My Blog: ADHD Since 1978-

Parenting children who struggle with ADLs

Activities of daily life are things like brushing teeth, bathing, brushing one’s hair, eating, drinking, getting dressed, etc. For an adult, you could group these things under the concept of automatic tasks or under the heading of self-care. Parenting children who struggle with these ADLs is tremendously challenging and thoroughly exhausting. Parenting is a hard job. Most people would argue it’s the hardest job. But, with neurotypical kids who are on a predictable path of development, everything gets easier. I think we all know when we have kids that the first year or two are going to be really hard. Sleepless nights. Diapers. Teething. Weaning. But, at some point, they start eating solid food. Eventually they are toilet trained. They probably sleep through the night. They only have so many teeth to come in. But we expect to have to brush those tiny little teeth when they come in. But I think we also expect our child to take over that task eventually. At first they need to be reminded. Eventually one would hope that it happens automatically. I don’t want to potentially stigmatize anyone by giving a specific developmental age for any specific ADL. It is important to remember that everyone is different. And there is often a pretty wide range of what is “normal.” I find it difficult to describe normal. But I don’t find it too hard to recognize things that are outside of the norm. So what happens when your kid has severe ADHD, or a significant mood disorder, or ASD, or sensory issues? I can tell you, from both personal and professional experience, that neurodivergent kids often struggle with ADLs long after what we would consider developmentally appropriate for a “normal” kid. And that will dramatically affect you as a parent. It’s exhausting when your…

Read MoreParenting children who struggle with ADLs

Not a fan of the DSM-5

Dr. Russell Barkley wrote a fabulous analysis of diagnostic criteria for ADHD in the latest digital issue of attitude. I posted a comment agreeing with Dr. Barkley and hopefully adding more to the conversation. Check out the link below to see the original article. And I will copy and paste my response below as well. ADHDCoachBostonOctober 20, 2023 at 2:42 pm I could not agree more with Dr. Barkley. I believe there are several underlying issues that make this whole conversation more complicated. First, I think that psychiatry suffers from certain delusions. It is not black and white. Yet the DSM has always sought to be the definitive answer to everything, without exception. I am a huge believer in science. I love duplicatable, peer reviewed research. Without science, people would still be making claims about red food dye or too much sugar causing ADHD, like they did when I was a child. But, I agree about the importance of looking at impairment. Because when you use science to exclude from a diagnosis, you can do just as much harm to the undiagnosed as you were doing good for those who neatly fit into the diagnostic criteria. I also agree that we need to re-conceptualize our concepts of ADHD and even of attention. I think it’s important to emphasize frustration tolerance, or lack there of as a symptom. I believe it is essential to understand how tedium and boredom are our neurobiological kryptonite. We need to get away from talking about lazy, unmotivated, and undisciplined. I would argue, what looks like all of those things is actually the core symptom of inattention. But I agree that getting at the heart of that symptom set is essential in accurate diagnosis. And to bring up a few related issues that are not…

Read MoreNot a fan of the DSM-5

Why a diagnosis isn’t a “label”

I got super far ahead and writing blog posts. I think I’ve got several queued up to post the next couple weeks. But I just have to write about something when it comes up in my practice or my personal life and I get excited to talk about it. Today I want to talk about the idea of a diagnosis being a label, in other words, a bad thing. I have heard so many people, mostly parents refer to an add diagnosis as a label. They are deathly afraid of their child being labeled, categorized, maybe even stigmatized. I’ve had clients who were diagnosed as kids and their parents never told them. And they end up in my office trying to manage their ADHD wishing they’d had a chance to start that process 20 years earlier. I think it’s really important to talk about this A lot of this comes for the underlying societal bias against ADHD. Can you imagine a parent refusing to take their child to get an eye test because they were worried about them being found to be nearsighted and then stigmatized because they have to wear glasses? Can you imagine a parent not wanting to get their kid diagnosed with cancer as soon as possible so they can start treatment and live? Would you resist saying you were diabetic, if you were diabetic? I realized there is a certain amount of denial present in human nature. But the level to which I’ve seen parents deny ADHD and sometimes other psychiatric issues, blows my mind. I just can’t think of an instance where it’s not better to know what you’re dealing with and be able to fix it, treat it, face it head on. I think it’s time we fought even harder against the stigma of…

Read MoreWhy a diagnosis isn’t a “label”

Surprise! Clocks help us keep time.

