.
The smaller the task, the more likely you’ll be to do it – especially if you’ve assigned a time to work on it.
Slow down and limit the amount of time you work on the task (so you’re more willing to do it!)
- These are the tasks that you haven’t been able to accomplish burst-working, so try a different approach – don’t try to get it all done in a day. Think progress, not immediate completion. (Also, be wary of perfection, which is often the enemy of progress).
- Assign just 20 minutes to the task, or if that seems like too much effort, go for 15 minutes… or even 10.
- The goal is to make your task-time short enough that you’ll actually get to it. You can do almost anything for 10 minutes! Don’t worry about finishing the task (unless you are on a deadline). The way you’ll finish is with consistent effort.
Shoot for the minimum time and set a timer
to keep you honest! If you’re on a roll and want
to work longer, it’s okay to keep the momentum going if
there’s nothing else you have scheduled. If you are still
having a hard time getting started on the task, use a timer
that shows the remaining minutes disappearing – so the end is actually in sight!
Like the tortoise, keep plodding onward.
Studies show that authors complete more books when they write for ten minutes a day than when they wait for the time and inspiration to do burst-writing sessions.
Commit to working on your task, or other parts of the project, on a regular basis (every day, four times a week, or whatever makes sense for you).
Even if you absolutely don’t feel like it, or you’ve been swamped by other, more pressing tasks, by carving out these short but regular sessions to work on tasks related to that important, but neglected project, you will get it done!
Often it helps to have other people to encourage your efforts and hold you accountable. My new program, Your Online Action Group, does just that, with the TUIT Project (so you’ll finally get around to it!). It’s inexpensive and super supportive. Everything is online or recorded, so no problem if you miss something. Check it out at www.OvercomeOverwhelm.com.
For individual coaching or group training, go to www.SusanLasky.com or contact me at Susan@SusanLasky.com.
Productivity, ADD/ADHD & Organization Coach at Susan Lasky Productivity Solutions
Susan Lasky helps people who are overworked, overwhelmed or disorganized to get things done by working with the way they think. For more than 25 years she’s helped them find the right tools and strategies to better manage their time, priorities, paperwork, projects, space and stuff, so they gain more time, energy and focus to grow their business, succeed in school or the workplace, balance work/home/self-care and truly live a life they love!
Susan is a Board Certified Coach, Senior Certified ADHD Coach, Edge-Certified Student Coach and Level II Specialist in Chronic Disorganization, as well as a trained Organizer-Coach and Office Productivity & Systems Consultant, certified Career & Life Planning Specialist, Holistic Time Mastery Coach, and a Golden Circle member of NAPO, National Association of Productivity and Organizing Professionals.