Distress Tolerance practice from Dialectical Behavior Therapy (from Marsha Linehan’s DBT Skills Handouts); video used to capture audio (nothing to watch)
This blog for lawyers has quite a bit for those with ADHD, including articles on procrastination.
Brief, fun video on what it is that accurately reflects the latest and greatest understanding.
Getting what you want when you have it
Effective interventions and therapies This gets you to the blog of the American Professional Society of ADHD and Related Disorders, which was partly formed to spread the word about evidence-based practices.
Practices Christine Carter, who’s connected to the Greater Good Science Center at UC Berkeley, offers a free ebook on ways to play the short game to win the long game. Go back and click on Practices to get to her site and the ebook link.
Coaches We still need good research on ADHD coaches, but what research we now have suggests high satisfaction from those who use them. Thing is, they can cost many quite a bit. A coach through Edge, for example, costs $400 for an initial session and then $125/week (if interested, go back and click on Coaches).
More Click on More for two resources that I previously posted. They remain awesome.
Hot news out of Israel (Bar Ilan University) and Los Angeles (UCLA): There’s a way to increase cognitive functioning among children with ADHD that is FREE and leads to BIGGER change than other non-chemical interventions.
What is this magic they speak of? Exercise.
Researchers searched through studies published between 1980 and 2017 on various non-pharmacological interventions for cognitive functions among children with ADHD and narrowed these down to the most trustworthy studies. One of the requirements the researchers had was that the study included an objective measure of cognitive functions.
They examined the effects of several non-pharmacological interventions–neurofeedback, cognitive-behavioral therapy, cognitive training, and physical exercises (aerobic)–and found all the interventions associated with desired changes. Physical exercise, however, rose to the top with the largest average effect size. Granted 18 studies across four interventions is small; however, the results are consistent with tons of research on the association between exercise and optimal physical, emotional and cognitive functioning.
So this is what my title is about…we often step over the dollars of optimal functioning and well-being to pick up pennies. The dollars are regular physical exercise (aerobic), enough sleep, and healthy eating. The pennies are the skills, strategies, games we may play with ourselves (fun or otherwise) that we often seek instead. The pennies matter; I’m just suggesting you pick up the dollars first.
My two cents. Or dollars. : )
With ADHD, you’re likely to give up a bigger reward for a smaller one if the smaller one comes NOW and the bigger one LATER. NOW wins time after time. Why? Partly because our future selves are strangers to most of us, and we feel little for them. What do we owe this stranger? For many of us it turns out, “Nothing.” We see this when it comes to money. Specifically, saving it.
I know this can be a bleak subject, but part of the remedy is facing reality. Let’s start with the state of the union on this. I, for one, was blown away.
In the U. S., post-retirement we live 17-20 years on average, and over 50% of us have less than $25,000 saved for these years. This means, apart from social security, over half of us have less than $123/month to live out our “golden years.” More like copper years, right? See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764505/.
Sure, for some, this is a continuation of pre-retirement poverty (it’s hard to save living hand to mouth), but for many this goes back to the present winning over the future. At a great cost.
With ADHD, the cost is likely to be higher. Recent research examining the financial status of adults with and without ADHD (https://www.ncbi.nlm.nih.gov/pubmed/31343233) went beyond confirming prior research noting bad financial news, on average, for those with ADHD. The researchers looked at some of the reasons why this is the case. That is, why less income, less savings, and more debt?
Here’s what they found. Compared to adults without ADHD, adults with it reported more often buying on impulse and more often using “an avoidant or spontaneous decision-making style” (e.g., I will avoid looking at my bank account before buying). On top of this, adults with ADHD scored lower when given measures of financial competence and capacity (e.g., being able to evaluate financial problems and understand bank statements).
But there is good news is. If you struggle with money, things can be better.
