Friday, August 9, 2013

Words of Encouragement

by Terry M. Dickson, MD, ACG, CPCC


One of the best things I learned from coach training is that you can’t make someone else act or think in a certain way. You can only model good behavior and be a good example. Ultimately, each person has to take ownership for his or her life. So whether you are addressing your spouse or your child with ADHD, don’t attempt to mold them like clay. It doesn’t work! Besides, you can’t wave the magic brain-changing wand and make ADHD symptoms go away. But there is one thing you can do: You can encourage people and build them up.

Words can build up or they can tear down. Words that tear down can be internalized and may falsely define who another person is. Words that build up may inspire another person to greatness. Discouraging words also can alienate and result in communication breakdown and lack of trust.
Encouragement goes straight to the heart, however.

Knowing what a big difference encouragement has made in your own life, how can you be an encouragement to those in your family? Here are some tips:
  1. Be aware of what encourages you and do the same for others.
  2. Write your spouse or child a note with words of encouragement.
  3. Always be specific when you offer praise: “You did a great job at _____.”   “I really appreciate that you _____.”
  4. When you see positive changes in the other person’s life, affirm that person: “You really seem to have a great attitude about _____.”
  5. If encouraging thoughts come to mind, share them with your family.
  6. We all make mistakes, so look beyond fault. It may just be an opportunity for you to teach that there is much learning to be gained through failure.
  7. Remember that most people may not reach their potential without someone believing in them and taking the time to tell them so.

Terry



Terry M. Dickson, MD, ACG, CPCC, is the founder and director of The Behavioral Medicine Clinic of NW Michigan that has served and supported children, adolescents, and adults with ADHD for over eleven years. He has been a principal study investigator for several clinical ADHD medication trials. A Certified Professional Co-Active Coach, he is a graduate of the ADD Coach Academy and the Coaches Training Institute. Diagnosed with ADHD as an adult, Dr. Dickson speaks regularly on ADHD and has been interviewed locally and nationally on radio, television, and CHADD’s Ask the Expert online. Dr. Dickson and his wife of 32 years have two teenage children, both of whom have ADHD.

Tuesday, October 4, 2011

Get Your House in Order

STRATEGIES FOR THE HOME ENVIRONMENT

People with ADHD often live in chaotic environments. They misplace things, they jump from project to project randomly, and they leave things incomplete or undone. Lacking skills to prioritize, seeing everything as “equal,” and not keeping things in short-term memory all contribute to making the tedious tasks of daily living—staying on top of finances, grocery shopping, laundry, or clutter—stifling. With the proper approach, these tasks can be managed, and then mastered!

FINANCES

Understand the cost benefit of delegating.

If you’re like most people with ADHD, you avoid details such as keeping up on bank accounts and paying bills on a regular basis. The thought of sitting down, sifting through mail, and writing checks is enough to make you run from the task, not toward it. Nonetheless, bills need to be paid or you’ll continue to get late notices, accrue bad credit, or run the risk of getting your electricity turned off, not to mention upsetting others who depend on you! If this describes you, learn to delegate. Pay someone to keep track of your finances. Arrange for bills to be automatically paid via your bank. Do what you can to get the job done. In the end, it will cost you less than you’re spending in late fees!

Separate the task from the set-up.

To make paying bills easier and less painful, do the set-up first before paying the bills, which is the real task. Equip a “bill-paying station” with your checkbook, stamps, envelopes, and a basket in which to collect the bills when they arrive in the mail. On a designated day, open the bills and stamp the return envelopes. On the next day, put your return address on the envelopes. On the next day, write and sign the checks. Then all you have to do is stuff the envelopes and send them! By separating setting up and execution, and by approaching the task step by step, you won’t find it so overwhelming, and the job will get done.

Create accountability.

I have several clients who meet with their accountant every three months simply to make sure they keep up with their finances. If this is something your accountant is willing to do, go for it! Your accountant can help you create systems for budgeting and tracking your income. Chances are, if left up to your own devices, you’ll get in trouble. Ask for help from an expert! You don’t have to do it alone.

Ritualize attending to your finances.

If you don’t create space in your life for paying bills and reviewing finances, it will never come to fruition and will remain only a wish. Set a regular weekly time and place to pay bills and review your accounts. Mark it as an appointment with yourself and don’t skip it, no matter what. Do it at the same time on the same day each week so it becomes a habit. Remember to choose a day when you are least likely to be distracted by a more entertaining activity.

Stay in the know to say NO.

Stay on top of how much money you have in your accounts and how much you owe. For example, when you get your bank statement, highlight the amounts and post it on the back of your door so you see it every day. Lack of information about what funds are actually available to you at any given time is a recipe for spending beyond your means and ultimately for financial disaster.

Create visual reminders.

Keep track of when bills are due. Post dates on your calendar. Or here is a favorite of one of my clients: “I open all the mail when it comes in, and immediately sort out the bills, highlight the due dates, and tape them on the wall by the light switch. This way, I can quickly glance at the wall and know how many bills I have to pay, and when they are due. Because they're right next to the light switch, I'm forced to look at them at least once a day!”

Budgeting: Create a tracking system.

Keep track of receipts by labeling and carrying envelopes labeled Business, Groceries, and so forth. Put all receipts in the appropriate envelope when you pay for it, and if you forget to get the receipt, write the cost of the item on the outside of the envelope. At the end of each month, file them away for your records in a small, accordion-style 3x12 expanding file. This strategy is great for tracking receipts for expense reports, too.

LAUNDRY

Take action.

People with ADHD are highly affected by their immediate environment. It’s very important, therefore, to keep your living area organized and picked up. If you know you’re challenged in keeping up with laundry, take measures to get it done! Either delegate it by hiring someone to do it, or send it out to be done. Set a specific day of the week to do that, and write it on your calendar. Otherwise, the vicious cycle of having it pile up while you avoid it will continue. A messy environment also puts a strain on relationships and on those around you, so that’s another reason to take action!

Set personal standards and stick to them.

What is acceptable? What is not? Set standards and stick to them. Enlist a “no excuses” attitude in sticking to a schedule that you have clearly marked on your calendar. At the beginning of each month, for example, write LAUNDRY in each Wednesday box, and include the time you plan to do it, 7 PM. Don’t allow yourself to negotiate with your ADHD by saying, “Oh, I can skip this laundry week,” especially if you know that skipping a week will only lead down a path of shame and blame four weeks later as dirty clothes block your door!

