My Blog: ADHD Since 1978-

Procrastination is not a real thing

When new clients come to me, almost all of them list procrastination as an issue that they would like to work on. I don’t believe in procrastination I think it is a word that we use to describe a behavior that we don’t understand. It’s a throwaway term that damages us by labeling us as somehow inferior and maladaptive. Nobody gets up in the morning and says to themselves, “I have a really important thing to do today and if I don’t do it I’m going to be totally screwed. But you know what, I’m not going to do it anyway.” Quite the opposite. As human beings, particularly those of us with ADHD, we two opposing forces working on us at all times. We have motivating forces and we have demotivating forces. For example, I may want to be skinny but I may also want to stop at McDonald’s everyday for lunch. I may want to be able to play the guitar but I may not be interested in practicing enough to get good at it. Of course, these are pretty simplistic examples. Now you have to layer on the fundamental attentional dysfunction that comes with adhd. What neurotypical people don’t understand about ADHD is that it is almost physically painful to do tedious, repetitive, unengaging tasks. So as much as we may want the end result, if we don’t have the attention available to initiate and follow through on a behavior the force pushing against us doing it is often greater than the force incentivizing us to do it. Fundamentally, this also means recognizing that for those of us with ADHD easy isn’t always easy. Sometimes easy is really hard. All the things that normal people take for granted as being easy, if they’re boring or tedious, challenge us…

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ADHD and decision making

How do account for decision making in your productivity? Do you account for it? Perhaps you should. Here’s the case for why. In my experience, when my clients are struggling with something on their to-do list and avoiding it, one of the biggest contributors is that there is a decision that needs to be made. How can you do a thing, if you haven’t decided how to do it? How can you do a thing if you’re not sure what the steps are? And how can you do a thing if you haven’t really decided if you want to do it? I would argue that you can’t do something under those circumstances. And my experience bears that out to be true. So what’s with ADHD people and decision making? Well, I believe that decision making is the perfect storm of all of the things that we’re not great at. In order to make a decision we have to pay attention deeply, use our executive function, specifically are working memory to weigh the options, we have to manage our impulsivity, and many of us have to manage anxiety that may or may not be an overcompensation trying to deal with the aforementioned impulsivity. All of this conspires to make decision making a thing that many of us struggle with. So what’s the answer? I believe the answer is to simply account for the decision making as a separate task. We need to have time, attention, and mental space to devote to that decision. Most of the time, if we simply see a task on our list that has a decision behind it our brain sort of short circuits. We may be mentally and attentionally available to do the task, but not make the decision. Because the decision may actually be a…

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psychiatry IS medicine

today’s topic is a bit of an opinion piece. In my opinion, psychiatry has always been a grab bag. Often referred to as part of the “soft sciences,” even though it’s a medical discipline. I don’t know if it will ever be the hard science that many medical disciplines are. We’re certainly a very long way off from blood tests, genetic testing, DNA testing or anything like that to diagnose or guide treatment for most psychiatric disorders. Those technologies are really in their infancy and are only of use and very specific cases if at all. and in a discipline that is not so cut and dry, many mistakes have been made over the years. Off the top of my head, the pathologizing of homosexuality. Reliance on dream interpretation and psychotherapy. In fact, until the DSM-5 it was not kosher to diagnose a child with autism and ADHD. Of course, we now know, that if you have either of those conditions, you’re more likely to have the other than the general population. personally, I think psychiatry has suffered from I need to overcompensate the fact that it’s not so cut and dry by trying to create very strict structures, guidelines, do’s and don’ts that are often two black and white and miss the gray of what psychiatry is at its heart. but I think that we are now at a crossroads with psychiatry. What we refer to as psychiatric disorders we are finding more and more are neurobiological brain disorders. That means they’re physiological. Much like space, and the deep ocean, the brain is largely unexplored and under understood. But what we do know, is that there are biological underpinnings for ADHD, for schizophrenia, for bipolar, for depression. whenever I take a new client through my ADD ucation session, I…

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“Treating” ADHD

Here a couple of quick thoughts about treating ADHD. my former doctor who is amazing, and just retired, said something once that has always stuck with me. He said, in medicine we don’t only treat the worst cases. I think that’s a pretty profound statement when applied to psychiatry and pharmacology. It’s a little more obvious when we’re talking about physical ailments. But one of the biggest problems we have in this country is not viewing mental health as real health. You break your arm, you go to the doctor. Both my sons have had a cast once in their life. My youngest just got a cast off because he had two small hairline fractures in his finger. It was painful. But the ER doctor didn’t even put a cast on it originally. But after a week with a splint, the orthopedist decided he needed a cast for 3 weeks. So, clearly not the worst break anyone’s ever seen. But it still needed to be treated. my oldest fell off the playground equipment when he was two and a half. He broke his right arm just above the elbow. As it turns out, it was a partially displaced fracture and he spent the night in the hospital, had surgery the next day where he had pins inserted, and had to wear a cast for 4 weeks and then get the pins removed. A much more serious injury than the one my youngest just had but the treatment was not too different. Obviously, the more severe break needed somewhat more intervention but they were both treated. the problem with psychiatric disorders is that there’s no x-ray. There’s no blood test. There’s no mri. And for the most part, all psychiatric illnesses, except perhaps the most severe, have some element of something…

