Center for Cognitive Therapy
Mark E. Oakley, Ph. D.
Adult Attention-Deficit Disorder/Hyperactivity Disorder (ADHD)
ADHD is a neurobiological disorder that is unrelated to psychopathology, intelligence, laziness or aptitude. People with ADHD have problems with three primary symptom categories involving poor attention, high impulsivity and high levels of activity (hyperactivity). Some people with ADHD have more problems with one category than another. ADHD begins in childhood (some symptoms present before the age of 7) but often continues into adulthood.
If you have either 6 or more of the following symptoms of Inattention or 6 or more of the following symptoms of Hyperactivity/Impulsivity you may meet the diagnostic criteria of ADHD. The symptoms must be present in two or more settings (e.g. work and home) and must have a clinically significant impairment upon social, academic or occupational functioning with some symptoms occurring before age 7, and are not better accounted for by another disorder such as Anxiety or Depression.
Symptoms of Inattention:
- Often fails to give appropriate attention to details or makes careless mistakes in schoolwork, work or other activities.
- Often has difficulty sustaining attention in tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties of the workplace (not because of oppositional behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities.
- Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort.
- Often loses things necessary for tasks or activities.
- Is often easily distracted by extraneous stimuli.
- Is often forgetful in daily activities.
Symptoms of Hyperactivity/Impulsivity:
- Often fidgets with hands or feet or squirms in seat.
- Often leaves seat in classroom or in other situations where remaining seated is expected.
- Often runs about or climbs excessively in situations where this would be inappropriate (in adolescents or adults this may be experienced as subjective feelings of restlessness).
- Often has difficulty playing or engaging in leisure activities quietly.
- Is often “on the go” or often acts as if “driven by a motor”.
- Often talks excessively.
- Often blurts out answers before questions have been completed.
- Often has difficulty waiting turn.
- Often interrupts or intrudes upon others.
EVIDENCE BASED TREATMENT FOR ADHD:
The good news for individuals struggling with ADHD is that effective treatment has been developed that has received solid research supporting its efficacy. A treatment developed by a team of Harvard University researchers led by Steven A. Safren, Ph.D. has been shown to benefit the management of ADHD symptoms beyond the effects of medication. Since ADHD is a neurobiological disorder, medications are considered to be the first order treatment but this program provides effective coping skills that support substantial further improvement beyond the effects of medication.
This evidence based treatment program is utilized by Dr. Oakley as a core ingredient of managing ADHD and involves learning coping skills for improved organization and planning, addressing procrastination, and managing distractability.
As a result of problems created by ADHD many patients have secondary problems of Anxiety and Depression due to underachievement or perceived underachievement. This is also addressed in the course of ADHD treatment. The course of treatment depends upon the severity and impairment caused by ADHD but typically is effectively accomplished within an 8 to 12 weekly session protocol.
Time management is a critical aspect of treatment for ADHD. The following guidelines may be helpful to follow in the interim before beginning treatment:
Time management is perhaps the most overlooked ingredient to happiness. In fact, time management is a critical component of managing life effectively. Those who master this basic skill are more likely to experience happiness and those who don’t are more likely to feel that life is out of balance and to be disillusioned or dissatisfied.
One of the best definitions of “stress” is the perception that the demands upon you are greater than what you can reasonably accomplish. If you are disorganized, or if you consistently plan more things than you can reasonably accomplish in a given day, then you will feel an inordinate degree of stress. If you do not manage time well you may become chronically over-committed and routinely feel a sense of “time pressure”.
The good news is that Time Management is composed of easy to learn steps that if practiced can lead to an established routine that maximizes enjoyment and meaning in life. The following is an outline of the most critical steps in Time Management that should be practiced on a daily basis.
FOUR BASIC STEPS IN TIME MANAGEMENT:
- Make a list of everything you want to do or accomplish the next day. It is recommended that you do this the day before so that you start the day with a plan. If you start your day without a plan it is much more likely that you will be caught in the web of reacting rather than being proactive with staying on a steady course where you devote your time and energy to the things that really matter the most.
- Estimate the time required for each item and assign a priority to each item so that all of your items have a rank order. For example, if there are twenty items, you will have your items numbered from one to twenty with # 1 being the most important and #20 being the least important. Prioritizing the importance of each item gives you an opportunity to think about what is really important to you. This will help you to optimize the meaning, sense of accomplishment and level of happiness for each day.
- Ask yourself :”Is it really reasonable to do all of this in the allotted time?” If the answer is yes, you are ready to proceed.
- If the answer to question #3 is “no”, then set limits where you bump the lowest priority items to tomorrow and you are left with a manageable to-do-list that focuses upon your highest priority items. Keep in mind that there is a charm to recognizing that you have limits ( we all do whether we like it or not). If you try to ask more out of yourself than what you reasonably have time to do you won’t get it anyway (without paying a very high price) so why not just stay focused on the most important things that you can reasonably do?
Time management is a lot like having a map or compass to chart a route towards getting the most out of your life. If you have a planned route for a destination and stay on it you are much more likely to get there. With effective time management, planning your route starts with making a list of all the things you want to do the next day. When making your list make sure it includes things that will bring pleasure and meaning as well as exercise, eating regular nutritious meals, time with family and friends and getting enough rest and sleep.
COMMON PROBLEMS WITH APPLICATIONS OF TIME MANAGEMENT:
- Unanticipated Demands or Priorities Change: If unanticipated demands arise during the day after you already have your To-Do-List established, before you commit to doing it, take a moment to ask yourself if it is a higher priority than what you already have scheduled. If it is a higher priority but you already have a full schedule such that adding one more thing will be more than you can reasonably handle, then bump items from your list that are lower priorities until you are left with a manageable amount of items that are within your limits. A cardinal rule of Time Management is to never let low priority items interfere with high priority items.
If you do not make this adjustment you run the risk of over-committing yourself and feeling needless stress. You can only do what you can do anyway, and if you ask for more from yourself you won’t get it without paying a high price. Furthermore, you also run the risk of not getting higher priority items completed. You will discover that your life will be much more enjoyable when you operate within your limits while focusing on the highest priority items each day.
- Don’t let how you feel determine what you do. Unfortunately, you are probably going to notice that many high priority items are difficult and not very pleasant. You won’t necessarily, “feel” like doing them. It is important to prove to yourself that you can do them even though you don’t feel like doing them. Furthermore, getting high priority items completed will feel much better than avoiding them. It is common and an example of human nature to pursue lower priority (and more pleasurable) items to avoid facing unpleasant high priority items. Unfortunately, these tasks don’t go away and you just feel more stressed from unfinished tasks that are important to complete.
- “I don’t have enough time (to manage my time).” While it is rare to hear this stated so directly, time pressure certainly plays a role initially in not taking the time to practice Time Management. It is ironic that those who need Time Management the most are those with the most time pressure and therefore least inclined to take the time to practice the steps of time management. I strongly recommend that you view practicing all the steps of time management as being an experiment. The experiment will be to compare your present method of dealing with your daily challenges to practicing Time Management. If Time Management helps you to be more productive, while maintaining a balanced lifestyle and significantly increase your general level of happiness, do you think you will want to continue with practicing Time Management? It has been my experience that practicing Time Management is a “much better deal” and that once you experience this it will be much easier to make it a part of your daily routine.