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50 Tips On The Management
Adult Attention Deficit Disorder
by Edward M. Hallowell, M.D.
and John J. Ratey, M.D.
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
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
- 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 treating ADD.
- 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
- 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
- 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
- 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 limitations.
- Acknowledge and anticipate the
inevitable collapse of X% of projects undertaken, relationships entered into,
- 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 trouble.
- 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 you.
III. Mood Management
- 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 way.
- 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
- 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, even months.
- 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
- 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
- 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 itching to.
- 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
- 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
- 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, enjoyed.
- Reverse of #47. Don't stay too
long where you aren't understood or appreciated.
- Pay compliments. Notice other
people. In general, get social training, as from your coach.
- Set social deadlines.
Edward M. Hallowell, MD
142 North Road, Sudbury, MA 01776
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