Adult ADHD Techniques

Excerpted from an excellent article (if a few years old) from CHADD on using a day planner (paper or electronic) to become better organized.  The article was published in 2003, and smart phones were not really invented yet, whereas they are ubiquitous now.  Probably most people with ADHD have a smart phone.  In my experience, phones are used mostly for playing games and surfing the internet rather than organizing one’s time.  These principles can be used effectively with current technology.

“Many adults with AD/HD have had multiple unsuccessful experiences with day planners, leading them to regard the task as one that is highly aversive or even hopeless….  [T]he necessary skills…. [s]hould be taken one at a time, and practiced for at least one week before beginning the next step. If a particular step takes more than one week to become a regular habit, practice it for 2-3 weeks before beginning the next step. Building in positive reinforcements or rewards may be helpful for successfully learning each step.

“Identify a friend or spouse to serve as your “planner coach.” Review this information… with your coach, and discuss each step before undertaking it. The coach’s role is to prompt practice of each step and monitor overall progress. The coach should praise you for your efforts and provide constructive — not critical or harsh — feedback about any mistakes. The coach should also encourage you to reward yourself at the end of the week. The planner coach should be a person who will focus on the positive, praising successes and cheering you on to the next step, and not a person who will criticize failures or imperfect achievement of any of the steps.

“1. Select a compatible day planner as your only planning calendar.

“At a minimum, a day planner is a device that includes a calendar, space to write “to-do” lists, and space to write telephone numbers, addresses, and other basic identifying/reference information. It can be a paper-and-pencil model, as with Franklin Planner, Day Timer, or Planner Pad brands. It can be a[n]… electronic organizer… or it can be time management software on a laptop or desktop computer. Electronic organizers have a number of advantages. They are compact; they provide audible reminders that can serve as memory management aides; they can sort, organize, and store more information more efficiently than paper and pencil planners; and they can easily exchange information with office and home computers.

“If you are a gadget-oriented person who learns new technology easily, pick an electronic organizer. If you are not technology-oriented, pick a paper and pencil model. Go on an outing to an office supply store and carefully review a number of different types of day planners. They come in all sizes, shapes, and colors, with different types of daily, weekly, and monthly views. Carefully inspect the different types of daily, weekly, and monthly pages. Do you schedule many appointments on the hour or half-hour? Then use a clear daily view. Are you making “to do” lists but not scheduling many appointments? Perhaps a weekly view with a lot of space for lists is needed.

“Your day planner should be the only planning calendar for everything you do (i.e., work, home, personal). Using separate calendars at home and at the office may become confusing and overwhelming; you will inevitably forget to transfer entries from one calendar to the other and miss appointments or important commitments.

“2. Find a single, accessible place to keep the day planner.

“After selecting a planner, the next step is to start keeping it in a single, accessible location at home and at work, so you will always know where to find it. The location should be clearly visible from a distance, even in a cluttered room or on a messy desk. Convenient locations might be next to the telephone, on a table near the front door, or on the desk at the office. If the day planner has a strap, it might be hung on a hook next to the front door, above the telephone, or together with the car keys. Carry it to and from work, and practice keeping it in the designated locations for a week.

“3. Enter the basics in the day planner.

“Gather the most common names, addresses, and phone numbers you use. Enter them into the planner in the alphabetical name/address section. Consider what vital information might be helpful to have in the planner, such as insurance policy numbers, computer passwords, equipment serial numbers, and birthdays and anniversaries, and enter this information in the designated spaces.

“4. Carry the day planner at all times.

“Now that there is some information in your planner, you should carry it with you at all times. Many people claim that they have carried their planner with them at all times, but then they “forget” the great idea they thought of while shopping. “At all times” means whenever you leave the car to go into a store or whenever you leave your desk to attend a meeting.

“5. Refer to the day planner regularly. 

“Many adults with AD/HD write things in their planners but rarely look at what they wrote, relying instead on memory, with disastrous consequences. Before you can use the planner for a calendar or “to do” lists, you need to develop the habit of checking it regularly. Start by checking the planner a minimum of three times per day — once in the morning to plan/review the day’s upcoming events, once in the middle of the day to make any mid-course corrections and refresh your memory about the remaining day’s events, and once in the evening, to plan/review the next day’s events.

“There are several ways to remember to check your planner. First… alarms for an electronic planner can be set to go off at regular intervals when you wish to check your planner. Second, you could associate checking your planner with habitual activities that are done at approximately the same time each day, e.g. eating meals, getting dressed in the morning or ready for bed at night, or entering or exiting the office. Third, leaving reminder notes in strategic locations (on the desk in the office, on the mirror in the bathroom, on the dashboard or door handle of the car) can be helpful in reminding you to look at the planner.

“6. Use the day planner as your calendar for everything. 

“You are now ready to use your planner as a calendar. On scrap paper, make a list of all appointments scheduled at any time in the future. Then, write these appointments in the appropriate time slots on the pages of the planner for the particular days and months. Review the scheduled appointments for that day each time you check the planner. During the day, write in any additional appointments as soon as you schedule them.