Make it routine.

You must create the time and space for laundry. Otherwise, doing it will remain only a wish! Set a time and day to do it on a regular basis. Think this out and make it realistic. Don’t say you’ll do it Sunday mornings if you go to church. That’s setting yourself up for failure. If for some reason you can’t do laundry on your designated laundry day, have a back-up day and time. This way it doesn’t pile up and become unmanageable.

Use your environment.

Planning to do it and doing it are two separate things. Be sure you have systems in place to remember the day and time you have scheduled. Post a note to yourself as a reminder, or put a sign over your laundry basket “Do on Tuesday evening.” This strategy worked so well for one of my clients that when her fiancĂ© saw the sign “Do laundry on Wednesday,” he thought it was directed to him and he did the laundry!

Combine it with another activity.

While you’re doing your laundry, also do another project or task you engage in on a regular basis. This will help you to remember to do it more readily, regularly, and painlessly. For example, designate Saturday mornings while reading the paper, or Sunday evenings while watching your favorite TV show as laundry time.

Follow it all the way through.

Doing laundry means folding it and putting it away, not just washing it! If you’re going to take the time to wash it, take the extra five minutes to fold it and put it away. A pile of clothes on your floor is still a pile of clothes, clean or dirty!


DECLUTTERING: STAYING ORGANIZED

No time for shame.

The only way to truly overcome the “messy closet” syndrome is to come out of the closet! That means accepting that your struggles are not a character flaw. It’s not you; it’s your ADHD. This doesn’t mean, however, that you don’t have to take responsibility for doing something about it. In order to take that first step, you must acknowledge it’s a problem and stop blaming yourself.

Know it could be emotional.

Going through old paperwork or clearing out clothes and clutter can be emotionally toxic, bringing up a host of feelings—shame, old memories, or horror that you’ve forgotten something important. Prepare yourself, and don’t allow negative tapes to sidetrack you.

Does it have a home?

Create “homes” for things like your keys, wallet, glasses, and cell phone—anything that you tend to lose track of easily. Some people use a small basket in the kitchen as a collection point for these items. One client keeps a pair of glasses next to her computer, another on the bathroom vanity, a third pair on the kitchen counter, and a fourth in her purse. It’s worth the expense, she says, to know she’ll be able to read anywhere!

Use the three-second rule.

When clearing out piles of papers or clothes, or doing any type of decluttering, don’t hold anything in your hand for more than three seconds. Make a quick decision: throw away, take action, or keep. Cleaning can be overwhelming, so take frequent breaks, but continue the process until it has been completed. Set a time and day for each “take action” item, and act on it! For example, if you have a pile of clothing to donate to your local church, designate Saturday, 9 AM, to deliver it.

Stand up and keep moving.

Stand up while decluttering, especially while going through paperwork. Don’t do it sitting down! Standing up helps your brain be more alert and prevents you from spacing out and/or hyperfocusing on one aspect of the job. Keep moving!

Don’t look back.

Once you’ve gone through clothes that you’re going to give to Goodwill or decided on things in the house you’re going to give away or throw out, DON’T LOOK BACK. Put everything in boxes or in non-see-through garbage bags. Get them out of the house or stick them in the trunk of your car as soon as you can. Otherwise, you might be tempted to go back through everything and keep things that you’ve already decided to eliminate.

Do a swap.

Have a friend help you clean, and agree that, in return, you’ll help him or her clear out clutter or go through paperwork. It’s a lot easier having someone with you who can keep you moving and who has no emotional attachments to your “things.”

Keep it alive through accountability.

The issue for people with ADHD isn’t the lack of desire to stay organized; it’s the ability to keep the importance of doing so in the forefront of their minds. Share your desired goals with someone, and keep him posted on your progress along the way. The power of verbalizing your intention, as well as having a watchdog of sorts, should help keep you on course and true to your plan.

It’s a process. Be vigilant!

Remember that you have ADHD. It takes longer for you to change your old ways and develop new habits. You have to be committed to staying in for the long haul to make things stick. Don’t give up! Discovering what systems and strategies work for you will take time. The worst thing you can do is give up. Know that you will slip and slide, but keep at it. It takes time to break old habits and develop new ones.

Create tangible accountability systems for yourself.

Create time sheets for doing dreaded tasks. For example, if you need to clean out the pantry, post a piece of paper on the pantry door. On the paper list the task: “Clean Pantry!” Under that, state the goal for the amount of time: “Spend One Hour Cleaning Top Shelf!” The time spent can be spread throughout the day. It does not have to be done all at once. Every time you go into the kitchen, time yourself and write the time spent (10 min, 15 min, 20 min, and so on) cleaning the pantry. When you reach one hour, stop. This serves two purposes: 1) to break the project into small, doable pieces; 2) to allow you to actually see that you spent one hour’s worth of time cleaning.

The key is to make your goal specific so that you can see and feel progress. For example, when you set out to clean one pantry shelf, you won’t be able to miss the difference in how that shelf looks compared to the other messy ones you haven’t yet touched. Or set out to do one load of laundry. You’ll be able to see that the original pile has become smaller.

Change settings to get mundane tasks done.

If you can’t do certain kinds of work in one room, try another. I personally find that I can’t pay my bills anywhere except at my kitchen table. I have clients who take mundane paperwork and drive to a parking lot and do it in their car. Do whatever it takes to find out exactly what helps you focus long enough to get the task done.

YOU CAN GET MORE TIPS AND STRATEGIES for getting your home environment in order in some of the articles in the Attention magazine archives on the CHADD website—if you're a CHADD member. Access to the archives is a very good reason to join CHADD!

And if you have other strategies that help you keep your house in order, please share them with the rest of us!

Warmly,
Nancy Ratey

Tuesday, September 13, 2011

Is Impulsivity Wrecking Your Social Life?

One of the first things a client I’ll call James said to me was, “If I could only keep my big mouth shut.” He painted a picture of a life beset by inappropriate behavior and mired in paradox. Young and independent, he was also handsome, athletic, and outgoing, a Wall Street trader on the fast track. He already owned a condo, a vacation club share in the Rockies, and a new sports car that he’d purchased for cash.

