Being a psychologist who specializes in the assessment and psychosocial treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in adults, there is often a hurdle to cross when collaborating with clients in their change process. This hurdle relates to the nature of ADHD as a performance problem and not a knowledge problem.1
More specifically, ADHD, at its core, manifests as difficulties organizing behavior across time to achieve personally desired goals. This coordination of actions over time affects both one’s plan for a day, such as following through on an exercise routine, or longer-range goals, such a working a little bit each day on an essay for school or a monthly report for work. The classic symptoms of inattention, hyperactivity, and impulsivity most certainly contribute to these difficulties, but ADHD is essentially a self-regulation problem, the “consistent inconsistency” in the organization and follow through on one’s objectives.
There are no trade secrets about how to cope with ADHD — the use of a daily planning system, organization skills, to-do lists, breaking down large tasks into smaller steps — we all know what works. Thus, a first hurdle to get over is a common client reaction to the fact that these coping strategies will be a part of treatment, often voiced as, “I know what I need to do, but I just don’t do it” or “I’ve tried all of those things and they don’t work for me.”
The discussion of how psychosocial treatments are specifically adapted to the unique features of ADHD in order to address these hurdles will be a recurring focus of many of future blog posts. This post focuses on a few unorthodox coping strategies tailored to adult ADHD, including a couple of innovative adaptations by clients themselves, that helped to personalize the strategies to meet their needs.
Talking to Yourself
One of the coping principles for ADHD is externalizing information, such as looking at one’s schedule for a day or keeping a clock within sight to “see” time. There also seems to be a benefit tied to actually talking to yourself aloud to manage many situations.
Speech is a behavior, which can be thought of as a way to take action on a situation and externalizing information that is in our mind. Our inner thoughts stem from an internalization of speech throughout childhood development that progressively goes inward and creates our private inner world of thoughts and beliefs and personal meaning.2 Talking to yourself, which is consistent with the benefits of therapeutic writing or journaling, makes you identify and organize the thoughts bouncing around in your head, and then articulate them. At the same time, there is an auditory processing of your verbalization.
You might be asking, “Ok, and how does this help me cope with ADHD?” Such self-directed verbalizations about, say, getting started on a task helps with follow through.3 This likely is a combined effect of inhibition — stopping to consider what needs to be done and saying it — and the fact that the externalization of this information may reduce any emotional discomfort4 associated with the task, what I’ve called the “ugh” feeling. These factors also make the task seem more “doable” and increase the chance you will get started on it. Talking aloud to yourself — or to the dog or to a plant — is also a good way to get unstuck when writing, as speech is an innate skill whereas writing is a learned skill.
The Reverse Shopping Trip
Devoting time to planning one’s day and specific steps for tasks helps facilitate engagement. In my work with adults with ADHD, the approach to coping strategies can be like Goldilocks and the Three Bears — they can be used too little (so that they are not helpful) or too much (that they become overwhelming and a source of avoidance) and the job is to find what’s “just right.” Over-planning can be as unhelpful as under-planning for many people.
Susan struggled with crafting the household menu and muddling through the corresponding shopping trip. She had difficulties organizing and tracking the different ingredients and repeatedly changed the menu. Even once settling on a menu, the trip to the store was overwhelming with all of the options, tracking down items, and sensory overload. Many a shopping trip ended with a partially-filled cart abandoned in the middle of the store.
After Susan ruled out other coping options (such as online shopping and delivery), she and I reverse engineered examples of better shopping experiences. Creativity was a strength for Susan and she recalled times in a store and seeing items that gave her inspirations for meals. She agreed to an experiment with what we deemed “reverse shopping” — going to the store and figuring out the menu while there. She allotted more time for the trip because she predicted it would take her longer than usual but hopefully would be less frustrating.
Susan found this approach to be much better for her and made the menu and shopping less stressful. It played to her strengths and was an example that some coping strategies for adult ADHD require more time and effort to employ, with the trade-off that they will ultimately pay off with better and less vexing results.
Take a Breath
Impulsivity is an under-appreciated feature of adult ADHD. It plays a role in procrastination but also has many ripple effects in one’s social life, such as saying or doing the wrong thing. It is intertwined with emotional dyscontrol, which is now understood as a core feature of ADHD despite not appearing in the official diagnostic criteria.5
Mike struggled with anger management. Apart from ADHD, he had been teased and bullied when he was younger. Now, a muscular man in his mid-twenties, he was quick to see insults in otherwise innocuous comments or “looks” by others. On at least one occasion, Mike came very close to getting into legal trouble due to an overreaction based on such a wrong impression on his part.
Mike outlined how he would like to be towards others and handle situations when he felt activated in order to calm himself and have positive interactions. He worked to better recognize his “tells” for rising anger, such as increased heart rate and muscle tension. As an easy-to-use, actionable coping skill that was suggested was that he take a deep breath when activated, which would at least buy time and somewhat neutralize his physiological reaction.
At Mike’s next session he reported a successful trial run with the plan:
Mike: “This guy I was talking with kept looking at his phone and I started getting angry, so I took a breath. I kept listening to him but as the pressure built up and I got really uncomfortable, I realized that it was really not worth getting upset about.”
Therapist: “Wait, what do you mean by the pressure building up and being uncomfortable?”
Mike: “Holding your breath that long — all of a sudden you are not focused on being angry.”
Mike had taken the advice to “take a breath” as to mean “and hold it.” We had a laugh about it but also came to realize that it was a brilliant coping strategy for him. In fact, he continued this skill with continued good results.
The purpose of these examples is to foster hope about the prospect of change for adults with ADHD. Even if it seems that coping strategies have not worked, it is likely that they may have been abandoned, such as not replacing a lost planner, although it may still work; on the other hand, as in the cases above, there are ways to make them work for you.
I’d love to hear examples from readers of other unconventional adapted coping strategies for managing adult ADHD. Feel free to share them in the comments section.
1 Ramsay, J. R. (2020). Rethinking adult ADHD: Helping clients turn intentions into actions. American Psychological Association.
2 Barkley, R. A. (1997). ADHD and the nature of self-control. Guilford.
3 Kross, E. et al. (2014). Self-talk as a regulatory mechanism: How you do it matters. Journal of Personality and Social Psychology, 106, 304-324. doi: 10.1037/a0035173
4 Lieberman, M. D. et al. (2007). Putting feeling into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18, 421-428.
5 Adler, L. A. et al. (2017). The structure of adult ADHD. International Journal of Methods in Psychiatric Research, 26, e1555. doi: 10.1002/mpr.1555