I’ve written some pretty long posts in the last few weeks. So I’m gonna hit you here with a really quick tip. Have a clock in every room of your house. I know there are some people are gonna say, “Duh.” But I am consistently surprised by how many of my clients lose track of time in rooms that don’t have clocks. Of course, we need to actually look at the clock, which requires a little mindfulness and presence in the moment. But that’s another conversation. Start with the clock in every room, including the bathroom, and let me know how it goes. Standard disclaimer. As a person with ADHD, I made the decision when I started my blog, that I didn’t want it to be that thing that I avoided out of perfectionism. I made the decision to get my ideas out there with very little filtering and rarely any editing. Adhering to this philosophy means that I may never have put out a perfect blog post. But it also means that I put a really good blog post out most weeks for the last decade. So please continue to bear with me by overlooking awkward phrasing, typos, grammatical quirks, etc. In the meantime, I hope you enjoy the heck out of the contact. P.S. I’m not even gonna read this before I start slapping it on the end of my blog posts. Ha!

Read MoreSurprise! Clocks help us keep time.

Standard disclaimer, version four.

In case you noticed that I updated my standard disclaimer and got back in the habit of adding it to every post. Or even if he didn’t… I thought i’ll explain a little bit more about what it means to me and how effective it has been. Marketing oneself as an ADHD coach is not easy. I actually do almost no marketing. I rely on some networking. I benefit from occasional referrals from colleagues in other niches in the ADHD world. I am particularly grateful for those referrals. I very rarely get direct client referrals, especially with adults. It happens a little bit more often with late teens and young adults because their parents talk. And lately I’ve been starting to get referrals from psychologists and psychiatrists who work with current or past clients and I’ve seen the benefits of the work that I do. That has taken many years to build. But I’m very proud of it. It’s nice to be respected by your peers. And as a coach, it’s nice to even be considered a peer with medical doctors and PhD’s. So what’s my point? The main thing that I do to be visible is keep my website up-to-date with new contact. I don’t actually change the main part of the site regularly. I generally overhaul it from soup to nuts about every four or five years. But I’m constantly producing new content by posting new blog entries. I am hardly a tech genius. But I am told that by having my website constantly refreshed with new content instead of being static, that has helped me climb higher with search engines. It seems to be true. Because the vast majority of my clients have found me online. I also like the side benefits of knowing that my blog…

Read MoreStandard disclaimer, version four.

A quick case study in ‘easy’ being ‘hard’ for the ADHD brain.

I’m going to give you one specific example, call it a case study of what I talked about last week in terms of easy often being really hard for us. It involves an anonymized former client. He was, in fact, one of my earliest clients when I was first doing professional organizing, before I even started coaching.  Awesome guy. Very nice. And very smart. Had a big job in the banking industry. Travel the country. Did lobbying work. Was paid handsomely. Excelled in his job in every way. Though I will note, I virtually guarantee you that was supported by a personal secretary who did all of the tedious day-to-day stuff. I’m so confident in that guarantee because of what he hired me for. It may best be described as a modern day archaeological dig. He hired me to go through his mail. As brilliant and talented as this man was, the tedium of opening his mail and dealing with its contents was completely overwhelming to him. That simple task, which most people look at as so easy they don’t even really have to think about it, was Kryptonite to him. The reason it felt archaeological, or maybe I should say anthropological, was that it was like going back through time because I needed to go through the seven years of unopened mail dating back to his divorce. This is the man who would be having dinner with us senator in Washington on Thursday only to come home to his beautiful house on Friday and find out that his cable had been turned off because he hadn’t paid the bill in two months. Not surprisingly if you did not know about ADHD and how it worked, you would have a hard time making sense of that guy. Of course, if…

Read MoreA quick case study in ‘easy’ being ‘hard’ for the ADHD brain.

Why is “easy” so “hard” for ADHD people?