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Family planning… Not the kind they have on the back wall at CVS

Our society has not caught up with the idea of two parent working families. In this country we don’t have enough time off, we don’t have enough vacation, we work too many hours, and we don’t value the family nearly enough, even though we say we do. And as you know from my previous writings, it’s not just you. It’s really hard to raise kids with issues. It’s also not so easy to manage a family and household if one or both of the adults have ADHD. The single greatest piece of advice I can give you, which I give many of my clients, is to schedule regular family meetings. Life gets busy. We get caught up in the day-to-day. Next thing you know, we haven’t made any plans and things seem to always be an emergency. By the time we get the kids and make dinner and everyone to bed, it’s been a long day. Lather, rinse, repeat. If we are not particularly intentional about making the time to communicate with each other, it can easily not happen. And even if we make the time to communicate with each other once, if we don’t do it regularly, a single planning meeting can only go so far. When our kids were really young and we were getting the hang of parenting, we used to get a pizza every Friday, put the kids in front of the tv, and go into my office to talk about the weekend through next week, through that weekend. We do it more organically now. We send each other texts or emails during the work day with a varying level of urgency. But we do occasionally have enough to talk about that we put time aside specifically for planning and logistics. If you start to institute…

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managing depression in the context of ADHD… Or in general

so you can probably tell it’s been a while since I posted. It is always a challenge for us ADHD folks to be consistent. I think of success as not being about falling off the horse, but about how fast we can get back on the horse. This tendency of ours to fall away from consistency is exacerbated by depression. if you don’t know, 85% of people with ADHD have at least one comorbidity, or co-occurring condition. Depression and anxiety are by far the most common. Those of you who read me regularly know that I’m open about my own issues with depression and anxiety. Those issues are currently more in the forefront than they have been for years due to some stressful family situations. one of the reasons I’m an expert on ADHD is that I manage it pretty darn well. However, it is consistently been my experience since I was 18 that all the ADHD management and all the Ritalin in the world will only do so much good if you’re clinically depressed. I will admit that I have been struggling lately. And that is the big reason that I haven’t been posting consistently. So why do I bring that up. I bring it up in order to share some of my recovery kung fu. I have committed to writing this blog for almost a decade now. It’s the major thing I do for marketing and to keep my site coming up high on search engines. It is important. But, strangely, it’s never really urgent. In the sense that no small children will die if I don’t post for a given week. But not posting for a month isn’t great. Not posting for longer could be the beginning of the end. here are some thoughts that I’ve had…

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Stress does weird things to you

I’m 43 years old. I have been taking stimulants since I was 10, more or less. Most people experience stimulant related insomnia based on the size of their dose and when they take their last dose during the day. I am at the extreme end of the scale. If I were to lick a ritalin at 10:00 a.m. I would not sleep that night. And it just so happens that I take about 160 mg of Ritalin derive stimulants every day because I’m not quite human. As a result, I did not take a nap for any reason other than having the flu between 1988 and 2021. But my account that’s 33 years, more or less. However, in the last year I’ve started taking these weird nap things where I’m sometimes semi-conscious and sometimes don’t realize how long I’ve been out but wake up remarkably refreshed. This is during the Crux of my medicated day. Today’s nap was from 9:30 to 10:30. It doesn’t happen super often. But it’s an entirely new thing. now, I’ve been a grinder my whole life. I got through high school with about 3 hours of sleep a lot of nights and did fall asleep in class, but only spanish, and I wouldn’t call it a nap. And I was a grinder as a chef for 10 years never feeling rested and never feeling together. But I never took a nap no matter how tired I was. It’s actually kind of a s***** thing. I always have to make the decision what time to get up based on the needs of the household. But then I’m up for the day. And if I don’t have enough energy or if I’m cranky cuz I didn’t get enough sleep it is what it is. I guess I’m…

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the two voices in our ADHD heads