What James couldn’t get was why he said things that people found uncouth and offensive; why a former fraternity president and popular super jock couldn’t keep a girlfriend for more than a few months while most of his old friends were settling down with spouses and children; why someone who’d already made “so much money it’s obscene” kept losing too much of it in casinos; why somebody who could make quick, lucrative trades on the floor of the stock market couldn’t manage his own credit cards or save more than a few thousand dollars.

“What’s up?” he wanted to know. “In the last two weeks, I lost my job, I got another notice from the condo association for parking in somebody else’s spot, I sprained my ankle skiing, and my girlfriend broke up with me. And oh yeah, I forgot my mom’s birthday on top of everything else, and now she’s all hurt and mad at me.”

IMPULSIVITY WREAKING HAVOC

By his own admission, James was displaying some of the classic characteristics of ADHD, specifically, an inability to control his impulsivity. “What’s with people?” he asked, speaking about his social life. “What do they want anyway? I see myself with a couple of kids someday, maybe a house at the beach, but hey, I’m not ready to settle down yet. Women—they want you to check in every day, they want to know what you’ll be doing six weeks from now, six years from now, and why don’t you come meet their mother in Minnesota after you’ve only just met them. All these women in the city are so boring, they’re all the same. Nobody just wants to do something without a million plans first, and it’s like they want you to try out for some Mr. Perfect prize. Nobody knows how to have fun anymore.”

Clearly, James was unable to understand that the frat boy behavior that had made him so popular in high school and college had worn thin. Old friends still included him when the Knicks or Jets or Mets were in town, but unable to predict what he might do or say next, especially after several drinks, few accompanied him on the ski vacations or fishing trips he often took, and no one invited him to gatherings including their wives and children. They weren’t willing to take a chance on James when their families were concerned.

Turned off by his excessive spending or rude remarks, newer acquaintances, especially women, were even less likely to last. At first he might seem charming and energetic and charismatic, but relationships usually ended abruptly when he was “loud, overbearing, and obnoxious, always the center of attention,” a description his girlfriend had recently invoked in ending their relationship. Other times, he simply got bored. The thrill of the hunt invigorated him, not the day-to-day commitment and empathy that invited intimacy.

Much of what James said in that initial interview troubled me, because I knew that if coaching were to make a difference for him, he would have to start assuming responsibility for his actions. At that point, everything was somebody else’s fault. Probably the most important issue for him was acknowledging the reality that his problems would not go away by themselves and that it was going to take hard work on his part to change things.

Impulsivity was wreaking havoc with his life, and he needed to face up to the fact that he’d been deceiving himself. His quick wit had helped him succeed thus far, but he’d been equally dependent on adrenaline, a formula that couldn’t last. He’d gotten as far as he could without a clearly identified long-term goal and a plan to achieve it. Now it was time to learn how ADHD was affecting his functioning, including his social life, and to take action to address it.

Unless he began to understand what was causing his behavior, and until he created strategies to compensate for his impulsivity, James would continue to jeopardize any chance of acquiring new, long-term relationships of any kind. While he could recognize, after the fact, that he’d said or done something untoward or indecent or downright rude, he never had a lesson learned from the past to apply to the future. And because he had never learned to inhibit his impulses, no matter how many promises he made to himself or to others, he always forgot. A prisoner of impulsivity, he was truly a prisoner of the present, and a lonely one at that. The number of acquaintances he had used to be enough, he admitted. The quality of relationships was finally beginning to matter, and he wanted to acquire a few strong ones.

You can read more about how coaching helped James and his difficult, but ultimately successful efforts to manage his impulsivity and improve his social life in my book, The Disorganized Mind. For now, in this blog, I’ll discuss the importance of adhering to basic social rules and some strategies that can help adults with ADHD improve their social lives.

ADHERING TO SOCIAL RULES

Many people consider etiquette a quaint art of the past, but while no one can dispute that we seem to be living in an “anything goes” society, there is a breaking point. “Enough!” we eventually hear when someone has brazenly, or even inadvertently, crossed a certain line. “I don’t have to listen to this, I don’t have to accept this anymore.”

Constructing a healthy social life requires people to adhere to social rules and to maintain personal boundaries—skills with which my client, and most people with ADHD, generally struggle. Talking too much and interrupting others, for example, or being too “honest,” without regard to anyone’s feelings are not acceptable. My client would have to face the fact that, even if talk show hosts and television personalities shout each other down with barbed insults and coarse language, ordinary people have a very limited threshold for absorbing such insults on a personal level.

Most won’t abide unreliability for too long, either. Repeatedly canceling appointments, showing up late, and forgetting important dates like anniversaries or birthdays test even a parent’s infinite patience, and it’s a rare individual—hardly a superficial acquaintance—who will put up with a pattern of it.

SOME STRATEGIES FOR DEVELOPING A SOCIAL LIFE

In order to have a life outside of work, you have to have the ability to construct a social life. This means making and keeping a variety of friends, getting along with others in group situations as well as one-on-one, reading and adhering to social rules, and maintaining personal boundaries—skills with which people with ADHD generally struggle. Other issues can include talking too much and interrupting others, being too “honest,” and being repeatedly unreliable with friends: canceling appointments, showing up late, forgetting important dates like anniversaries or birthdays. These symptoms often make you come across as arrogant, selfish, aggressive, or not honoring personal boundaries.

Know the steps.

The first step in knowing how to make and keep friends is knowing yourself. What are your interests? What type of things do you like to do? Once you can identify what your interests are, you can then increase the opportunities of meeting like-minded people. That means locating clubs or activities that focus on those same interests. Next is carving out the time to be involved and showing up to meetings and activities so you can increase your possibilities of meeting people. Lastly, if you get nervous in new situations, you must have a dialogue rehearsed to break the ice and introduce yourself to others.

Make soft commitments.

Keep friends by keeping the lines of communication open. If you are the type of person who often backs out of plans due to over-commitments or who gets overwhelmed at the last minute, simply let people know that you’re making a “soft commitment” and not a “hard one.” Tell them, for example, that you’d like to go to the show and are tentatively saying yes, but that you might have a conflict and be unable to make it at the last minute. That way you will avoid disappointing people if you don’t show up. Do, however, have the courtesy to at least let the person know you’re backing out as much in advance as possible!

