Thinking Through Adult ADHD
Change your outlook and cope better with ADHD.
Posted Oct 24, 2020
Although one’s thoughts play no causal role in whether one has Attention-Deficit/Hyperactivity Disorder (ADHD), they are a persistent and persuasive issue for those living with it.1 These thoughts and beliefs are odorless, tasteless, and weightless, but their influence runs the gamut — from a fixation on an idea or task, procrastination despite being aware of the consequences, to blurting out the exact wrong thing at the exact wrong time, later dope-slapping one’s head and wondering “What was I thinking?”
ADHD is a neurodevelopmental syndrome of self-dysregulation that creates difficulties in organizing and sustaining behavior across time towards personally desired but deferred goals. For the most part, adults with ADHD have demonstrated the capacity to achieve these objectives or at least make an honest attempt at pursuing them. But that is the issue at the heart of ADHD — it is a performance problem, not a knowledge problem.
The pursuit of these goals involves coordinating actions designed to actualize one’s plans, but the thoughts and attitudes related to the specific behaviors are an influential ligament between intentions and actions. One’s overarching self-concept and confidence also have downstream effects on these goals and other matters related to coping with ADHD and fulfilling one’s potential. The next sections will review some ways thoughts have special relevance for adults with ADHD.
Procrastination is likely the most common complaint voiced by adults with ADHD seeking treatment. Difficulties initiating plans and repeatedly putting off tasks is stressful and often forces last-minute binge-work to meet deadlines or dealing with the repercussions of missed cutoffs. Chronic, severe procrastination is a player in many work and school troubles, relationship friction, and financial difficulties, not to mention aggravation from lost opportunities that are commonly reported by adults with ADHD.
A key issue for managing ADHD is the implementation of plans and strategies that one logically knows are beneficial but that, nonetheless, still fall prey to recurring avoidance and procrastination. The cognitive strategy of reframing, or changing how one views a task at hand, can be helpful. The goal with task initiation is to frame the job to see it as feasible or “doable.”
Defining a task in specific, behavioral terms increases the likelihood of at least getting started on it. Even this suggestion is an actionable reframe of the common advice to break down a task into smaller steps.
For example, cleaning up the kitchen can be reframed with the first step of “unloading the top rack of the dishwasher;” or working on a monthly report can be framed as “opening the report file.” If even these steps still seem unmanageable, they can be framed in even smaller increments that enable one to “touch the task,” such as “open the dishwasher door” or “sit at the desk” where work on the report will be done.
At the very least, thinking about a task delays escape and increases the likelihood of sticking with a plan and getting something done. This strategy is designed to increase one’s sense of efficacy for the action, which is another element that is relevant to the influence of thoughts and beliefs for adults with ADHD.
Efficacy is one’s belief in their ability to do a task. The higher one’s efficacy rating for a job, the more likely they will do it. A lesser-known facet of self-efficacy particularly relevant for adult ADHD is self-regulatory efficacy — the ability to navigate all the hassles, tedious nature of some tasks, and other dissuading factors in order to follow through.2 This self-regulatory efficacy issue has been proposed as the central theme of cognitions and beliefs in adults with ADHD1, namely the issue of self-mistrust — “I know I’m capable of doing this — but I do not trust that I can make myself do it when I have to.”
Reframing tasks helps “lower the bar” to make them appear more achievable by finding a step that is “doable.” When facing individual tasks, an important efficacy reframe for adults with ADHD that is key for their overarching self-view is a switch from an assumption of “insufficiency” to one of “sufficiency.”
An insufficiency view is that one is not up to a task, such as being too tired, not focused enough, or not being “in the mood” for a task. There will be times when these may be accurate appraisals, but just as often it is a reflex reaction to facing a difficult but necessary task that justifies escape. The insufficiency reaction is often accompanied with what has been deemed the “ugh” feeling1 that magnifies the rationale for escape (e.g., “Ugh, I’m not in the mood for this now. I’ll do it later when I feel like doing it,” — but no one is really ever “in the mood” to do homework, work projects, chores, etc.).
When facing an individual task, catching insufficiency thoughts allows one to reconsider them and make an informed decision about task engagement. The idea is that waiting to be perfectly focused, energized, motivated, or “in the mood” sets an unrealistic standard. Instead, the sufficiency reframe is that one has “enough” focus, energy, and willingness to devote at least some time and effort to the task at hand.
In a broader sense, an insidious aspect of adult ADHD is that it has corrosive effects on one’s general sense of agency and efficacy. There is often a history of frustrations, incomplete endeavors, and various setbacks that are a direct result of the consistent inconsistency that is a characteristic of ADHD. These frustrations occur despite one’s best efforts to manage the effects of ADHD, which is what makes ADHD such a uniquely confounding diagnosis.
Developing a sufficiency mindset involves not only the “enough” reframes mentioned above, but also recognizing and reinforcing one’s skills, strengths, and interests. Even with the many “have to” tasks and roles in adult life, identifying their value for the person is an important cognitive skill. For example, cleaning the kitchen will reduce sight pollution and look nice; and submitting the work report on time will both reduce stress and be consistent with one’s values for how they do their job.
