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Added Mar. 29, 2004
50 Tips On The Management of Adult Attention Deficit Disorder
available courtesy of the author and Attention Deficit Disorder Resources,
a non-profit organization based in Tacoma, whose purpose is to help people
with Attention Deficit Disorder achieve their full potential. We have
numerous materials as well as a quarterly newsletter for sale. Phone:
Address: ADD Resources, 223 Tacoma Av S #100, Tacoma WA
E-mail: email@example.com; Web
The treatment of ADD begins with hope. Most people who discover they
have ADD, whether they be children or adults, have suffered a great deal
of pain. The emotional experience of ADD is filled with embarrassment,
humiliation, and self-castigation. By the time the diagnosis is made, many
people with ADD have lost confidence in themselves. Many have consulted
with numerous specialists, only to find no real help. As a result, many
have lost hope.
The most important step at the beginning of treatment is to instill
hope once again. Individuals with ADD may have forgotten what is good
about themselves. They may have lost, long ago, any sense of the
possibility of things working out. They are often locked in a kind of
tenacious holding pattern, bringing all theory, considerable resiliency,
and ingenuity just to keeping their heads above water. It is a tragic
loss, the giving up on life too soon. But many people with ADD have seen
no other way than repeated failures. To hope, for them, is only to risk
getting knocked down once more.
And yet, their capacity to hope and to dream is immense. More than most
people, individuals with ADD have visionary imaginations. They think big
thoughts and dream big dreams. They can take the smallest opportunity and
imagine turning it into a major break. They can take a chance encounter
and turn it into a grand evening out. They thrive on dreams, and they need
organizing methods to make sense of things and keep them on track.
But like most dreamers, they go limp when the dream collapses. Usually,
by the time the diagnosis of ADD has been made, this collapse has happened
often enough to leave them wary of hoping again. The little child would
rather stay silent than risk being taunted once again. The adult would
rather keep his mouth shut than risk flubbing things up once more. The
treatment, then, must begin with hope.
We break down the treatment of ADD into five basic areas:
- Structure, support, and coaching
- Various forms of psychotherapy
In this pamphlet we will outline some general principles that apply
both to children and adults concerning the non-medication aspects of the
treatment of ADD. One way to organize the non-medication treatment of ADD
is through practical suggestions or "tips" on management. Fifty such tips
are presented below:
Insight and Education
- Be sure of the diagnosis. Make sure you're working with a
professional who really understands ADD and has excluded related or
similar conditions such as anxiety states, agitated depression,
hyperthyroidism, manic-depressive illness, or obsessive-compulsive
- Educate yourself. Perhaps the single most powerful treatment for ADD
is understanding ADD in the first place. Read books. Talk with
professionals. Talk with other adults who have ADD. You'll be able to
design your own treatment to fit your own version of ADD.
- Coaching. It is useful for you to have a coach, for some person near
you to keep after you, but always with humor. Your coach can help you
get organized, stay on task, give you encouragement or remind you to get
back to work. Friend, colleague, or therapist (it is possible, but risky
for your coach to be your spouse), a coach is someone to stay on you to
get things done, exhort you as coaches do, keep tabs on you, and in
general be in your corner. A coach can be tremendously helpful in
- Encouragement. ADD adults need lots of encouragement. This is in
part due to their having many self-doubts that have accumulated over the
years. But it goes beyond that. More than the average person, the ADD
adult withers without encouragement and positively lights up like a
Christmas tree when given it. They will often work for another person in
a way they won't work for themselves. This is not "bad", it just is. It
should be recognized and taken advantage of.
- Realize what ADD is NOT, i.e., conflict with mother, etc.
- Educate and involve others. Just as it is key for you to understand
ADD, it equally if not more important for those around you to understand
it--family, job, school, friends. Once they get the concept they will be
able to understand you much better and to help you as well.
- Give up guilt over high-stimulus-seeking behavior. Understand that
you are drawn to high stimuli. Try to choose them wisely, rather than
brooding over the "bad" ones.
- Listen to feedback from trusted others. Adults (and children, too)
with ADD are notoriously poor self-observers. They use a lot of what can
appear to be denial.
- Consider joining or starting a support group. Much of the most
useful information about ADD has not yet found its way into books but
remains stored in the minds of the people who have ADD. In groups this
information can come out. Plus, groups are really helpful in giving the
kind of support that is so badly needed.