Here are some antidotes to an impoverished future (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764505/):
1) Episodic Future Thinking, or EFT (https://tonyalippert.blog/2019/03/19/what-gets-us-to-change/),
2) Focus on the “cool” versus the “hot” aspects of what you want NOW (e.g., on the color and shape of a cinnamon roll versus the anticipated taste),
3) Sinking your ships by giving yourself no way out (or in) by, for example, leaving money at home when you are out and about apart from what’s needed–no credit cards, Apple Pay, etc.–on hand)–see https://www.youtube.com/watch?v=PPQhj6ktYSo starting where Dan Ariely talks about self-control contracts for more–, and
4) Connect to your future self (https://ggia.berkeley.edu/practice/best_possible_self).
For more examples on the above antidotes, go to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764505/.
Here’s a toast to your future self! And to your present one who cares.
A short supply of self-restraint and other characteristics of ADHD can hurt relationships. Social skills training is one of the interventions used to prevent relationship damage and increase relationship repair. But does it work?
The results of a fresh-off-the-presses study on social skills training support Russell Barkley’s argument (Understanding ADHD) that skills presented and practiced away from real-life situations at the moment of trouble (e.g., as one is about to curse someone out) may be of little value.
Social skills training had “limited efficacy” according to Canadian researchers reviewing social skills training for kids and teens with ADHD (study here). Nonetheless, they identified “two promising” ways to increase its usefulness. First, offer “increased reinforcement and reminders of appropriate social behavior at the point of performance to youth with ADHD (e.g., in vivo, in real life peer situations as opposed to in the clinic).” Second, encourage “peers to be more socially accepting and inclusive of youth with ADHD.”
In other words, go to the youths’ environments to work on what’s happening there (looking at both their actions and the actions of others toward them).
Maybe some day, we’ll send kids to mental health clinics less often and start going to them, where the action is. And where science suggests we need to be.
When you have ADHD, here’s your recipe for disaster: Mix sleep deprivation with carnival food. Deep fry.
Hold the physical exercise and Omega-3s.
No one says, “I want to be my worse self.” Yet many of us are doing exactly what we need to get us there or keep us there.
When you have ADHD, sleep deprivation makes your symptoms worse, carnival-like food makes your symptoms (particularly forgetfulness) worse and lack of physical exercise and Omega-3s keeps them from getting better.
If you want to give yourself the best chance at optimal brain functioning, here’s the winning combination: sleep enough, eat healthy food (including Omega-3s), and exercise regularly. This is true for all us but is essential when you have ADHD.
Consider that chronic sleep deprivation looks like ADHD. Imagine what happens when you combine them. Check out recent research on ADHD and circadian rhythms here.
Omega-3s matter so much, there’s even an Omega-3 prescription for ADHD called Vayarin. See specifics on the Omega-3 and ADHD connection here: Something Fishy.
For a recent review and meta-analysis on use of Omega-3s for ADHD, go here.
As for exercise, namely cardio exercise, check out this recent review.
Try the winning combination for even just one week and see what you notice. I bet your brain will thank you.
Per Russell Barkley (RB), ADHD guru (i.e., scholar and scientist):
ADHD is a disorder of self-regulation that can also be described as a “disorder of age-inappropriate behavior” that looks like inattention and lack of inhibition.
Though I want to clarify that the inattention depends on what you are doing; another guru of ADHD, Thomas Brown, says the “central mystery” of ADHD is that those with it can pay attention to some things and seem incapable of paying attention to other things.
But back to RB and ADHD as a disorder of self-regulation.
RB defines self-regulation as “self-directed action intended to alter subsequent behavior so as to change the probability of a future event or consequence” (to improve your longer-term welfare).
For example, say you have a problem with money and keep getting into debt by living off credit. You want to pay off your debt (self-directed action) to be able to cancel your credit card and limit spending (subsequent behavior) to reduce the chance you’ll get into debt again (change the probability of a future event).
Where does ADHD fit? With ADHD one has the intention to alter behavior (e.g, limit spending) to change the future (e.g., live debt-free) but struggles with the self-directed action (e.g., paying off debt) required for this.
Barkley says it’s a disorder where knowledge fails to guide performance. You know what to do but struggle to do it.