Plan! Plan! Plan!

If you don’t make the time and space for meeting up with friends and having a social life, it won’t happen. Learn to plan to see your friends and to have fun! Be sure to look at your calendar weekly and actually block out social time. Make a commitment and keep to it. Make it a regular and re-occurring activity so it becomes a ritual, like a movie on Sunday evening or a bike ride on Saturday afternoon.

Keep organized!

If you don’t have or can’t find your friends’ e-mail addresses or telephone numbers, how can you keep in touch with them! Create a system to track these details. Put numbers in your palm pilot, in Outlook, or type out a list and post them over your phone. Don’t fool yourself into thinking that you’ll find that post-it when the time comes and you really need it! Make creating and maintaining an organizational system for these details a priority!

The small things count.

People with ADHD often let small things slide, like remembering a birthday, returning a call, or responding to e-mail. These small details can go a long, long way in helping to build relationships. Set reminders; write birthdays in your calendar or PDF and make plans around the special events. If you don’t have time to chat on the phone, at least acknowledge that you received the call and are busy, but don’t just let things hang and expect people to understand. Making and keeping friends is a two-way street, and communication is a large part of it.

Get feedback.

Some people with ADHD are very adept at social skills, while others are not. If you have challenges starting small talk or reading nonverbal social cues, for example, or if you simply want to improve your general social skills, ask a trusted observer for candid feedback on how you present yourself. This feedback can be invaluable in helping to know how you come across. It can help you learn to better self-observe, to fine-tune things like eye contact and table manners, and to avoid talking too much or too loudly.

Don’t let yourself get trapped.

If you know you get bored quickly at parties, or get tired and want to leave but are dependent on others for a ride, plan an escape route! Drive separately, or take money for a cab. Tell your friends ahead of time that you might leave early so they’re not surprised. Don’t allow yourself to be in any open-ended situations if they cause you problems. It is essential that everything be as planned and structured as possible.


IF YOU'RE TRYING TO CONTROL YOUR IMPULSIVITY AND IMPROVE YOUR SOCIAL LIFE, the key to success is to select a strategy, work through it, and judge its effectiveness. If you’ve given a strategy sufficient time and it’s really not working, try something else. Use your creativity to design strategies of your own and share what works for you. And you can learn more about social skills on the Adults with ADHD and Relationships page of CHADD’s website.

Tuesday, July 19, 2011

Do You Leap Before You Look?

Years ago, I was surprised when a client told me that during the twenty-odd years since he’d graduated from college, he had worked for eight different companies. “Yeah, I told my manager to shove it,” was how he described the latest time he’d been fired. “And he told me goodbye. Too bad I’m so used to it.”

Unfortunately, stories like his no longer surprise me. Many of my clients have gone from job to job, let go each time by employers no longer willing to overlook offensive actions and speech directed at clients, colleagues, and the bosses themselves. Sadly, these individuals have often been highly intelligent and skilled, in many ways so well suited for their jobs that success should have been automatic. What they’ve lacked has been a way to keep from saying and doing things so inappropriate that dismissal was their employers’ only option.

One of the classic characteristics of ADHD, impulsivity is a lack of the brain’s self-inhibiting function. In simpler terms, it’s an emotional response to the world characteristic of childhood, rather than a rational response—one that includes deliberation, judgment, and reflection—characteristic of adulthood. Instead of thinking about their intended actions or weighing the consequences sure to follow, people with impulsivity issues leap before they look, with neither foresight nor hindsight to guide them.

Those who manifest impulsivity lack impulse control—a way for their minds to “put the brakes on.” Without a cognitive response to a stimulus—without working memory or judgment or a way to evaluate consequences—they find it impossible not to speak their minds in the moment, and they often blurt things out, interrupt, or even finish other people’s thoughts for them, eliciting a lot of resentment along the way.

True, it might be refreshing to hear somebody speak without a script once in a while, but it’s also disconcerting to be on the receiving end of an unfiltered rant. Nobody likes it, and very few adults are willing to put up with it. Nor are they willing to endure indefinitely the company of someone who constantly draws attention to himself. To put it bluntly, that kind of behavior becomes embarrassing, if not exhausting, to be around.

Specifically, then, unless impulsive individuals begin to understand what was causing their behavior, and until they create strategies to compensate for impulsivity, they would continue to jeopardize any chance of acquiring new, long-term relationships of any kind. Whatever job they have would also be in constant jeopardy, and money problems would continue to haunt them because of excessive spending and frequent gambling. If the impulsivity remained unaddressed, their struggles would be seen as character flaws or a lack of desire to change and improve. They need to understand that their neurobiology is at the root of their struggles. Acknowledging that ADHD is causing—and, unchecked, would continue to cause—real problems is their first step in understanding what they need to do to help themselves.

One of the most difficult struggles for people with ADHD is being stuck in the perpetual “now.” They are unable to learn from past experiences in order to evaluate the potential consequences of present or future ones. Every situation is therefore something new, and their reactions are based solely on the moment in which they find themselves. It’s not unlike the person who continues to touch the lit burner on the stove, even though he’s been burned every other time he’s done the same thing. There’s nothing in his head saying, “Hey, wait. Don’t touch. You don’t want to get burned again.”

That’s what happens to individuals with ADHD. In any given moment, they can’t keep in mind the idea of the past or the idea of a future—that tomorrow or even an hour from now will actually exist. Mistakes don’t get “cemented” in memory in the ADHD brain, so there is no plan in place to prevent new mistakes—mistakes just like the old ones—from happening yet again.

STRATEGIES TO CURB YOUR IMPULSIVITY

The strategies that have worked for my clients might work for you, too, especially engaging an accountability partner with whom to role-play or rehearse before a social or business event. Many have found keeping a log of impulsive behaviors and asking for feedback to be helpful (as long as you’re willing to accept the feedback openly). You can try any of the following strategies, being sure to give yourself enough time to evaluate how they’re working. Change will not happen overnight, though, so don’t give up after one or two attempts.

Appoint a “watch dog.”

Enlist a trusted friend to watch over you and your actions. Give this person permission to be very honest and to confront you if you are about to do something you might regret, like calling an old flame, for example, or walking off your job or skipping a business meeting. Go over an agreed-upon dialogue for these circumstances—for example, “Jake, remember you told me to hold you back when you try to do these types of things because you forget the consequences.” For this to work, you must allow the appointed person to become firm with you if you continue to try to justify your actions.