- Try to get rid of the negativity that may have infested your system
if you have lived for years without knowing what you had was ADD. A good
psychotherapist may help in this regard.
- Don't feel chained to conventional careers or conventional ways of
coping. Give yourself permission to be yourself. Give up trying to be
the person you always thought you should be--the model student or the
organized executive, for example--and let yourself be who you are.
- Remember that what you have is a neuropsychiatric condition. It is
genetically transmitted. It is caused by biology, by how your brain is
wired. It is NOT a disease of the will, nor a moral failing. It is NOT
caused by a weakness in character, nor by a failure to mature. It's cure
is not to be found in the power of the will, nor in punishment, nor in
sacrifice, nor in pain. ALWAYS REMEMBER THIS. Try as they might, many
people with ADD have great trouble accepting the syndrome as being
rooted in biology rather than weakness of character.
- Try to help others with ADD. You'll learn a lot about the condition
in the process, as well as feel good to boot.
- External structure. Structure is the hallmark of the
non-pharmacological treatment of the ADD child. It can be equally useful
with adults. Tedious to set up, once in place structure works like the
walls of the bobsled slide, keeping the speedball sled from careening
off the track.
- Make frequent use of:
- notes to self
- Color coding. Mentioned above, color-coding deserves emphasis. Many
people with ADD are visually oriented. Take advantage of this by making
things memorable with color: files, memoranda, texts, schedules, etc.
Virtually anything in the black and white of type can be made more
memorable, arresting, and therefore attention-getting with color.
- Use pizzazz. In keeping with #15, try to make your environment as
peppy as you want it to be without letting it boil over.
- Set up your environment to reward rather than deflate. To understand
what a deflating environment is, all most adult ADD'ers need do is think
back to school. Now that you have the freedom of adulthood, try to set
things up so that you will not constantly be reminded of your
- Acknowledge and anticipate the inevitable collapse of X% of projects
undertaken, relationships entered into, obligations incurred.
- Embrace challenges. ADD people thrive with many challenges. As long
as you know they won't all pan out, as long as you don't get too
perfectionistic and fussy, you'll get a lot done and stay out of
- Make deadlines.
- Break down large tasks into small ones. Attach deadlines to the
small parts. Then, like magic, the large task will get done. This is one
of the simplest and most powerful of all structuring devices. Often a
large task will feel overwhelming to the person with ADD. The mere
thought of trying to perform the task makes one turn away. On the other
hand, if the large task is broken down into small parts, each component
may feel quite manageable.
- Prioritize. Avoid procrastination. When things get busy, the adult
ADD person loses perspective: paying an unpaid parking ticket can feel
as pressing as putting out the fire that just got started in the
wastebasket. Prioritize. Take a deep breath. Put first things first.
Procrastination is one of the hallmarks of adult ADD. You have to really
discipline yourself to watch out for it and avoid it.
- Accept fear of things going well. Accept edginess when things are
too easy, when there's no conflict. Don't gum things up just to make
them more stimulating.
- Notice how and where you work best: in a noisy room, on the train,
wrapped in three blankets, listening to music, whatever. Children and
adults with ADD can do their best under rather odd conditions. Let
yourself work under whatever conditions are best for you.
- Know that it is O.K. to do two things at once: carry on a
conversation and knit, or take a shower and do your best thinking, or
jog and plan a business meeting. Often people with ADD need to be doing
several things at once in order to get anything done at all.
- Do what you're good at. Again, if it seems easy, that is O.K. There
is no rule that says you can only do what you're bad at.
- Leave time between engagements to gather your thoughts. Transitions
are difficult for ADD'ers, and mini-breaks can help ease the transition.
- Keep a notepad in your car, by your bed, and in your pocketbook or
jacket. You never know when a good idea will hit you, or you'll want to
remember something else.
- Read with a pen in hand, not only for marginal notes or underlining,
but for the inevitable cascade of "other" thoughts that will occur to
- Have structured "blow-out" time. Set aside some time in every week
for just letting go. Whatever you like to do--blasting yourself with
loud music, taking a trip to the race track, having a feast--pick some
kind of activity from time to time where you can let loose in a safe
- Recharge your batteries. Related to #30, most adults with ADD need,
on a daily basis, some time to waste without feeling guilty about it.
