July 3, 2020

Taking Charge of Adult ADHD by Russell A. Barkley and Christine M. Benton

Kindle Highlights

One of the most tragic consequences of ADHD. You might think you’re doing what you desire. Yet if you can’t inhibit your behavior, you miss out on the delay between an event and your response. That delay is essential: It gives you the chance to think. Even more critically, that delay empowers you to choose freely. LOCATION: 1107

  • Nonverbal working memory  
  • Verbal working memory  
  • Emotion regulation  
  • Planning/problem solving LOCATION: 1216

On internal/external manifestations of executive functions

Executive functions are more obvious in children and more internalized in adults LOCATION: 1222

Executive functions were likely also public or obvious early in human evolution, when the human brain was much more primitive. LOCATION: 1225

Six-year-old Lena puts her hand over her mouth when she wants to tell a secret that her friends just told her not to. At age 16, she won’t need the physical restraint; she’ll use internal self-talk to stop herself even if she really wants to tell. Eight-year-old Rico softly but audibly repeats Stay inside the lines” and Don’t push too hard on the pencil” during classroom writing assignments to keep himself focused on the teacher’s rules and reminders. When he’s older, he’ll be able to use his mind’s voice” so automatically that he may not even be aware that he’s issuing his own silent reminders. Crissy and her classmates start out using their fingers, some beads, and then a number line on their desk to carry out the steps to solve a math problem. As they mature, they’ll be able to complete problems using mental manipulation. LOCATION: 1227

Planning and problem solving (‘using the mind’s playground’)

How ADHD Interferes with Planning and Problem Solving Are your problems with self-control connected to an inability to plan and problem-solve? You can’t think on your feet. Yes, I know: people usually view your tendency to react fast as a negative. But thinking on your feet means choosing a wise course of action quickly when the need arises suddenly, as it so often does in daily life. Not only is it tough for you to hold lots of information in mind (because of deficits in working memory), but without the planning/problem-solving executive function you can’t manipulate the information quickly to plan out possible courses of action or to problem-solve your way around obstacles. NOTE: I have to plan and problem-solve very consciously; I need time to process LOCATION: 1566

You can’t get or stay organized. Even when circumstances don’t call for a snap decision, you’re going to have trouble keeping materials and data organized. This goes for everything from the documentation for your tax return to your files at work LOCATION: 1574

Every couple of years Marty decided to redo her family’s personal financial files because she could never find anything.” She would yank everything out of the file drawers and start trying to come up with her own system. But invariably she quickly got lost in all the paper, and her husband, Gary, would come home to find files and documents scattered everywhere. LOCATION: 1577

Putting ideas in the correct order is a big challenge for you. Keep in mind that when you take something apart, you have to put it together in a certain order for it to operate correctly or make sense. This means that part of the process going on in this executive function module involves assembling ideas into their correct order so that they function as intended to solve the problem or make sense in reality. Reasoning, problem solving, planning, explaining, writing, and otherwise conveying your ideas rapidly and in a logical sequence are all going to be tough tasks for you. LOCATION: 1580

The Four Executive Functions That Foster Self-Control

  • The mind’s eye
  • The mind’s voice
  • The mind’s heart
  • The mind’s playground NOTE: The mind’s playground is the one I have the most trouble with LOCATION: 1594

On the time component of ADHD

It’s a condition that robs you of the ability to ignore impulses. It’s a deficit in the brain’s executive functioning that makes it very difficult to regulate and organize your behavior over time to prepare best for the future. LOCATION: 1599

To put it simply, you and other adults with ADHD are blind to time—or at least myopic. You’re not lacking knowledge or skill. Your problems lie in the executive mechanisms that take what you already know and the skills you already possess and apply them to more effective behavior toward others and the future. In a sense, your intellect (knowledge) has been disconnected from your daily actions (performance). You may know how to act but may not act that way when placed in social settings where such action would benefit you. LOCATION: 1603

Treatments for ADHD will be most helpful when they assist you in doing what you know at the point of performance in the natural environments where you conduct your daily life.  The farther away in space and time a treatment is from this point, the less likely it is to help you.  Assistance with the time, timing, and timeliness of behavior is critical. This means modifying your environment to help you do what you need to do when you need to do it. It also means keeping your aids in place. NOTE: Overlaps with some of the advice in Atomic Habits about designing your environment LOCATION: 1617