Use a team of advisors.

One of my most impulsive clients surrounds herself with a strong team of advisors and uses them regularly. She says to build this philosophy into your life: “Don't make too many moves without consulting at least three trusted advisors. Choose people whose values are closest to yours and whose minds are more logical than yours.” Using this strategy, you’ll stay more on-course by thinking through consequences.

Plan ahead by rehearsing or role-playing.

Rehearsing and role-playing are ways of planning possible details for an upcoming conversation so you can collect your thoughts ahead of time. They also help you avoid emotionally charged, counterproductive responses to others, exactly the kind of behavior you’re trying to eliminate.

People who are at ease socially might wonder about such deliberate planning ahead of time, but for people with ADHD issues, especially impulsivity, it can mean the difference between keeping and losing friends. The strategy can work just as well professionally.

Write out your schedule nightly.

To successfully self-manage, it is imperative that you mark out a To-Do list and a schedule at the end of each day. Waking up without a designated structure for the day is as good as taking a day off! Look at the schedule first thing in the morning. Make this a ritual.

Create a “home” for thoughts.

If you’re someone who often complains that great ideas come to you in the middle of meetings or when you’re concentrating on something else, you can capture those ideas by giving them a home and writing them down. Keep track of your ideas in a notebook or computer file so that you can get to them at a better time. The purpose is to provide “containers” for thoughts so that you don’t impulsively act on them in the moment.

Think before jumping.

Before agreeing to work on yet one more project, join one more board, or meet someone for lunch, stop and ask yourself, before answering: Is this reasonable?

It is okay to say “no.” Do not overextend yourself! Often people say “yes” too quickly without first thinking of the consequences. Have a dialogue rehearsed in your mind to be ready for requests on your time. Say, for example, “I need some time to think about how this will fit it into my schedule. Let me get back to you.” If they demand an immediate answer, simply say no!

Rid yourself of toxic feelings.

If you do get sidetracked and consumed by toxic emotions, it’s important to get rid of them before going into a meeting or having an important conversation. Do what one of my clients did” Call a (close) friend and say, “I have to clear my head, can I just talk at you? After five minutes tell me to hang up! Okay?” Then let it rip! This helps to clear your head of your extraneous thoughts and enables you to more fully concentrate on what is in front of you without the fear of blurting something out that you'll regret later.

Learn to self-observe.

To help curb acting on impulsive thoughts, learn to “watch” yourself in action and monitor what you do, and don’t do! I personally pretend I have a mini-camera attached to a hat I’m wearing. I try to observe myself through the lens of this camera—my hands, my body – in all actions I take throughout the day. I continually ask myself, “Am I on-task? Off-task? Am I where I am supposed to be? Am I working on priority items?” This strategy worked so well for me that once I slapped one of my hands when I noticed it had “wandered off” and was brushing my dog’s teeth instead of at the computer keyboard writing my book, where it was supposed to be!

Do it actively.

Allow yourself to use flipcharts or to hash things out on pieces of paper as you talk. Often, standing up or pacing while talking can help thoughts come together in a more organized manner.

Practice bottom-lining.

If you’re like a lot of people with ADHD, you may have difficulty getting to the essence of a thought and will engage, instead, in long, descriptive stories. If this is you, practice the art of ‘bottom-lining,” which means getting to the point. Ask yourself, “What is the key thing I want the other person to understand?” By clarifying your point this way first, you’ll make it more easily when you actually speak to the other person.


IF YOU’RE TRYING TO CONTROL YOUR IMPULSIVITY, the key to success is to select a strategy, work through it, and judge its effectiveness. If you’ve given a strategy sufficient time and it’s really not working, try something else. Remember, impulsive people are usually creative people, so use that creativity to design strategies of your own. Share what works for you!

Warmly,
Nancy Ratey

Tuesday, June 14, 2011

Derailed by Distraction?


“I pulled a Lucy again,” my friend Cathy joked the other day, a reference to the TV character of old whose antics constantly confounded her husband, Ricky, and who occasionally reminds us of ourselves. “I had another ADD moment! I went to go out and I got in the car, I started it, forgot my list inside and went back to the house to get it, the phone rang, I answered it, and well, you know the rest! An hour and a half later, I was looking for my purse and remembered it was in the car, and I went out and found the car still running in the driveway!”

And so it sometimes goes for those of us with ADHD, who find ourselves suddenly distracted from the task at hand and winding our way from one activity or idea to the next, “like somebody is clicking a remote control and switching the thought process in your mind,” as one of my clients put it.

Cathy and I are lucky, though. We joke about what we sometimes do because we can joke. When we give in to distractions, we know how to pull ourselves back. We acknowledge our ADHD tendencies, and we’re able to recognize when we wander off course. We’re beyond the dysfunction that led to our respective diagnoses long ago, and we accept moments like Cathy’s latest “adventure” as part of what living with ADHD means. We can laugh about things we do because (1) we already know we are not our ADHD – we’ve separated ourselves from this sporadic behavior, and (2) we have strategies and structures in place to keep us on track. Our occasional wanderings don’t define us in our own or in other people’s minds.

DISTRACTIBILITY
When they say they’re distracted, most people mean that they’re temporarily unable to focus or concentrate, a situational condition that will pass when the factors underlying it change. When ADHD individuals are distracted, however, their condition is ongoing, a brain anomaly that leaves them unable to screen out competing stimuli or hold their focus on something long enough to do anything with it. Distractibility is a condition with which they live, a particularly troublesome one given a culture that appears bent on aggravating it.

Sometimes it seems that one would have to live out a vow of silence in a monastic cell somewhere not to be on sensory overload, scattered and frenzied and off in a million directions. As a people, we’re wired and connected, clicking our way through the days, and for all the ways in which technology serves us, it also manages to keep us at its mercy. There’s a constant demand from this technology-driven environment to shift attention quickly and often, to shift and shift again, so we have little time or impetus to think, let alone think deeply, about anything. The minute we try to focus on one thing, a light flashes or a ring-tone sounds or a buzzer vibrates, and off we go to answer the call of what’s next.

