How much do you know about ADHD? And how it affects those who are diagnosed with it? People with ADHD show a persistent pattern of inattention and/or hyperactivity–impulsivity that interferes with their day-to-day functioning. Psychoeducation involves helping therapy clients understand their challenges so that they are better able to manage their lives. The subtitle of this book is “Proven strategies to succeed at work, at home and in relationships” so it is a source of help to those diagnosed with ADHD. Yet we all have a responsibility to understand how ADHD impacts people’s behaviour as we work in increasingly neurodiverse workplaces. It will also be important for Human Resources professionals, coaches, therapists and other helpers who support those with ADHD. Book review: Taking charge of Adult ADHD by Russell A Barkley PhD.
About ADHD
ADHD stands for Attention Deficit Hyperactivity Disorder. It is a medical condition. A person with ADHD has differences in brain development and brain activity that affect attention, the ability to sit still and their self-control.
Common ADHD symptoms include: time management issues, trouble concentrating, easily distracted, highly impulsive, difficulty with organisation, talking too much, difficulties listening to others, interrupting when others speak, struggling to articulate views succinctly, restlessness, forgetfulness and easily-aroused emotions. Hyperactivity is more often observed in children with ADHD. ADHD causes serious impairment across all domains of adult life from education to work and family.
What is ADHD – About ADHD (adhduk.co.uk) estimates that 2.6 million people in the UK have ADHD (694,000 children). Two thirds of people who have ADHD as children still have it when they are adults. However, only 600,000 of these people have been formally diagnosed. 98% of symptoms start when people are under 16 years old.
The definition of ADHD is set out by the Diagnostic and Statistical Manual of Mental Disorders. Diagnosis can only be performed by a medical professional. There are 18 symptoms to diagnose ADHD – nine focus on inattention and nine on hyperactivity-impulsivity DSM-5 Criteria for ADHD: How Is Adult ADHD Evaluated? – ADDA – Attention Deficit Disorder Association. (They are also listed in the appendix of the book). People are supposed to have at least five of the symptoms in order to be diagnosed with ADHD. Symptoms aren’t enough to produce a diagnosis of ADHD – you have to be impaired by those symptoms.
There are interesting statistics showing the percentage of Adults with ADHD experiencing the various symptoms compared to adults in the community. There are three presentations of ADHD – predominantly hyperactive, predominantly inattentive (30%) and combined (65%).
Sometimes ADHD is confused with Bipolar Disorder.
In childhood ADHD is three times more common in boys than girls, it is somewhat more common in urban and population-dense regions and is more common in some professions (e.g. military, performing artists, sales, professional athletes, physical education teachers and entrepreneurs).
Most adults who have ADHD and are seen in clinics (80-85%) have at least one other mental health condition or psychological disorder including anxiety, learning disabilities and addictions.
Overview of the book Taking Charge of Adult ADHD by Russell A Barkley PhD
Published in 2022, this 260 page book will be valuable to all those who have ADHD – and their loved ones. It’s clear, easy to read and practical. There are questions and an assessment to help you decide if it is likely you have ADHD – and urges you to obtain a medical evaluation if so.
It provides scientific facts, describes the best treatments, provides strategies and skills to overcome symptoms and helps those with ADHD play to their strengths. More importantly, it shares stories of those who have ADHD so we can appreciate what life is like for them.
It’s a realistic but positive book – it shows that those with ADHD can obtain the necessary medications to alleviate many of their symptoms.
It’s helpful. There’s insight into what to expect at a medical evaluation (which includes psychological tests, questions about hereditary factors and views from those who are close to you). It describes in detail the medications that can normalise the behaviour of 50-65% of those with ADHD and substantially improve the behaviour of another 20-30% (Note that the author is American so there may be variations on medications in the UK).
It also offers practical techniques to minimise the impact of other symptoms. And there are exercises to help you self-assess in each area and decide on which action might be appropriate.
I have recommended the book to therapy clients who suspect they have ADHD. Many found it helpful, but some found it a little repetitive and sometimes tough going technically.
Taking charge of Adult ADHD book contents:
Step One – To get started, get evaluated
Step Two – Change your mindset: Know and own your ADHD
Step Three – Change your brain: Medications for mastering ADHD
Step Four – Change your life: Everyday rules for success
Step Five – Change your situation: Mastering ADHD in specific areas of your life (education, work, money, relationships, driving, health, lifestyle, other emotional problems, drugs and crime)
Step One – Get evaluated
There’s a detailed description of what to expect when you are evaluated by a medical professional and how to prepare for the examination.
Step Two – Change your mindset
Having a diagnosis of ADHD provides access to medication, psychological therapies, coaching, strategies, tools, coping skills, support and accommodations in education and the workplace.
Accepting the diagnosis can be liberating for adults. Reframing your view of yourself and your life to put ADHD in the picture is amongst the most crucial changes you can make to master ADHD. You start by coming to know it, then you own it and finally you’re able to work with it.