I think I touched on this a little bit a few weeks ago. But I partially can’t remember and I’m sure it can use repetition and more flushing out anyway. And it’s a direct continuation from last week. We have established that boredom is our kryptonite. Let’s expand that definition to include boredom, tedium, repetition, lack of variety, or really anything that falls under the heading of what we call a non-preferred task. This often manifests in even the brightest and most capable ADHD people as a the mind-bending paradox of “easy” being really “hard.” But let’s back up for a second. What do I mean by hard? I know, not a word you really need to think of a definition for. What if we changed it so difficult? How about challenging? How about attentionally challenging? Are you following me? Language is important. I have always said there’s a word missing in English between want and be able to. When we don’t do something that we know is important, most people framed that as, “I didn’t want to.” Of course they wanted to do it. Why the hell else would we be talking about it and Coaching?  OK. I recognize that’s a slight oversimplification. And I think I’ll do a post about the difference between wanting the result of something and wanting to engage in the process of doing it sometime soon, if I haven’t recently already. But my point is we always default to the word want, which really is like saying we have a character flaw and is undermining in the long term, because we don’t know how to conceptualize not being able to do a thing that we are aware we are capable of doing. Don’t think about that sentence for too long. It’ll make your head…

Read MoreWhy is “easy” so “hard” for ADHD people?

The Goldilocks zone for ADHD.

Scientists refer to planets where water is liquid and life could potentially be sustained as being in the Goldilocks zone. As people with ADHD, we have our own Goldilocks zone. As I am pretty sure I mentioned in last weeks post, boredom is our kryptonite. It’s difficult to even explain to neurotypical people how we experience boredom. On a neurochemical level our brain shuts off. Behaviorally that may make it look like we’re not trying, we gave up, we refused to persevere, we’re not interested in achieving our potential, we’re lazy, or generally have some sort of inherent character flaw. Our brains clearly do not respond to a cold lumpy bullet porridge. On the other hand, how many of us are prone to being overwhelmed, overstimulated, and get freaked out in someway when everything just seems like too much. Much like boredom, this is part of the human condition. I know ADHD people experience boredom on a whole other level. Honestly I’m not sure if our tendency to get overwhelmed and the severity of it is worse than it is with your average human. The reason it’s hard to tell is that getting overwhelmed is the perfect intersection of ADHD and anxiety. So it’s hard to isolate the overwhelm factor as it relates to ADHD as a standalone. Not to mention there are sensory processing issues and executive dysfunction to throw into this delicious stew. Regardless of whether it’s just ADD or a delightful gumbo of convergent neurodiversities, it’s clear that the ADHD is a major contributing factor. But, again this aspect of how we respond to the world can be tremendously counterintuitive to the untrained eye. Because our brains are particularly wired to activate when we are interested, passionate, or particularly in our element and area of expertise, we…

Read MoreThe Goldilocks zone for ADHD.

A new definition of ADHD?

I don’t I think we have an understanding of what ADHD is as a culture. It is the rare disorder that is named by its symptoms. I believe this falsely leads people to believe that its name encompasses all of its symptoms. This couldn’t be further from the truth. Or, perhaps, we just need to have a broader sense of what attention is. I find that most people think of attention as sitting still and paying attention to a lecture in school or getting through a meeting at work. But it is so much more complex than that. If you take into account the neurobiological underpinnings of ADHD, we could redefine it as a disorder of under stimulation. We are constantly at war with our intentions. We often lack the ability to execute on those intentions because of our lack of ability to focus on what we call non-preferred tasks. In other words, being bored is our kryptonite. it is hard to even explain to neurotypical people what boredom is like for the ADHD brain. Frankly, it is not unlike trying to explain what it is like to be chronically inattentive. Both of these facets of ADHD are also parts of the human condition. But there is a clinical and practical difference between how we as ADHD people experience them and what they’re like for the general population. Literally, when we are not stimulated, our brains shut off in certain meaningful ways. it can be a Herculean effort to simply do the normal everyday things that we find boring but neurotypical people take for granted. And that can significantly deplete our resources for the rest of life. so, as ADHD people, and for ADHD clinicians, I would suggest that a good metric for the severity of a person’s ADHD as…

Read MoreA new definition of ADHD?

