Nearsighted to the Future

To put it simply, you and other adults with ADHD are blind to time–or at least myopic.

You're not lacking knowledge or skill. Your problems lie in the executive mechanisms that take what you already know and the skills you already possess and apply them to more effective behavior toward others and the future.

Your lack of a sense of time has debilitating, even heartbreaking, effects. You probably don't prepare for predictable events until they are practically upon you--if at all. This pattern is a recipe for a life of chaos and crisis. You're left to squander your energies dealing with the emergencies or urgencies of the immediate moment when a little forethought and planning could have eased the burden and likely avoided the crisis.

Dealing with Your ADHD: The Big Picture

This description of ADHD tells us that the strategies and tools that can help you most will be those that help you do what you know:

• Treatments for ADHD will be most helpful when they assist you in doing what you know at the point of performance in the natural environments where you conduct your daily life.

• The farther away in space and time a treatment is from this point, the less it is likely to help you.

• Assistance with the time, timing, and timeliness of behavior is critical. This means arranging the particular problem setting to assist you in doing what you need to do when you need to do it. It also means keeping your aids in place.

Fit the Solution to the Specific Problem

Chapters 7-9 described four types of self-control you might struggle with to different degrees. All of the following guidelines for designing effective treatments, strategies, tools, and coping methods can help you.

In choosing your own aids, however, you might pay particular attention to those aimed at the deficits you identified with most.

• Externalize information that is usually held in the mind.

This simply means putting key pieces of information into some physical form and putting it where the problem now exists. Stop trying to use mental information so much.

If your boss or someone else has given you a set of instructions to get something done over the next few days, stop trying to carry this around in your head and remember it over that period of time. That won't work with ADHD. Instead, always carry a small journal and pen in your pocket and instantly write down the task, any steps given to you to get it done, and the deadline. Then keep this in front of you where your work is to be done over the next few days to serve as your external working memory – your reminder to get it done.

You can even translate this plan into smaller steps and insert them into your day planner as goals for each hour of that day and the next few before the work is due. The technique here is not what is important – the principle behind it is!

• Make time physical.

ADHD makes you concentrate mainly on the moment, taking your focus away from the signals and internal sense that time is passing.

Use kitchen timers, clocks, computers, calendars, and any other devices that can break time down by the hour and issue alarms when a chunk of time has passed. The more external you make the passage of time and the way you structure that time with periodic physical reminders, the more likely you are to manage your time well.

• Use external incentives.

Arrange for frequent external types of motivation to help get you through any job. For instance, break your project into smaller steps and give yourself a small reward for completing each hour or half-hour of sustained work.

Motivational “prostheses” are nearly essential to your fulfilling longer-term projects, assignments, personal plans, or social promises. Whether the reward is to briefly check on the status of your favorite sports team on the Internet, to listen to a short tune on your music player or radio, or even just to give yourself a token, arrange small rewards for completing smaller work quotas instead of waiting until the work is all done.

• Normalize the underlying neurological deficits in the brain’s executive system.

To date, the only treatment that shows any hope of achieving this end is medication. The ADHD medicines (see Step Three in the book), such as stimulants or the nonstimulants atomoxetine or guanfacine, can improve or even normalize the neurological substrates in the executive regions of the brain and their related networks that likely underlie this disorder. They do not reverse these deficits permanently; they do, however, have a remarkable positive effect while they remain in your system.

• Replace distractions with reinforcers to focus on the task at hand.
  
  Use whatever physical prompts will keep your mind focused on the task and goals at hand

• Make the rules into physical lists.
  
  Post signs, lists, charts, etc., in the appropriate school, work, or social environment and frequently refer to them while you are in those situations. You can even talk out loud in a low voice to yourself and so state these rules aloud before and during these situations. You can also use a device to record and play back these reminders (using earphones to avoid distracting others!)

• Break down any task that includes large time gaps into smaller chunks spaced more closely together.
  
  For instance, rather than accept a project that must be done over the next month as is, break it down into much smaller steps and do a step a day toward that eventual goal. That way, each step does not seem so overwhelming. And you can stay motivated using immediate feedback and incentives for completing each step.

• Stay flexible and be prepared to change your plan.
  
  As with a chronic medical condition, such as diabetes, a treatment plan is made up of lots of interventions that provide symptomatic relief. But over time, symptom breakthroughs and crises are likely to occur periodically. Don't be afraid to change course--ask for help in doing so whenever you need it--and look for new ways to compensate for the deficits ADHD imposes on you. It's only what you deserve.

With these major ideas in mind, you are now ready to master your ADHD.

Never forget that with proper assistance--including education, counseling, medication, behavioral strategies, hard work, advocacy, and the support of family and friends--you can make significant and possibly dramatic improvements in your life.

Russell A. Barkley, Ph.D., is internationally known for his career-long research into ADHD and his efforts to educate professionals and the public. He is Clinical Professor of Psychiatry at the Medical University of South Carolina and Research Professor of Psychiatry at the State University of New York Upstate Medical University at Syracuse. You can learn more about Dr. Barkley at his website.