What causes ADHD? As far as its known – it is neurological (in the brain) and hereditary (in the genes). There are differences in brain development in those with ADHD. Problems cluster around three areas:
- Poor inhibition (e.g. impatient, impulsive, off-the-cuff comments, difficulty stopping activities)
- Poor self-regulation (e.g. can’t wait for payoff, fail to consider consequences, skip out early to do something more fun, start projects without listening to directions carefully)
- Problems with executive functions – Those mental abilities that allow us to regulate our own behaviour are under-developed in those with ADHD. For example, they may experience: a poor sense of time, forget to do things, be unable to comprehend what is read, get frustrated or emotionally upset easily, be poorly organised and have trouble planning and meeting goals.
A little repetitively, the main problem areas are explored in more detail:
- Poor self-management relative to time, planning and goals (“ADHD is a form of time blindness”)
- Poor self-organisation, problem-solving and working memory
- Poor self-restraint
- Poor self-motivation
- Poor emotional self-regulation
It notes that ADHD doesn’t cause problems with knowledge (the rear part of brain) but with performance (the front part of brain).
Resisting impulses
“We all need to stop and think before we act”. This help combat impulsivity. A number of situations are explored:
- Dragged away by distractions
- Too quick on the trigger
- One track mind
Six processes involved in self-control (inhibition)
- Self-control is a self-directed action (e.g. engage in self-restraint by pausing, writing yourself notes to break down complex decisions and remembering things to be done)
- Self-directed actions (seven are described) are designed to change your subsequent behaviour
- The change in subsequent behaviour is designed to achieve a net gain of positive outcomes across both the short and long term
- Self-control depends on a preference for larger delayed rewards over smaller, immediate ones
- Self-control bridges the time lapse between an event, our response and an outcome
- For self-control to occur, we need the capacity for both hindsight and foresight
Seven executive functions (abilities) that make up self-control
Executive functions are more obvious in children and more internalised in adults. They allow us to do things in a virtual world without really doing them in the real world. We get to simulate our ideas and plans before implementing them. The author describes the executive functions and explores how those with ADHD are affected in each area.
Research suggests there are seven different actions we use to monitor our own behaviour, stop ourselves, think things over and guide our behaviour while controlling our emotions and motivations to optimise our success at attaining goals.
- Self-awareness – We use the “mind’s mirror” and are aware of ourselves, our surroundings and others. People with ADHD may be less aware of how loudly they’re talking, how much they’re talking and how much they are moving while talking (verbal heedlessness). People with ADHD may not realise how emotional they are becoming during social exchanges. (One of the reasons why corroboration from others is required during ADHD assessments)
- Inhibition (see above)
- Nonverbal working memory – The ability to hold information in mind and engage in visual imagery. Nonverbal working memory helps us create a map that leads us to the future we want. We gain a powerful tool called imitation (“photocopy” what we see someone else do). Vicarious learning is avoiding what someone else did that proved ineffective. It allows us to foresee the consequences of our actions, sense the flow of time, learn to defer gratification and value co-operation and sharing. This is often impaired in those with ADHD.
- Verbal working memory – Allows us to describe and contemplate an event or situation. It makes problem-solving possible and allows us to formulate rules and plans. We can hold in mind what we have read or heard from others. Moral reasoning is possible. With ADHD you may speak too loudly or too much and don’t use self-talk to control yourself or solve problems. There may be difficult setting your own standards and making plans.
- Emotion regulation – Allows us to control our own arousal, motivate ourselves, express emotion in socially acceptable ways and have a sense of mastery over ourselves. With ADHD your emotional reactions may be impulsive and disproportionate.
- Self-motivation – With ADHD, you may find it difficult to motivate yourself to do what you need to do.
- Planning/Problem-solving – Imagination helps is in this area – to consider all the options, decide on the best sequence of actions to reach a goal. It also allows creativity and innovation. With ADHD you may not be able to think on your feet, you may having trouble getting or staying organised. Putting ideas in the right order may prove a challenge.
Nature of ADHD and how you can master it
The author returns to the theme of time-blindness and notes “In a sense, your intellect (knowledge) has been disconnected from your daily actions (performance)”.
The author suggests you fit the various solutions to the specific problem. For example, transition planning when engaging in a new activity, cues to stop and be self-aware, externalise information that is usually held in mind, use timers and small incentives and break tasks into smaller chunks.
Own your ADHD
A diagnosis of ADHD may prompt strong emotions (sadness, frustration, anger, grief) and it may require therapy to process these. But ADHD is an explanation, not an excuse. The author repeats that having ADHD is not your fault (there are research references relating to the cause) but accepting it is your responsibility.
There are suggestions for shaping your environment to help you manage your ADHD. There are suggestions about suitable career options with supportive environments.
The author urges you to check the authority and veracity of sources of information about ADHD. And there are lists of helpful organisations.
Step Three – Change your brain
“Research shows medications are the most effective treatment for ADHD, being at least twice as effective as non-medication treatments and improving symptoms in 70-95% of adults who take them”.
