TIFT #116: Talking to Adult ADHD

This post is built on what I often say to adult clients with ADHD. 

ADHD has advantages as well as challenges

We start by countering the negatives about ADHD. This form of neurodiversity comes with definite advantages along with the challenges. The main positives are creativity, hyperfocus, meaning the ability to focus intently on one thing, and the ability to handle situations of high stress effectively. ADHD people get deeply into subjects, but after a while those become routine, and their interests may seek another focus. Wide ranging interests are good for interdisciplinary thinking. It has been said that this these characteristics may be advantageous for evolution by giving some people a different set of skills. On the challenge side, especially when things are going smoothly and the level of intensity is low, ADHD people may become disorganized, bored, and feel like they have to change something NOW!

The emotional cost of ADHD

Some of the problems ADHD people have are not from the neurodiversity itself, but due to the psychological toll of trying to fit into a world made for the 95% who don’t have ADHD. It starts with being told in school, “Why don’t you try harder” when you are already doing that but can't help making the same “careless” mistakes. The same critical messages continue through life, coming from people who simply have no understanding of how trying harder doesn’t work.

Compensation can be learned but it is hard

It is not entirely true that trying harder does not work. When ADHD people are highly motivated, they can gradually learn to make themselves function more like others. They can do boring jobs consistently and fairly well, but they have to be highly motivated to force themselves to learn. Think of the boring details that go with any passionate activity, like cleaning out the stall of the horse you love. The motivational factor is the reason why others’ suggestions usually don’t work.

Respect and make use of your need for a high level of stimulation

One of the most important things to say is that ADHD people should shape their lives around their neurodiversity, rather than the other way around. Respecting one’s own inborn characteristics can lead to success, growth, and happiness, while trying to be someone you are not leads to misery, depression, and failure. 

There are many possible career trajectories through life. ADHD lawyers may have to struggle through years of reading boring contracts before becoming stars at inventing solutions that no one else thought of. Entrepreneurs may take advantage of their focus and passion, but have to force themselves to be organized until they can hire someone to do the boring part. Careers that are good for ADHD people often involve moving about, changing from one focus to another, dealing with high stress as in emergency services, and engaging in creative pursuits. High intensity is pleasurable and may lead to the long practice that gives extra skill in sports or unusual ability in interaction with people.

Creativity

My favorite explanation for ADHD creativity is that when "normals" encounter a problem, they solve it like they did last time, while ADHD people can't remember what they did before, so they invent an entirely new approach. There is another explanation. Their Default Mode Netowrk (DMN), the part of the brain that is operating when you are not focused, keeps on working even when a task demands attention. The DMN is where creative ideas arise from putting things together in ways that haven't been thought of before.

Whatever the reason, creativity is a gift that ADHD people often have, whether it is a new solution for an engineering problem, a novel choreography, or a fresh business idea.

Hyperfocus and task switching

Hyperfocus is a name for the ability to dive unusually deep into a subject or experience. Doing so is often a source of great pleasure and potential success.

The other side of the same coin is that having to pull oneself out of this kind of immersion can be painful and often triggers anger at a person who is asking for attention. Task switching, in general, can be annoying and difficult. Partners may learn to give the ADHD person a 5 minute warning, but will still have to be firm when the one with ADHD continues to enjoy their total concentration.

Procrastination

ADHD people wait till the last minute to start jobs they don't want to do or to dig into large projects like writing a term paper. Don’t tell them to start earlier because if they do, the result will be of lower quality. They need the intensity of a looming deadline. Adrenaline is the body's natural stimulant. Another explanation of procrastination is dread of getting started on a complex task that requires organization.

Here are a number of ways to overcome procrastination. One is “managed procrastination.” This means waiting until the pressure begins to build, then getting started, but not so late that there isn’t room to get bogged down and start over. Another is doing the work in chunks, for example, starting a term paper by gathering the materials, waiting, then jotting down some ideas, waiting, writing an outline, and finally starting to write. Another is starting with the easiest or most pleasurable part. “First the dessert.” The Pomodoro technique involves doing work in chunks of time. One can also use the time limit as a deadline to raise the intensity. Making a commitment with consequences can be another way to raise the intensity. And finally, sharing your list of things you don’t want to do with a trusted other is a good way to enlist understanding and support.

Organizing your life

Make it simple. Use piles, not files! Organizational methods are only OK if they are very simple and beloved. The ones that work for others will probably not meet those criteria. ADHD people tend to be impatient, so they don’t realize that “normals” actually spend a good deal of time and effort on the boring tasks of staying organized. It may be news that you actually have to be consistent and write things down or put them in your phone, making sure to do it in the same place every time. That can seem very boring, but may be necessary, and there will still be a percentage of errors. Changing organizational systems can rekindle a passion for consistency, but can also represent a wasteful rabbit hole. A schedule with regular deadlines or commitments can provide a framework around which days and weeks are organized. Oh, and you must have one and only one place to put your keys!

Dealing with impulsiveness

Embarrassing oneself is quite painful, and may be the best deterrent to impulsiveness. It takes self-honesty and constant vigilance to limit this characteristic. One thing that has been observed with people who have addictions is that for them, the future seems pale and indistinct. This is true of ADHD people as well. There is a tendency to need to experience mistakes, rather than simply imagining them in order to feel the pain of their consequences. Addicted people learn to talk themselves through the events that will follow an impulsive choice or ill advised decision.

Medication

The upside of medication is that it can change the course of life for young people in school. That’s partly because school is a fiendish invention of those who don’t have ADHD. As a result, medication can be life changing, especially at a young age.

For adults, stimulants work best for boring jobs that require concentration and accuracy. I don’t withhold meds for people studying for the Bar exam. It also helps with being at loose ends, not knowing what to do next. On the other hand, in the US, the pharmaceutical industry has promoted the idea that medication reverses human problems. It doesn’t, but tends to make people feel that the drug is all they need. Then they may not think of or work at the above ways to compensate. 

And stimulant meds have additional downsides. They are occasionally addicting and can be severely so. They can promote concentration on video games just as easily as paying bills. They can make one concentrate to the point of neglecting the partner’s need for attention. They can cause a “crash” of pronounced fatigue when the level drops. And they may not be necessary if one is able to practice good “mental hygiene,” meaning shaping life to fit with the need for some intensity and not too much boring stuff.

Effects on others and relationships

AHDD has profound effects on relationships. Especially if the partner doesn’t understand, it can cause feelings that the one with ADHD doesn’t care. "If you really cared you would…” And those expectations may include paying attention to the partner instead of being immersed in something, not making mistakes, and willingness to do boring tasks. A loving partner, once they understand that failure in these areas is really not under the other one’s control, may be able to see that the pain they experience is not due to the ADHD person’s lack of caring.

The ADHD person must also understand that their neurodiversity truly does place a burden on the other. Being the one who inherits all the boring tasks may not be pleasant, nor is helping to clean up the messes that result from errors or impulsive decisions.

Once understanding is achieved, there will still have to be a balancing of responsibilities. The ADHD person may contribute in areas like humor, excitement, variety, and fun. They may also be good at taking on tasks that involve creativity or personal passions. But those are the fun things to do, which may lead to feelings of unfairness for the partner. There is much room for smoldering resentments, but when it all gets worked out in the open a positive balance can be found.

Jeffery Smith MD

Photo Credit: Khara Woods, Unsplash