How to keep up, we wonder? How to be everywhere, yet feel nowhere? So many devices, so little eye contact; so many rushed emails and voicemails, so little thought-provoking dialogue; so much noise, so little meditative silence. Who even knows what to do with quiet these days, except turn up the volume to drown out the discomfort of a solitary thought: What am I missing?

Most of us are stretched to the breaking point, with so many demands on our time and so many people wanting so many things from us, that without the wires of interconnectedness, we fear we’ll fall behind. And where will we be then, we wonder. Who’ll get the edge if we turn down the volume and disconnect?

To one degree or another, everybody is rushed, everybody is scattered, everybody has those miles to go before sitting back and taking stock. The wonder is that somehow, despite their hectic and crazy lifestyles, most people manage to get on with the business of doing what they have to do, and still remain in control of their lives.

Then again, most people aren’t living with ADHD.

There’s a difference in the degree and the frequency to which individuals with ADHD are susceptible to all the distractions out there, and there’s a major difference in the consequences of their behavior. They start off with a compromised ability to stay on task, and the demands of the click-click, push-button world make everything worse. “Oh, well, everybody feels this way,” doesn’t apply to them. ADHD individuals know full well that that everybody does not feel out of control the way they do. What they don’t know is what to do about it.

TRY THESE STRATEGIES

You can create strength-based strategies for dealing with distraction. I’ve had clients who write on their bathroom mirrors with dry erase markers to remind them of their priorities for that week, and others who pretend to be taking notes during meetings to stay alert. Try any of the following, adapting them to your own needs and style.

Filter out background noise to enhance focus.

Distractible individuals are overly responsive to both the external stimuli of their environment and the internal stimuli of their own thought process. They act on the stimuli, jumping from thing to thing or thought to thought, captive to every whim and fancy.

Be honest about the kind of environment that suits you. To avoid getting carried away and lost, you might have to put yourself in a setting that is completely free of distractions — nothing on the walls, no music or ringing phones, total quiet.

Find the right place that works for you.

If you know that working in a totally quiet space doesn’t help you concentrate, then give yourself permission to go to a cafĂ© or a coffee shop, someplace that has a bit of a “buzz” in the background. Many of my clients leave the office for a while and go to such a place to work on a particular project. They say that the “buzz” helps to activate their brain to screen out the background noise so they can focus.
Use music to stay on track.

When I need to put in several hours of writing, I have one CD that I play over and over again. I only use this particular CD to write to. I’ve trained myself to sit down and start to work as soon as it begins playing. It took a while, but it works! Try it!

Be aware of the passing of time.

Wear a sports watch, and set it to beep every hour on the hour to help you “hear the passing of time.” When it beeps, stop and do a self-check. Ask yourself, “Am I doing what I am supposed to be doing?”
Create self-accountability every hour on the hour.

To make sure you stay on course and focus on what you need to be doing—and to learn to be accountable to yourself—take a post-it or a blank piece of paper and write down the three tasks you will complete over the next hour. At the end of the hour, throw away the piece of paper or post-it, and write down your next three to-do items on a new sheet. These need to be concrete and doable, things like “call Charlie” or “water plants” or “mail letter.” Knowing that you have to complete the tasks within the designated time will keep you moving so that you don’t hyper-focus on one activity to the exclusion of the others on your list.

Park it!

Whenever you get the urge to veer off course, park it. Designate a notebook or an electronic file for those extraneous thoughts that pop up. Get them out of your head and onto a piece of paper, delegate them to another time and day, and keep going! This way you feel as though you’ve acted on whatever it was, so it’s out of your head and therefore out of your mind!

If you’re someone who often complains that great ideas come to you in the middle of meetings or when you’re concentrating on something else, you can capture those ideas by writing them down as they occur to you. This helps you gain more control over your creative ideas and your impulsiveness, and it provides a way to follow up on your many great ideas.

Make it a personal policy not to make stops en route.

Many of my clients, already on the verge of being late for a meeting or appointment, will decide to make a quick stop at a store or run a quick errand on the way. History, of course, will tell you the consequences of these actions: getting stressed, being even later, missing your appointment altogether, disappointing others, and beating yourself up for repeating the same mistake over and over again.

Post a sign on your dashboard that says DON’T STOP! If you walk or use public transportation, stick a post-it on your wallet reminding you to GO DIRECTLY TO WORK or GO DIRECTLY HOME! And do what it says!

Avoid those traps!

Don’t fool yourself into thinking, “Oh, I can read one more e-mail before I leave for my appointment,” or, “I can do X, Y, Z really quickly before I go.” Don’t listen to that voice inside your head! It will only get you into trouble. “Just one more minute” doesn’t give you more time; it only makes you late. If you know, for example, that e-mail distracts you, use a timer to signal you to turn off your computer an hour before your appointment.

Beware of “see do.”

Most of my clients respond well to their immediate physical environment, meaning they get caught in what they call the “see-do” cycle and forget their designated priorities. They answer each e-mail that comes in, for instance, or notice dry plants and begin watering, or look for a snack and start cleaning out the refrigerator.

If this describes you, set up visual cues to keep you on track. Post signs to yourself like, “Complete project X by 5:00,” or create a screen saver to scroll across your computer screen saying, “Where Is Project X?” For longer-term goals and follow-through, you might want to post a calendar over your desk or in your kitchen with the due dates clearly marked in neon colors.

Distinguish the NOW from the NOT NOW.

Ask yourself, "Does this have to be done by today?" If it doesn’t, type or write it into your calendar with the date by which it needs to be done. Then you know that for now, it's dealt with.  If you follow this process all the way through your list, you’ll be left with only the things that must be completed now!

One of my clients uses this strategy to help him prioritize his to-do lists so that he’s always working on the most important things on the list. He says it reduces his temptation to act on non-essential items, and best of all, it keeps him honest.

“If I have a long list to handle every day, I’m setting myself up for failure,” he said. “I’m lying to myself. I’ve promised myself a million times that I’ll finish the entire to-do list, but it's impossible. In the end, I look at all the undone items and feel demoralized…again. So I got rid of the lists, and it works for me, especially because nothing gets forgotten!”

Maybe his strategy will work for you!

Prepare ahead of time.

If you know you’re frequently late to appointments because you get distracted, prepare as much as you can the day before the appointment. Put the files you need in your briefcase, the PowerPoint files on your computer desktop, your coat by the door, and so on. Do anything you can to make it as easy as possible for you to simply grab what you need and run.