“We know that ADHD medications can normalize the behaviour of 50-65% of those with ADHD and result in substantial improvements in another 20-30% of people with the disorder”
There follows quite a long and technical section on medications (how they work neurogenetically, how they are taken, the pros and cons) for mastering ADHD. Medications fall into three groups:
- stimulants (potentially addictive)
- nonstimulants
- antihypertensives
There’s a table listing the medication, the duration of activity and how they are supplied.
What to expect from treatment (Note: The psychiatrist addresses the physical symptoms and therapists help with the emotional adjustment).
There’s a reminder of what happens at the physical examination and interview. And a reassuring note that you have about a 75% chance of responding to whatever ADHD drug is tried although different dosages might require experimentation.
The psychiatrist usually monitors progress weekly initially and then there are follow-up exams every 3-6 months. An ADHD Symptom Tracking Scale is provided in the book. There’s a warning that the medication may restrict users’ range of emotions and creativity.
Step Four – Change your life (everyday rules for success)
There are eight rules (along with practical tools) for everyday success once the medication is working
- Stop the Action!
- Assess where impulsivity hurts you most and practice resisting impulses (e.g. slow breathing, slow down speech, place your hand over your mouth, repeat back what others say)
- See the past – and then see the future
- Identify your weaknesses in nonverbal working memory. Use an imaginary visual device to turn on your mind’s eye or a tangible visual aid
- Say the past – and then the future
- Talk to yourself – become your own interviewer or narrate what’s happening out loud
- Externalise key information
- Obtain something to rely on besides your own memory. Put physical cues in plain view. Make lists of steps or procedures to follow. Carry a journal at all times. Note down anything you agree to do with or for others.
- Feel the future
- Figure out where you are least motivated to get things done. Ask yourself how it will feel when things are done. Cut out pictures of rewards.
- Break it down and make it matter
- Break down longer-term tasks into smaller units – perhaps showing what must be done each day and then into 15 minute tasks. Make yourself accountable to someone else. Give yourself little rewards as you accomplish each small objective.
- Make problems external, physical and manual
- Create visual aids you can scan, understand what type of learner you are (e.g. visual, auditory, tactile etc)
- Have a sense of humour
- Smile and mention your ADHD is to blame, apologise and indicate what you will do next.
There’s an interesting comment about emotions: “Scientists studying human emotion concluded that a major function is to cause or motivate us to act. Although emotions are complex, certain emotions generally lead to certain types of action e.g.
- Fear leads to ‘fight or flight”
- Anger leads us to right a wrong
- Joy leads to the urge to keep doing what we’re doing
- Shame dissuades us from repeating the act”
Step Five – Change your situation
There’s an interesting chart showing how people with ADHD are impaired in activities such as work, home, social, clubs, school and dating compared to those in the general population.
This is followed with ideas to help in different situations, for example:
Education – Those without a diagnosis are likely to suffer more than those who do and where accommodations have been made. A minority of adults with ADHD also have specific learning disabilities. It suggests connecting with those responsible for ADHD and other special educational needs (i.e. SEND representatives in the UK) and obtaining a coach or mentor. It suggests using tools such as daily assignment calendars, journals, notebooks and coloured folders. Schedule harder classes for your “peak performance” times. Record lessons and also take notes to maintain alertness. Exercise before exams. Use SQ4R (Survey and draft questions, Read, Recite, Write and Review) for reading comprehension. Use a stopwatch during timed tests. Avoid caffeine and nicotine.
Work – Adults with ADHD were found to change jobs more often than those without. Seek a career that accommodates (hyper)activity – it notes careers that are more ADHD-friendly. Seek support from supervisors. Use professional life coaches or vocational counsellors. Choose a suitable work environment (noisy, open plan offices can cause issues for those with ADHD) or use noise-cancelling headphones. Minimise distractions by checking emails periodically. Speak to the Human Resources department. Take notes during meetings. Cultivate allies.
Money – Learn to produce financial plans and budgets. Use community resources (e.g. debt advice lines). Ask a partner or parent to manage your money. Keep living expenses below 90% of your monthly earnings and save the rest. Obtain health and disability insurance, Check your bank statements every month. Operate on a cash basis to curb spending. Consider CBT to control impulse buying. Do not sign credit agreements without talking to a “money manager”.
Relationships – Problems for those with ADHD with managing anger, frustration and hostility can cause social conflict. ADHD diminishes your ability to monitor ongoing behaviour which might include dominating conversations, failing to listen closely, not taking turns, making tactless comments and failing to honour social etiquette. Other issues in intimate relationships, parenting and friendships are described.
Driving, health and lifestyle risks – Adults with ADHD receive three to five times as many speeding tickets and more parking tickets.
Other mental and emotional problems – 80% of adults with ADHD have at lest one other psychiatric disorder. More than 50% have at least two other disorders. There are also references to the fact that those with ADHD are more likely to have substance abuse issues.
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