Meeting Your Goals When You Have ADHD

Meeting Your Goals When You Have ADHDAs someone with attention deficit hyperactivity disorder (ADHD), you probably know all too well the difficulty of accomplishing your goals. It can seem utterly daunting.

That’s because realizing goals taxes the executive functions in your brain, said Roberto Olivardia, Ph.D, a clinical psychologist and clinical instructor in the department of psychiatry at Harvard Medical School. These functions include everything from organizing to prioritizing to making decisions to managing time, he said.

Tedious tasks are especially tough. “Laundry, paying bills, attending business meetings — things that are not intrinsically interesting can put an adult with ADD into a tailspin of inaction,” said Terry Matlen, ACSW, a psychotherapist and author of Survival Tips for Women with AD/HD.

Lack of reward with long-term goals adds to the challenge.

“ADHD brains are low in dopamine, a neurotransmitter associated with reward, arousal and motivation. Because of this, ADHD brains are starving for instant stimulation and reward,” Olivardia said.

It can seem like the odds are stacked against you in meeting your goals. But while accomplishing goals might be more challenging if you have ADHD, the key is to find the best strategies for you.

That’s what Matlen and Olivardia have done. In addition to being successful practitioners and seasoned experts in ADHD, both Matlen and Olivardia have ADHD. Here, they share insights to help you accomplish your goals.

1. Brainstorm backward. First, write down your final goal, Matlen said, “then go backward from there, and write down [all] the steps needed to accomplish the goal.” While it might seem silly, do this for seemingly straightforward tasks, too, she said. Take laundry, for instance. It’s boring and repetitive, has many steps and no one pats you on the back when you’re finished, she said.

Matlen suggested breaking it down like this: Write down, “Do family laundry.” Next, write out each step, such as:

  1. Pick up laundry from every room, and put it in the basket.

  2. Take baskets to laundry room.
  3. Sort lights and darks.
  4. Sort cold water and warm water. And so on.

Write this list on a poster, and paste it in your laundry area. As Matlen said, writing out specific steps gives your brain a roadmap to follow.

Splitting your goals into steps also helps you realize that success is within reach. When you’re working on a big project, it can feel demoralizing to realize that you haven’t finished it yet, Olivardia said. But when you break your goal into steps, you’re able to say, “I completed 4 out of 10 steps,” he said.

2. Reward yourself for every step. “People with ADHD have a higher degree of motivation if they get rewards along the way,” Olivardia said. So consider how you can reward yourself for every step accomplished.

3. Just do it. People with ADHD struggle with procrastination, which becomes especially problematic when you think you need to be motivated to get started. You don’t, Olivardia said. “In fact, getting started can get you motivated,” he said. (Here’s more tips on getting motivated when you have ADHD.)

4. Set a timer for one hour. “Time is an amorphous concept to those with ADHD,” Olivardia said. Setting a timer gives you “concrete parameters to work from,” he said. Plus, after the hour, you might even want to do more work, he added.

5. Focus on the end feeling. Visualize yourself finishing the project – and how great you’ll feel once you do, according to both experts. “Sometimes we focus too much on the actual task, rather than how it will make us feel when it’s completed,” Matlen said. Focus, for instance, on how good you’ll feel after paying your taxes, she said.

“Since ADHD-ers can lose a sense of urgency or excitement around a task easily, you may need to keep that alive in your imagination,” Olivardia said.

6. Focus on self-care. Whenever people with ADHD hyper-focus on a task, they ditch healthy self-care, such as getting enough sleep or even drinking enough water, Olivardia said. You worry that stopping will sabotage your progress, he said. “However, being tired and hungry are the very things that will guarantee that you will lose steam,” he said. So make sure you’re taking care of your bare essentials, including sleeping and eating well.

7. Take breaks. If you’re getting distracted easily – also common in ADHD – Olivardia suggested taking a complete break for 10 minutes. Then return to your task.

8. Work with a partner. Partnering up is especially helpful for tedious tasks, Matlen said. “If bill paying is a horrifying experience, set up a time each month with a friend and do it together,” she said.

Having a friend who keeps you accountable for your goal also helps, Olivardia said. “Sometimes just knowing that you will be reporting your progress — or lack of progress — can provide you with the sense of focus to stick with it,” he said.