Use distractions as rewards.

Come up with a list of things you know will distract you, and use them as rewards. Plug these items in upon completion of a task or at the end of a designated time segment.

One client, for example, knew that computer games were definitely a distraction, so he scheduled playing a few into his work plan to keep him motivated. By saying, "If I work 1 hour on my report, I can spend 10 minutes on computer games," he was able to complete his reports.
Do whatever fits! For this strategy, you have to ask yourself, “Is the reward motivating enough to keep me working at my assigned task no matter how hard it is for me to stick with it?” You also have to be very careful that you keep the reward time limited. If not, it will become a distraction again, rather than a reward.


I’ve coached many clients with distraction issues, and while it hasn’t been easy, it really has been fun. The strategies that we’ve created might seem outrageous to other people, but I can say unequivocally that they’ve worked. Try your own, and be as creative as you want!


Warmly,
Nancy Ratey

Tuesday, May 17, 2011

Stop “Circling the Airport”: Procrastination, Part Two



“Productive procrastination” is a popular survival tactic among my clients. They enjoy feeling busy, and they fool themselves into thinking that of course they are busy, they’re not procrastinating, they’re getting so much accomplished, so how could anyone say they’re not working? They delude themselves into thinking, “Let me just do these other little things first. That way I’ll be able to focus completely on the important thing because I won’t have all this other stuff hanging over my head, so I’ll really do a better job.”

Procrastinators often wait to begin a task until they’ve run out of time, until they have painted themselves into that proverbial corner, literally creating the “high stakes” situation that their brains need. Part of the problem for those of us with ADHD is that the attention system of our brain is often “sleepy” or lethargic when not fully aroused, so we go from stimulus to stimulus, from issue to issue, seeking ever-immediate gratification and completely forgetting whatever it was that we were initially considering. We can’t sustain the interest and effort and ability to focus on a single issue that, as adults, we’re expected to have, so we’re on to the next idea before completing the original one.

We’re so easily lured into unrelated activities, in fact, that people suspect our motives, calling us irresponsible and lazy, undependable and even self-centered. Well, some us probably are, just like some people without ADHD are. We’re human, after all, so we’re subject to the same human flaws as everybody else. For years we’ve also been told we’re all those things, so some of us probably believe it, perpetuating the self-destructive myth even further. But for most of us, it’s not irresponsibility or laziness or selfishness that lies at the root of our behavior. It’s biology. And it’s usually compounded by a lack of understanding about how to compensate for it.

We’re called stress junkies with our need for high stimulation, but it’s that very stress that actually focuses us. With it, we somehow prioritize better. We can suddenly sequence the steps we need to follow, and we can sustain the effort we need to complete the task at hand. We can stop “circling the airport,” as one client put it, where “I see the target, I know that I’m circling, but I can’t seem to land.” With the right stress, we know that we can land, so we seek the stimulation that allows us to do what we must. Like anybody else, we like to feel good, and we choose reward over punishment every time. The problem comes when we feel good about the wrong things. Then the pleasure turns to pain when we realize we've disappointed those we love and failed to live up to our best intentions.

Although it sounds paradoxical, good stress and an aroused attention system help us make the decisions that usually frustrate us into avoidance. When we can’t imagine where to begin, we don’t begin at all, doing everything else that we can think of to avoid the pain of being overwhelmed. Last-second stress turns us on, though, and in the frenzy of the rush, we can suddenly make the choices that paralyzed us earlier. How many term papers were written that way, how many exams passed, how many guestrooms and bathrooms and patios renovated for guests about to arrive? Being out of time has always forced people into action, but those of us with ADHD have a whole personal history to remind us how we get by.

MORE STRATEGIES TO DEFEAT PROCRASTINATION

Here are some more strategies to try—but be sure to add your own personal touches to suit your own personal circumstances.

Co-coach your way forward.

Find someone who has similar goals, and work out a co-coaching relationship. Both of you, however, must be willing to do the following:
• Set up mutual goals and guidelines for the relationship.
• Be sure the co-coaching includes only what is appropriate. If it’s about work, stick to work issues.
• Be consistent in your contact with your coaching partner.
• Be honest and open to suggestions, and trust your coaching partner to have your best interests in mind.

Use a witness.

Clients often benefit from the mere presence of someone to help them start or complete a task. This seems to work well with tasks that have been put off for a long while or that are emotionally charged, such as doing the income taxes or clearing the house of clutter. Many of my clients don’t need the person to help them with the actual task. Just making the appointment and having them show up to sit in the same room with them is enough!

Use a model.

If you are asked to write a report or do a project and are stuck, get a sample or a model to work from. This will help you see the end product so you’ll know what is expected of you. It is a tangible way of having your goal in sight.

Match peak performance with priority projects.

Do you know your “peak performance” time of day? When do you get the most work done? When are you the most focused?

Know whether you’re a “morning,” an “afternoon,” or an “evening” person, and be sure to have your most important project in front of you at your best time. If you don’t, you’re apt to do a task of lesser importance, and exhaust your energy that way. I’ve had clients who were “morning” people but who ended up re-grouting their showers or balancing their checkbook during peak performance time. One devised a computer program that he wanted to market to banks, all the while putting his actual job in jeopardy.

You become the first thing you do in the morning.

A well-known author and friend of mine once said to me, “You become the very first thing you do in the morning,” meaning that if you do the thing that is most important to your career each morning, first thing, and if you make doing this a habit, you’ll be successful.

Take this advice to heart, as I did. It definitely worked for me when writing my book, and it has worked for many of my clients. It will work for you!

Make actions concrete.

Goals and plans are only wishes unless you establish a “when” for each individual step and action. Be specific on the breakdown of the steps you plan to take and the times you plan to do each one. Set a clear time and day for the completion of each.

Always have a back-up plan.

It’s typical for my clients to sabotage their first set of plans and then to give up completely. Don’t let that happen! When you mark out a schedule with start times and days to begin working on the project, set up several back-up times so you can’t escape starting work. For example, set a start time/day of Tuesday 11AM with a back up of Tuesday 2PM, and then the DO-OR-DIE start time/day of Tuesday 4PM.

Share your goals!