Owning my ADHD anger.

This is going to be a weird post, so buckle up. On the upside, I’m not sure anybody reads this after I switch platforms. So perhaps I’m just yelling into the void. I had a very interesting session with a younger client today. She’s a rising senior at a very prestigious university. One that I did not get into, I might add. She’s at somewhat of a crossroads in terms of trying to figure out what she wants to do with her life. In order to protect your privacy I won’t go into details. But I’ll say that she was planning to go into a certain profession. And I’m recently sure she’d be good at that profession. But I’m not sure she could survive all of the school necessary to get to the end result of being in that profession. the reason I bring this up is that it touched on a nerve for me. I don’t want to sound self-important or egotistical. But I have several rounds of neuropsych testing to prove how smart I am. And I’m considerably smarter than the average bear. But what does smart mean, if school is really hard? What does it mean if sitting still is not what you’re good at? What does it mean to understand things at a high level if you can’t produce the amount of work that’s expected of intellectually advanced students? What good is it to get a political science degree if you don’t want to sit behind a desk? Coincidentally, that last question is part of why I freaked out when I was at UMass many moons ago. And that’s also why I ended up pursuing culinary arts. Not that there’s anything wrong with pursuing that. And one could argue it was right for me at the…

Read MoreOwning my ADHD anger.

Reminder fatigue

We live in an amazing technological time. The tools that are at our disposal to help manage our lives and our ADHD are unprecedented. But, they don’t always work. Usually there’s a behavioral reason behind it. Or we may be using the wrong technology for the wrong purpose. Today I want to talk about reminders on your phone. Our cell phones are amazing tools to manage our ADHD and our lives in general. Possibly the best feature of having these amazing pocket size computers with us all the time is the ability to set reminders. And when I mean reminders, I’m talking about calendar reminders. Alarms are also useful. But I’ll probably talk about those in another post. When I think about reminders, I’m thinking about something very specific. I’m thinking about a specific event on your calendar, a thing that you’re going to do at a specific time, and the reminder for you to do that thing. When I talk to newer clients and suggest they set reminders for certain things they often tell me that they have lots of reminders but they just ignore them. Of course, some of this is behavioral. And that’s something we work on. But almost always there is a problem with how my clients are interacting with the technology that doesn’t set them up for success A reminder should be specific to the event/activity and should be customized to just the right amount of time before the event. This is the most important feature of reminders. Here’s are some examples from my life. My default reminder setting for work events is only 3 minutes. This makes most of my clients’ heads explode. But here’s why I have such a short reminder. For all my clients sessions, I’m at home working from my office.…

Read MoreReminder fatigue

Paralysis by analysis

You might find me to be one of the most thorough planners on the planet. Despite being a pretty emotional guy, I also very analytical. I rarely, if ever, make a move without planning, scheduling, and considering the consequences. But the reality of living on this planet is that we can’t always know everything we need to know to make “the best” decision. Furthermore, we can, especially in this day and age of having the entirety of human knowledge… and then some… at the tips of our digital fingers, very easily over research a decision. I know I’ve written about decision making in the past. Here’s a quick refresher of my feelings on the topic. Making any decision, large or small, is the perfect storm of Attention, Anxiety, Impulsivity, & Executive Functioning, particularly Working Memory. In short, everything that we suck at! Particularly of interest for today’s topic the the intersection of Anxiety and ADHD. The more afraid we are to make the “wrong” decision, the more we are likely to go down and endless rabbit hole of research or perseverate indefinitely without doing anything. I think it is really important to know that, for any decision, there may not be a right answer. Or there may be several. Regardless, we will come to a point where continued (productive) thought and research will either not yield anything helpful, will confuse the issue more, or will throughly demonstrate the concept of the law of diminishing returns. In short, we have to have the confidence to gather the information that we can, what is reasonable at least and then “pull the trigger.” We have to trust ourselves to make the best choice, given the options, given the information available. And we have to accept that it isn’t always going to work out…

Read MoreParalysis by analysis