9. Get creative. Think of how you can make meeting your goals a more enjoyable or interesting experience. For instance, play music when you’re cleaning your house or use colorful stickers for filing, Matlen said.

10. Get help. Hiring outside help doesn’t just help you meet your goal; it might even save you money. For instance, if you hire a bookkeeper to pay your bills and balance your account once a month, you’ll likely save money on bank and other late fees in the long run, Matlen said.

11. Don’t assume that you can’t accomplish goals.  “Most importantly, never assume that you are not meant to accomplish great things because you have ADHD,” Olivardia said. “It can feel that way because you know that you are executing goals in a different manner from your non-ADHD counterparts,” he explained. But there’s nothing wrong with using a different strategy.

One size never fits all. The key is to find specific tactics that work well for you. And, again, don’t forget that even though meeting your goals might be challenging, as Olivardia said, you can absolutely accomplish great things.

Are You a Hero in Waiting?

Are You a Hero in Waiting?This is a true story.

Imagine that you are at a Wal-Mart around midnight. Dark parking lot. Little security and yet a number of random people wandering around. A man with a little boy thrown over his shoulder passes you. The little boy is screaming and kicking and crying and yelling for his mama.

The man slaps and spanks the boy and is telling him to shut up. He never uses the boy’s name. There is no woman near them and the man is moving faster. Also, imagine the boy is blond and the man has dark hair. Onlookers shake their heads but do nothing.

What would you do? Would you watch and not do anything? Or would you intervene? Social psychologists tell us there is a very good likelihood we will do nothing.

But this is the story of a woman, Pam, who did.

Pam asked the security to go check on the boy. The security man did, and then turned away. Pam asked the security guard what transpired. As she does the man screams at her: “The little shit is crying for his mother like a pansy-ass.”

“At that moment,” said Pam as she recalled her ordeal, “I forgot to be scared.”

The man shoved the boy into the back set of the car all the while cursing and screaming at him. He got in the car and backed up. Pam stood behind the car and blocked the man from going. She walked over to the driver, told him to roll down his window and then asked the boy if the man was his dad. The boy said nothing.

The man pushed Pam back from the window and threw open the door. He swore at her, stumbled and fell onto the car next to his. He was drunk. Very drunk. As this was happening Pam went over to the boy and asked again if the man was his dad. She tells him she knows he is very good at telling the truth, and that she is just there to see what is the matter for all those tears. The man is quiet and never moves but mutters something and then laughs.

Pam faces the man, apologizes for inconveniencing him and tells him she knows how unpredictable children who are tired can be. But given the circumstances she was pretty sure a good dad like him would want people to care that no child was being abducted in their presence. She said she hopes she is wrong in her suspicion.

Pam’s powerful display of courage, acting to help a victim while others are not responding is a correction for one of the most replicable effects in social psychology. The bystander effect, or Genovese syndrome, is the name given to the phenomenon where the presence of bystanders decreases the likelihood that someone will intervene. In fact, there is an inverse relationship between the number of witnesses and the likelihood someone will help: The greater the number of bystanders, the less likely someone is to respond.

Researchers John Darley and Bibb Latene were interested in the 1964 murder of Kitty Genovese in New York City where witnesses to the murder did not respond. While there is controversy about the reports on the number of witnesses and their reasons for not responding, the newspaper reports of the murder and apathy inspired the researchers to conduct experiments to demonstrate the effect.

But there is more to Pam’s story than just speaking up.

Pam introduces herself to the boy and asks him again if the man is his dad. He nods and is able to tell her his daddy’s name. She then asks the man to show her his driver’s license. By then the security guard has returned to check the license, which is expired. The security guard hands the license back to the man and walks away.

He walks away.

Pam says in a very loud voice that she will be happy to wait until the police arrive so this little boy doesn’t have to drive in a car with a drunk driver who has an expired license. She then dials 911, asks the security guard to stay with her and she talks to the boy. The father is furious. He curses and kicks a can at Pam. It hits her in the shoulder and Pam is unmoved as she continues to talk to the boy, asking him about his mama. He tells Pam about her, his sister, and his grandpa.