RB highlights that ADHD brains show prefrontal cortical network differences (these networks are responsible for Executive Functioning and self-regulation is the core of Executive Functioning). Here is where the differences exist and what comes into play:
- Frontal-striatal circuit, the “what” network (what we think influences what we do) Here lives…
- Freedom from distraction
- Working memory
- Organization and planning
- Frontal-cerebellar circuit, the “when” network (timing of thought, behavior)
- With ADHD, there’s “time blindness,” and
- A “myopia to the future”
- Frontal-limbic circuit, the “why” network. Here lives…
- The decision-maker of the brain (if you have multiple goals, which do you pursue? this circuit, as RB puts it, “makes the final call”)
- Emotional control or dyscontrol
These network differences show up as self-regulation differences that encompass
Self-directed action, Self-awareness, Self-motivation, Self-directed attention, Self-restraint, Self-directed sensing, Self-directed emotions, and Self-directed play.
WHAT TO DO?
Outsource these brain functions.
RB calls this externalizing the brain functions where there are deficits. For example, he says, use “artificial prosthetic cues to substitute for working memory deficits.”
Ideally, this is what ADHD coaches will help you do (for more on this, see Does ADHD Coaching Work?)
Here are some pointers for externalization:
- Per RB, the externalization of brain functions is needed at the point of performance and within your natural setting (e.g., if you struggle to write a report at work, you need external factors to guide your attention at work at the time you need to write); and
- To externalize, change your environment (think planners, alarms, points, signs).
Replenish your self-regulation (think self-control) resource pool. It’s depleted by simple use as well as stress, drug abuse, illness. Replenish through
- Rewards, positive emotions
- Positive self-talk
- 10 minute breaks between tasks requiring self-control
- 3 minutes of relaxation or meditation
- Glucose ingestion (Gatorade, lemonade, sugar water) while working on tasks requiring self-control
- Daily physical exercise
Also, break lengthy or complicated tasks down. One of my favorite reminders of this, though I really like elephants, is, “How do you eat an elephant?”
Answer: one bite at a time.
RB adds that accommodations or scaffolding and the compassion and willingness of others to make accommodations are “vital” to your self-regulation effectiveness.
Sources: Two talks by Russell Barkley on ADHD, one from 2013 entitled, “The Importance of Emotion in Understanding and Managing ADHD (here) and one from 2012 entitled, “ADHD, Self-Regulation, and Executive Functioning: Theory and Implications for Management” (the part of it I used is here).
There are three things to know about coaching.
First, if you read Russell Barkley, scholar and researcher on ADHD, the idea of coaching makes sense. Barkley argues that what you need with ADHD is something external to guide your behavior right at the moment that the behavior’s needed.
Imagine you need to study for a job interview you have the next day and you are about to surf online. Right at that moment, with your fingers poised to tap the keyboard, you need something external to stop you (or to guide you toward stopping). This something will then need to remind you of your interview and reinforce studying over surfing. This is ideally what a coach does…guides your behavior at the moment it most matters, which is when you play the game…of job-seeking or whatever it is.
A coach guides your action as it is happening.
Second thing to know is that the reality of ADHD coaching appears to approximate this at best.
You can get a coach working with you multiple times a week and the work can center around where you most struggle. But, at best, it’s like having a coach available by phone some of the times you play the game. It’s just unrealistic to have the ideal kind of coaching…unless you’re wealthy and want to pay someone to be with you, guiding your behavior at various points of the day, as needed. Perhaps one day, we’ll have robots do this for us, should we choose…hmm.
The third thing to know is that the research on what makes for an effective ADHD coach is sorely lacking. Only a few exploratory kind of studies, primarily focused on college students, seem to look at this, with the recommendation for future larger scale, more rigorous research. So while you can find folks credentialed to be an ADHD coach, there’s no real research showing coaching clearly works and under what circumstances.
This leaves us all figuring out for ourselves, if we pursue coaching, whether it’s working. Actually, even if research clearly said it’s likely to be effective for most, we’d still have to figure out whether it was effective for us.