I find that there are always two voices in my head. Or maybe I should say there’s one voice that comes from two different places. There’s a voice that says I don’t want to do that thing. And then there’s a voice that says I can’t do that thing cuz I don’t have the attention right now. Learning to tell the difference is the key aspect of managing ADHD. I also think it’s a key aspect of managing anxiety. the first voice it’s not a helpful voice. But it becomes our default because everything is a lot harder for us than a neurotypical person even though “easy stuff.” But as I always say, there is a word missing in English between want and able to. I do a lot of stuff everyday that I don’t want to do. But with a great medication regimen, a lot of self-care, and all the work I’ve done on myself over the years, I get everything that needs to get done done eventually. but I do have moments, days, mornings, period when I just don’t have the attention to do the things that I don’t want to do and that’s very different. There’s a danger in listening to the first voice when we don’t want to do something but if we really tried we would be able to do it. We fall into a helplessness and lack of productivity that can really make things worse. conversely, there is also a danger to not listening to your brain and body when you are in a place where you’re not able to do things because you don’t have the attention available. You could spend an hour staring at your computer or you could take a break and do something restorative so that at the end of…

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“in medicine we don’t only treat the worst cases.”

I think that understanding this concept when dealing with ADHD is important and under recognized. And more than just ADHD, I think all psychiatric disorders can suffer from a reticence to be dealt with unless they’re extremely severe. As far as I’m concerned that is in regards to the spectrum of psychiatric disorders overall as well as within individual disorders. I think most of us would agree that treating a paranoid schizophrenic it’s probably a good idea. I think we’d all agree that treating someone with severe melancholic depression who has talked about, threatened, or attempted suicide is a good idea. but wisdom that my pharmacologist departed to me once was that, “the medicine we don’t only treat the worst cases.” We treat a hairline fracture as much as we treat a compound fracture. We even treat a sprain, which isn’t even a break. Yet when it comes to mental health many people feel like they need to hit some undefined but specific level of suffering or dysfunction in order to seek help. And shamefully, many physicians don’t take patients seriously enough until they get to a catastrophic point where treatment is infinitely harder. this came up in my life when I was getting my oldest diagnosed with ADHD. As an ADHD person myself and an ADHD coach professionally, I knew he had adhd. But he didn’t necessarily present in a typical way. He was doing really well at school because he enjoyed it. But he was really struggling and the rest of life in ways that I won’t get into, but that made it very obvious that he was on his own planet. He wasn’t the traditional hyperactive ADHD boy. So even though I see one of the best ADHD doctors in the world, I still felt like I…

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The scales of motivation

Imagine the statue of the Scales of Justice. Now just imagine her scale. Or if you’ve ever used a really old school baking scale, imagine that. Let’s call that the scale of motivation. Everything we do or don’t do has motivating and demotivating factors. Something as simple as getting up to pee when you’re reading an amazing book or can’t take your eyes off Stranger Things. I don’t know about you, but sometimes I hold it for quite a while if I’m doing something interesting. In fact, this can often make it harder to potty train ADHD kids. They tend to have accidents when they’re doing things that they don’t want to stop doing because they hold it for too long. But let’s get back to the scale analogy. On one side, I have to pee. On the other side, I want to keep watching stranger things. When my sense of having to go to the bathroom begins, it’s not pushing hard enough down on its side of the scale to make me stop doing my “preferred activity.” But, eventually, as the pressure builds, having to pee will be more unpleasant than it is pleasant to continue watching. Add in the factors of how good is the episode, how close I am to the end of it, how far away the bathroom is, how tired I am… And even deciding when to get up and pee is a reasonably complex equation. And that’s about as easy as it gets. Of course, this is a basic human situation. But it is dramatically magnified by how our brains are wired. Our threshold for boredom is lower. And we are constantly fighting the battle to do the “non-preferred activity” that we need to do in the face of other “preferred activities” that we…

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Do ADHDers get a bad rap for having bad memories?

Most people will tell you that those of us with ADHD don’t have a good memories. I thoroughly dispute this. I think there are two issues at work that make it look like we don’t have good memories. The first is our lack of attention. If we’re not deeply attending when something comes into our sensory universe, we don’t lock it in to our memory. So it’s not that our memory is faulty. It’s that we’re not paying attention in the first place. The other issue we have is that we do not have good situational memory. Part of the stems from our lack of time sense. We’re kind of like giant toddlers. Everything is either yesterday, right now, or later. And we don’t experience time as a constant because time moves much faster when we’re engaged and torturously slowly when we’re bored. The result is that we’re just not good at remembering whatever the thing is when we need to remember it. We might remember before and after we need to remember, but just not at the right moment. All the more reason we need to have external structures to manage our time and remember our tasks. Standard disclaimer: I promised myself when I started this blog that I would post regularly, hopefully weekly. In order to achieve this goal, I have to fight against my own perfectionists. That means I edit very little if at all. I’m focusing on content not on detail. So please forgive any mypellings grammatical / punctuation mishaps, and anything Strange like weird capitalizations due to my using voice recognition.

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