Nevertheless, task-interfering cognitions and other unhelpful thoughts run the risk of undermining plans and strengths. The next section will review these sorts of thoughts.
In case the topics reviewed thus far seem to promote the “power of positive thinking,” it should be noted that positive thoughts can be distorted — gamblers are very positive thinkers. In fact, a thought questionnaire for adults with ADHD was developed and it turned out that the 7-item scale is composed of positive thoughts that are associated with avoidance, such as “Though this usually ‘sucks me in,’ I’ll just do it for a minute.”3 The cognitive strategy promoted here is taking a second look at one’s thoughts and reconsidering their relative accuracy, utility, and potential amendments to the initial interpretation of events.
A study that found that there was an association between distorted thoughts and adult ADHD when controlling for mood and anxiety also found that perfectionism was the most commonly endorsed category.4 A clinically-informed conjecture about this finding is that it reflects “front-end” perfectionism, or circumstances having to be “just right” (or being “in the mood”) as a precondition for task engagement, consistent with the insufficiency/sufficiency section of this post. Thus, avoidance is justified based on the hopeful prospect that these desired conditions will be met in the near future — but not now.
Another familiar thought pattern for adults with ADHD is comparative thinking. This category reflects the tendency to base one’s self-view on how one sizes up against others. Adults with ADHD often have experienced more than their fair share of frustrations and are prone to find examples of others who are better organized or otherwise “more together” than they are.
As with other distorted thoughts, there may be a degree of truth in the initial interpretation, such as a friend or co-worker who is organized and reliable. However, there may be important variables not considered. For example, a co-worker who is reliably on time to work may be single and live within walking distance, whereas the adult with ADHD has children and runs the risk of missing her train.
There is also a cognitive shift when someone is diagnosed with ADHD to acknowledge its effects on their life and that there are coping skills that can be used to improve functioning and well-being. There is often an assumption voiced by adults with ADHD that everyone else seems to manage without difficulty. While ADHD certainly introduces an added degree of difficulty in coping, individuals without ADHD also rely on many organizational tools to stay on top of things and the relapse rate for procrastination and other organizational difficulties is 100%, ADHD or not. The issue is how these slip-ups are managed. Similarly, adults with ADHD will have unhelpful thoughts and the task is to catch and revise them.
Revising Your Mindset
Equifinality reflects the concept that there are diverse ways to achieve desired results. Working through one’s mindset is a case in point, as different people may latch onto different outlooks that help them engage and persist in endeavors. The following are some common questions used to guide the modification of thoughts:
- What is the evidence for the way I’m thinking? Is there evidence that does not support this view? Do I need more information?
- Is there another way to view this situation that will help me handle it better? Am I engaging in any distorted thoughts?
- If a friend of mine (especially one with ADHD) encountered this situation and described this thought, how would I advise them? (We are often more compassionate toward others than we are toward ourselves.)
- In the grand scheme of things, how important is this situation? How will I view it in an hour? Day? Week? Year?
- What is the worst-case scenario? What is the best-case scenario? What is the most likely scenario? Can I manage it?
- What can I do to influence or change this situation? Can I accept it and move on?
Answering these questions is a form of externalization of information, which helps evaluate them in a more reasonable fashion. This can be a strategy that is used as a self-help plan and is a focus in CBT for adult ADHD.
No one thinks themselves into having ADHD. However, a lifetime of living with it, particularly if it has gone undiagnosed until adulthood, affects how adults with ADHD automatically interpret events, themselves, and their futures. Getting in touch with these reactions and their influences is a helpful step in being better able to catch and re-evaluate them. In doing so, alternative options can be contemplated and implemented, as captured in the following quote by Dov Seidman:5
“When you press the pause button on a machine, it stops. But when you press the pause button on human beings, they start. You start to reflect, you start to rethink your assumptions, you start to reimagine what is possible, and most importantly, you start to reconnect with your most deeply held beliefs. Once you’ve done that, you can begin to reimagine a better path.”
1 Ramsay (2020). Rethinking adult ADHD: Helping clients turn intentions into action. American Psychological Association.
2 Bandura, A. (1997). Self-efficacy. W. H. Freeman and Company.
3 Knouse, L. E., Mitchell, J. T., Kimbrel, N. A., & Anastopoulos, A. D. (2019). Development and evaluation of the ADHD Cognitions Scale for Adults. Journal of Attention Disorders, 23, 1090-1100. doi: 10.1177/1087054717707580
4 Strohmeier, C., Rosenfield, B., DiTomasso, R.A., & Ramsay, J. R. (2016). Assessment of the relationship between cognitive distortions, adult ADHD, anxiety, depression, and hopelessness. Psychiatry Research, 238, 153-158. doi: 10.1016/j.psychres.2016.02.034
5 Friedman, T. L. (2016). Thank you for being late: An optimist’s guide to thriving in the age of accelerations. FSG. (Dov Seidman quote on page 4)