Tell someone about your goals for the day. Sharing what you want to do helps in making it happen! Accountability can create the necessary motivation, and help you to be more consistent.

Understand why you "circle the airport."

Some of my clients describe their tendency to avoid long-term projects as “circling the airport.” They know what they need to do, and they understand the importance of starting, but they just can’t seem to “land.” What ensues is a cycle of self-loathing that perpetuates the “circling.”

Understand what this is about. For some, it’s an issue of not knowing where to start. For others, it’s an issue of dreading what it will take to get the task completed—hours, if not days, of making up for having put it off. Simply knowing this can help you cut yourself off at the pass before you start to panic and circle again and again.

NEVER GIVE UP!
I end on the same note as last month. The only “best” strategies to defeat procrastination are the ones that work for you as an individual. The most effective strategies will probably be the ones you create on your own. Only a process of trial and error will reveal what works for you. Modify and customize these strategies until they are exactly right in your own life. 

Warmly,
Nancy Ratey

Tuesday, April 26, 2011

Procrastination and Adult ADHD





Who among us doesn’t love the luxury of an occasional lazy afternoon, putting off till tomorrow what we might have done today?

We all do, of course, but when people with ADHD procrastinate, they aren’t feeling momentarily lazy or giving in to a harmless, well-earned need to unwind. Procrastinating might qualify as a justifiable indulgence or a rare, sweet choice for the majority of people without ADHD, but for those living with it, there is nothing sweet about it. It comes layered with guilt and humiliation and an intuitive sense that you are letting others down.
For adults with ADHD, procrastination is a significant problem with a biological base, not an occasional reward for serious and consistent work or the result of a mood swing. And while you can learn to compensate for it, you can never change the biology in which your procrastination is rooted.

If you struggle with procrastination, you may find that working with an ADHD coach will help you to overcome this self-defeating behavior. Self-coaching with strategies that have helped others may also help you take control of your time, tasks, and talents. Try any of the following strategies as a start. Through trial and error, my clients and I have created all kinds of strategies, some of which might also give you ideas. Add your own personal touches to suit your own personal circumstances. Once the strategies begin to work, you can practice, practice, practice until they become new habits, a part of your brain's "machinery."


Keep the goal in mind.

One of the hardest struggles for my clients is keeping their goals in mind. If you can’t see your goals, you’ll be more likely to get off track. Devise methods to keep the goal in mind, and to see, and track, progress. Mark your goals with colored markers on a monthly calendar and post it where you will see it throughout the day, in the kitchen, perhaps, or over your workstation or desk.

Separate the set-up from the task.

Eliminate the confused feeling of “Where do I start?” by separating the set-up from the actual task. For example, place a blank word document with the title “Year End Report” on your computer desktop, but don’t start the report until later. You can do the same for paying bills by stamping and addressing envelopes at one time, but writing the checks and mailing them later. Doing the set-up as a separate task can make the task less daunting.


Establish and meet the minimal goal.

Start by defining the smallest possible goal that will accomplish something meaningful on the project or task. Call this the “minimal” goal and schedule a time to complete it. At the scheduled time, do only what you stated as minimal, even if it’s simply opening up a file and looking at the project for 10 minutes! That’s what I mean by minimal! This allows you to approach a tiny aspect of the project without becoming overwhelmed.


Limit time spent on making plans.


Do you tend to spend hours making detailed plans with the best of intentions, but never seem to get around to implementing them? Set a timer for 10 minutes, and allow yourself to write down only the basic things you need to do, not every single detail. Work on daily goals rather than scheduling every single minute. Then get moving!


Use rewards as good stress.


Most of my clients work well under pressure, so try to use this insight in a positive way. Set a lunch or dinner date with a friend, or plan to go to a movie. Tell your friend you can’t go until you’ve finished three hours of work on your project, or until you’ve cleaned your house, for example, and say that if you don’t finish, you must cancel. This is not meant to be a punitive exercise, but one to fire you up to get the work done.


Create false deadlines.


If you’re avoiding starting a long-term project, find someone you respect (and fear a little!) and set several mini-deadlines for handing in parts of the work. It can be your supervisor, boss, or a trusted advisor. For example, tell them, “I’ll turn in a draft of the first part of the report by next week.”

Many times this false deadline can stimulate you enough to get the work done. This strategy needs to be used carefully because it’s meant to create positive energy, not make you more stressed, so be realistic and don’t over-promise!


Beware of "productive procrastination."


A majority of my clients fool themselves into thinking they’re being productive by getting other projects of lesser importance off their plates first. Generally speaking, they can be incredibly productive doing everything BUT what they are supposed to be doing!

Beware! You are fooling yourself! Understand that much of this has to do with a sense of immediate gratification! See it for what it is. Use those small projects as rewards for actually working on your most immediate priority.


Remember the pain of the past.


A typical pattern my clients fall into is saying to themselves, “Let me clear my desk of other work first, then carve out time over the weekend for project X,” when history dictates that every time they do this, they put X off until the night before it’s due. This tactic might have worked in high school, but you know it’s not serving you anymore. Know that your brain will fool you in the moment and convince you that this time you’ll actually accomplish it. Ask others around you to remind you of the pain of the past. It’s one way you can stop this self-destructive cycle.


Create “safe” high stakes for yourself.


People with ADHD often wait until they’ve boxed themselves into the corner before they finally start a project. I know this about myself, so I’ve used the knowledge to my advantage. I take my laptop computer and drive to a parking lot or to a park bench. I turn on my computer and basically play a game of chicken with myself. I sit there staring at the battery drain, and without fail, when it hits 73%, my brain kicks in and I start to write like a maniac until the battery drains. Then I head home. Doing this always guarantees me roughly two hours of writing.


Keep daily lists.


Keep it simple in the beginning. Start the day by writing down your primary goal. At the end of the day, list as many things as you remember doing that day, and put a check next to each one that was connected to your goal. It will give you a clear picture of the relationship of your goals to your actions. It will also show you the kinds of things that pull you off course, so you can learn to identify barriers.


It bears repeating that the only “best” strategies are the ones that work for you individually, so the strategies that are most effective will probably be the ones you create on your own. If something seems “almost there,” modify it until it’s exactly right in your own life. And don’t forget that trial and error will reveal what’s best—which means don’t give up!

Warmly,
Nancy Ratey