One guilt-free way to conceptualize it is to call it time to recharge
your batteries. Take a nap, watch T.V., meditate. Something calm,
restful, at ease.
- Choose "good", helpful addictions such as exercise. Many adults with
ADD have an addictive or compulsive personality such that they are
always hooked on something. Try to make this something positive.
- Understand mood changes and ways to manage these. Know that your
moods will change willy-nilly, independent of what's going on in the
external world. Don't waste your time ferreting out the reason why or
looking for someone to blame. Focus rather on learning to tolerate a bad
mood, knowing that it will pass, and learning strategies to make it pass
sooner. Changing sets, i.e., getting involved with some new activity
(preferably interactive) such as a conversation with a friend or a
tennis game or reading a book will often help.
- Related to #33, recognize the following cycle which is very common
among adults with ADD:
- Something "startles" your psychological system, a change or
transition, a disappointment or even a success. The precipitant may be
quite trivial. This "startle" is followed by a mini-panic with a sudden
loss of perspective, the world being set topsy-turvy. You try to deal
with this panic by falling into a mode of obsessing and ruminating over
one or another aspect of the situation. This can last for hours, days,
- Plan scenarios to deal with the inevitable blahs. Have a list of
friends to call. Have a few videos that always engross you and get your
mind off things. Have ready access to exercise. Have a punching bag or
pillow handy if there's extra angry energy. Rehearse a few pep talks you
can give yourself, like, "You've been here before. These are the ADD
blues. They will soon pass. You are O.K."
- Expect depression after success. People with ADD commonly complain
of feeling depressed, paradoxically, after a big success. This is
because the high stimulus of the chase or the challenge or the
preparation is over. The deed is done. Win or lose, the adult with ADD
misses the conflict, the high stimulus, and feels depressed.
- Learn symbols, slogans, sayings as shorthand ways of labelling and
quickly putting into perspectives slip-ups, mistakes, or mood swings.
When you turn left instead of right and take your family on a 20-minute
detour, it is better to be able to say, "There goes my ADD again," than
to have a 6-hour fight over your unconscious desire to sabotage the
whole trip. These are not excuses. You still have to take responsibility
for your actions. It is just good to know where your actions are coming
from and where they're not.
- Use "time-outs" as with children. When you are upset or
overstimulated, take a time-out. Go away. Calm down.
- Learn how to advocate for yourself. Adults with ADD are so used to
being criticized, they are often unnecessarily defensive in putting
their own case forward. Learn to get off the defensive.
- Avoid premature closure of a project, a conflict, a deal, or a
conversation. Don't "cut to the chase" too soon, even though you're
- Try to let the successful moment last and be remembered, become
sustaining over time. You'll have to consciously and deliberately train
yourself to do this because you'll just as soon forget.
- Remember that ADD usually includes a tendency to overfocus or
hyperfocus at times. This hyperfocusing can be used constructively or
destructively. Be aware of its destructive use: a tendency to obsess or
ruminate over some imagined problem without being able to let it go.
- Exercise vigorously and regularly. You should schedule this into
your life and stick with it. Exercise is positively one of the best
treatments for ADD. It helps work off excess energy and aggression in a
positive way, it allows for noise-reduction within the mind, it
stimulates the hormonal and neurochemical system in a most therapeutic
way, and it soothes and calms the body. When you add all that to the
well-known health benefits of exercise, you can see how important
exercise is. Make it something fun so you can stick with it over the
long haul, i.e., the rest of your life.
- Make a good choice in a significant other. Obviously this is good
advice for anyone. But it is striking how the adult with ADD can thrive
or flounder depending on the choice of mate.
- Learn to joke with yourself and others about your various symptoms,
from forgetfulness, to getting lost all the time, to being tactless or
impulsive, whatever. If you can be relaxed about it all to have a sense
of humor, others will forgive you much more.
- Schedule activities with friends. Adhere to these schedules
faithfully. It is crucial for you to keep connected to other people.
- Find and join groups where you are liked, appreciated, understood,
- Reverse of #47. Don't stay too long where you aren't understood or
- Pay compliments. Notice other people. In general, get social
training, as from your coach.
- Set social deadlines.
Anthony Kane, MD
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