Strategies

Externalize information that is usually held in the mind. NOTE: Related to my advice on Your brain is a sieve- write everything down LOCATION: 1626

Use external incentives. Arrange for frequent external types of motivation to help get you through any job. For instance, break your project into smaller steps and give yourself a small reward for completing each hour or half-hour of sustained work. LOCATION: 1643

There is no scientific evidence for the effectiveness of intervention outside the points of performance in your life where your major problems occur. Avoid talk- or insight-oriented therapy, psychoanalysis, weekly group therapy focusing on complaining, etc. LOCATION: 1660

Replace distractions with reinforcers to focus on the task at hand. Use whatever physical prompts will keep your mind focused on the task and goals at hand. LOCATION: 1663

Externalize your rules. Make the rules into physical lists. Post signs, lists, charts, and other aids in the appropriate LOCATION: 1667

Break down any task that includes large time gaps into smaller chunks spaced more closely together. That way, each step does not seem so overwhelming. And you can stay motivated using immediate feedback and incentives for completing each step. LOCATION: 1673

On medication

We now know that ADHD medications can normalize the behavior of 50–65% of those with ADHD and result in substantial improvements, if not normalization, in another 20–30% of people with the disorder. LOCATION: 1899

the positive change brought about by ADHD medications is probably unrivaled by any treatment for any other disorder in psychiatry. LOCATION: 1902

The Stimulants: Pros and Cons

The Pros:

  • The stimulants increase inhibition, resistance to distraction, and the capacity to sustain attention while holding in mind what you are supposed to be doing or planning to do.
  • They increase motor timing and coordination as well as emotional self-control. As a result, they reduce the adverse impact these and other ADHD symptoms have on various domains of our major life activities. With the new sustained-release forms of these medicines, these positive benefits can last for 8–12 hours instead of the typical 3–5 with immediate-release forms. The Cons:
  • Some people experience problems with insomnia, loss of appetite, stomachaches, and headaches with these medications. Others feel somewhat tense, as if they have had too much caffeine, for instance.
  • A small percentage of cases report increased anxiety, tics, or other nervous mannerisms, especially if these were preexisting problems before starting medications.
  • The medicines cannot be taken 24 hours a day, so they can leave some times of the day uncovered or with too little medication for it to be effective, such as late evening hours if the medicine was taken in the morning. LOCATION: 2045

The amphetamines mainly pump up the amount of dopamine (and, to a lesser extent, norepinephrine) produced and expressed by the nerve cells so that more ends up in those spaces. Their effect in the brain is like opening a gate to let the water rush into the LOCATION: 2068

Methylphenidate mainly decreases the amount of dopamine that is absorbed back into the nerve cell after being released—it keeps the lock closed so that the water (neurochemical) level remains high. LOCATION: 2070

The term stimulant is misleading. Stimulant medications like MPH (Ritalin, etc.) do make people without ADHD more alert and awake; they stimulate activity in the frontal regions of the brain. The reason they don’t make hyperactive kids and adults even more restless than they already are due to ADHD is that these parts of the brain are underactive in those with ADHD. LOCATION: 2073

The available evidence actually shows that people on stimulants have a somewhat lower likelihood of sudden death than the general population. This is probably because physicians routinely screen for heart problems before prescribing stimulants and don’t use them for anyone with a family history of sudden death or a personal history of structural heart abnormalities, major arrhythmias, other major cardiac problems, or even high blood pressure. This means that those at greatest cardiac risk with stimulants usually don’t end up with this prescription. This could be why the risk ends up lower than in the general population. LOCATION: 2109

The chances are quite good that the first medication you try will work for you: You have only a 10–25% chance of not responding to the first drug tried. You have only a 3–10% chance of not being able to tolerate the drug at all. LOCATION: 2475

Once you’ve landed on the right medication for you, you’ll notice that:  