When the police arrived Pam gave a statement and they arrested the man for public intoxication. Pam waited with the little boy, another policeman, and the security guard until the boy’s grandpa came to get him.

Pam has done more than challenge the bystander effect. She is an everyday hero. Research on the Genovese syndrome has resulted in three processes that are important for people to respond to others in distress. The first is to actually notice the situation. When there are many other people around we may narrow our awareness – so the first thing Pam did was realize something was happening with the man and the boy. In other words, she paid attention to her surroundings.

Second, those who respond interpret the situation as an emergency. Pam did this the moment she saw the boy being hit. The best response I have ever heard for an intervention came from a woman who witnessed another woman hit her child several times at a park. The witness told her to stop and the abusive parent said, “It is none of your business.” The woman who intervened said: “If you do this in public it makes it my business.”

Pam made it her business, which is the final point the researchers formulated. Once you notice, and interpret the situation as an emergency, then you finally take responsibility for helping.

This is an area Phil Zimbardo, another leading social psychologist, is studying: What it takes to be a hero. His latest endeavor involves fostering heroic imagination. He has noted that heroes are never going to conform to group norms and highlights the two core principles of heroism:

  1. Heroes act when others are passive.
  2. Heroes act sociocentrically, not egocentrically.

They act alone, and for the good of others. It also seems they don’t like to boast about their deeds. That is why we need to honor their stories and retell them when we hear about them. That is why Pam’s story appears here.

Dr. Zimbardo calls it Heroes in Waiting, and we need to be prepared. In his own words, we need to be “waiting for the right situation to come along, to put heroic imagination into action. Because it may only happen once in your life, and when you pass it by you’ll always know, I could have been a hero and I let it pass me by. So the point is thinking it and then doing it.”

Pam is an inspiration because she didn’t let her opportunity pass her by. I hope we can all do the same when it is our turn.

Responsibility for Treatment Compliance

Responsibility for Treatment ComplianceOne of the most difficult challenges to overcome when dealing with a mental illness is the temptation of the excuse.

With a psychiatric diagnosis comes an excuse for everything. Any bad behavior, lack of motivation, or failure can be passed off as a symptom or the result of an episode. The excuse is always available. Don’t take it.

No one’s asking you to take responsibility for having a mental illness. That’s not your fault.

But you have to take responsibility for your actions and for your recovery. Sure, unexpected things happen as a result of serious mental illness, but most of our behavior is within our control, or at least our influence. And the behavior that most influences our wellness is treatment compliance.

If you have a treatment regimen that works, stick with it. If you had one and left it, get back on it.

While many of us bemoan the fact that we’ll never be well, treatment success rates for mental illness are very high. The National Institute of Mental Health has shown success rate of treatment for schizophrenia of 60 percent, depression, 70 to 80 percent, and panic disorder, 70 to 90 percent.

Compare this to treatment success rates for heart disease of only 45 to 50 percent. But treatment only works if the patient complies with the doctor’s orders. So take your medicine as directed, stay away from non-prescribed drugs and alcohol, exercise, sleep, and eat well. Manage stress. Chances are you will get better. But you’ll lose your excuse. Then you’ll have to start taking responsibility for your actions.

Responsibility brings a sense of control. This is important because one who feels he has control over key aspects of his life is most destined for success and well-being. If all things that happen to me, or if my very own behavior, is beyond my control, why should I bother?

But if prescribed treatment brings me a measure of control over events and my behavior, then I can positively influence what happens to me and those I love. I’ll have to get out of bed, get off the disability insurance, go to work, and suffer the challenges that everyone faces. Life may even be a bit more boring. But I can contribute, connect with others, and work toward dreams I may have long ago abandoned. Yes, this can be very hard. I may have to deal with side effects and limitations. I may have to say no when I want to say yes. And compliance can be costly. But wellness is possible.

Unfortunately, access to treatment is not available to everyone. Finding a correct diagnosis and a successful treatment regimen can take years.

But if you have access to treatment, you have a responsibility to work with doctors, counselors, social workers, and any family and friends available to help you to find a successful treatment regimen. And then you have a responsibility to stick with it. Health can be more challenging than illness, but the life that results is always more satisfying.

 

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