  • You’re more productive at work.
  • You’re better at sticking to tasks you need to do.
  • Your impulse control has improved.
  • You’re more thoughtful about what you’re doing.
  • You can better organize your thoughts.
  • It’s easier to carry on conversations.
  • Writing business letters or reports is possible.
  • You’re following through on promises. LOCATION: 2488

More strategies

Visualize what happened the last time you were in a situation like this. Get creative. See the past unfolding in all its colorful, detailed action, as if you’re filming it or replaying it right in the space you’re in. NOTE: Something I have also explicitly suggested here LOCATION: 2708

ADHD can make it tough for you to grasp the moral imperative behind getting a task done for its own sake, so that’s not likely to move you.  ADHD can turn uninteresting into agonizingly boring, making you feel like you’re going to explode with restlessness if you can’t get away from a task that’s no fun.  ADHD can make it impossible to see that what you do may have not just one bad consequence but two or three, each of which can lead to its own six undesired outcomes, and that each of those can produce twelve others, and so forth.  And a poor sense of time can prevent you from grasping that all these consequences can unfold much faster than you’d imagine, before you have a chance to jump in and stop the avalanche. LOCATION: 2941

ADHD makes it hard to stay motivated to complete tasks for all the reasons listed above. But there’s another reason that various responsibilities seem so uncompelling, so flat and abstract in purpose: There is no emotion attached to getting them done. LOCATION: 2951

Strategy: Ask yourself point blank, What will it feel like when I get this done?” LOCATION: 2973

Whatever that emotion is, work hard to feel it, right then, right there, as you contemplate your goals. NOTE: could result in being satisfied so not finishing, like Moral-licensing? LOCATION: 2981

Do you panic or simply go blank when someone gives you a deadline so distant you can’t even imagine that far ahead? Where does this typically happen in your life? Do complex projects overwhelm you? What types do you usually have to tackle? LOCATION: 3027

Chunk it.  Make the goal and smaller quotas public.  Take brief breaks.  Reward yourself after each one. LOCATION: 3114

Our studies have shown that difficulty solving problems in their head keeps affecting people with ADHD as they get older, though in different ways. Young children may have trouble with mental arithmetic. They may not be able to recite backwards a string of digits read aloud to them. As they get older, they can’t hold all the parts of a story in mind (characters, places, dates, actions, etc.) as well as other adults when asked to explain the story concisely or write a paper analyzing the story in some way. Our research now shows that this problem affects adults with ADHD just as much. LOCATION: 3161

Strategy: Use physical, external tools to solve problems whenever you can. LOCATION: 3173

If you have lots of reading to do for school or work, learn to use the SQ4R method for reading comprehension. Here, briefly, is how it works:

  • Survey the material to be read—just leaf through it quickly to get some idea of how much is to be read, how it is broken up, and so forth.
  • Draft some questions that need to be answered from what you are to read. Often these are at the end of the chapter to be read or have been given to you by your teacher.
  • Now use the 4Rs: read just one paragraph, recite out loud in a soft voice or whisper what was important in that material, write that material down in your notebook, then review what you just wrote.
  • Do this for each paragraph. This not only makes you review what you’re reading four times per paragraph (read, recite, write, review) but also gives you frequent mental breaks as you shift your concentration at the end of each paragraph from reading to reciting to writing to reviewing across the assignment. As you get good at this, you can read longer passages, such as two paragraphs at a time or an entire page, before engaging in the recite, write, and review steps. This is a great strategy for people with working memory problems. LOCATION: 3421

Will you be working at a computer with e-mail? If so, resolve to check it briefly at the beginning of the day for urgent messages from supervisors or coworkers, then shut off the e-mail program and don’t check it again until lunch or, better yet, the end of the day. This gives you more time in the middle of the day to focus on the projects you need to tackle and eliminates one of the greatest sources of distraction and low productivity in the workplace. LOCATION: 3605

If you must carry a cell phone … Make it the cheapest model out there and the cheapest calling plan you can find. You don’t need a camera or Internet, e-mail, or Twitter access everywhere you go. No one is that important. Stop using your cell phone as an entertainment device and start using it as a practical tool to call the people you must and to hear only from those you must hear from, and nothing more. NOTE: lol LOCATION: 3894

Updated Sep, 24 2020


#Literature-notes #ADHD #Books