“Using different color pens for writing different types of things on your calendar (e.g. red for appointments, blue for work activities, and green for family events) permits you to recognize different types of events as your eye scans the page. For a very busy family, use different colors for each family member’s activities.

“7. Use your planner as a “brain dump” to capture your ideas.

“Adults with AD/HD experience a constant stream of ideas flooding their minds. They often become frustrated because they cannot remember these ideas when they need them. Using the day planner as a “brain dump” avoids this dilemma. With your planner with you at all times, practice writing down any ideas you want to capture as they occur to you. Write these down either on blank, lined planner pages or in the section of the planner for that day’s “to do” list. If you find that many of your important ideas come at times when it is impossible to write them down (e.g. in the shower, while driving), consider carrying a small, digital recorder. Dictate your ideas into the recorder and transcribe them to your planner later that day. Some hand-held computers and pocket PCs may have built-in digital recorders.

“8. Construct a daily “to do” list and refer to it often.

“Only after you experience success using your planner as a calendar should you start making a daily “to do” list. Most planners have a place adjoining the calendar for each day for “to do” lists. During the first review of your planner in the morning, make a list of everything that needs to get done that day. Use your “brain dump” notes to help you make the list. Keep the list relatively short, e.g. 5-8 items, so that you can experience success completing all of the items. Be realistic about what can be accomplished in one day, and remember to schedule some “me time,” by listing a personal activity or time as one item. List specific actions, rather than vague concepts. For example, “buy my wife flowers” would be a more specific item than “be nice to my wife.”

“Examine the list and assign the items to particular dates and times in the day planner. Try to complete them as scheduled, referring to the list often. Check off any completed items and review remaining uncompleted items.

“At the end of the day, examine the list. Congratulate yourself if you completed all of the items on the list. Do not berate yourself if you did not complete all of the items. If there were only a few unfinished items, move them forward to the next day’s list. However, if you have many unfinished items, consider whether you have unrealistic expectations for how much can be done. Analyze the uncompleted items and what got in the way of completing everything on your list (phone calls, other interruptions, not enough time, not having everything you need to accomplish the task, unexpected crises). Thinking in these terms will help you become more realistic about what can be accomplished in a day. Either scale back expectations or find other approaches to completing tasks, such as delegating, streamlining, or eliminating tasks.

“9. Prioritize your “to-do” list and act in accordance with your priorities.

“There are many ways to prioritize a “to do” list. One way is to number all of the items on the list in order of decreasing priority. Another way is to classify items into one of three categories: “Essential,” “Important,” and “Do only if I have extra time.” Pick the method that best fits your style, and begin prioritizing your daily “to do” list.

“As you go through the day, perform the items on the “to do” list in order of decreasing priority. Adults with AD/HD are often tempted to ignore the priorities and may need strategies to keep themselves on track. Set the alarms on your [cellphone], electronic planner, computer task management software, or beeper to go off at regular intervals as a signal to check whether you are on task following your priorities. Use self-talk to help avoid distractions. Train yourself to repeat reminders such as “I have to keep from getting distracted,” “I have to stick with my priorities,” and “Don’t switch now, I am almost done.” Also, make sure that you are taking an effective dose of medication that lasts throughout the day.

“10. Conduct a daily planning session.

“By the time you have completed the first eight steps, you will be conducting “ad hoc” daily planning sessions where you construct and prioritize your daily “to do” list. It is time to formalize this process as “the daily planning session.” Consider the time for constructing and prioritizing lists as a daily planning session. The goal of this session is to plan the upcoming day’s activities and develop a plan of attack to carry them out. In addition to listing priorities and reviewing schedules, the planning session is the time to consider exactly how each task will be accomplished. What materials will be needed? What individuals will have to be consulted? What obstacles are likely to be encountered? How can these obstacles be overcome? Asking and answering these questions will facilitate the process of prioritizing the items on your “to do” list. The planning session will provide a mental map that guides you in carrying out the tasks on your list.

“When you have reached this point in the program, congratulate yourself! You have mastered the basic steps of using a day planner to manage time! Continue to follow these steps. As they become habitual, consider trying the last step, which bridges the gap between short-term and long-term planning, but understand that it is more challenging and may require the assistance of an AD/HD coach or a therapist.

“11. Generate a list of long-term goals and break the long-term goals into small, manageable chunks, allocating these chunks to monthly and weekly planning sessions.

“First, generate a list of all long-term goals. These are broad goals to be accomplished over many months and years. Then, take one goal at a time and break it down into small chunks or sub-goals that might be accomplished on a monthly basis. Assign one sub-goal to each month of the year. At the beginning of the month, conduct a monthly planning session where you decide how to accomplish the sub-goal over the course of the month. Assign various tasks to each week of the month. At the beginning of each week, conduct a weekly planning session where you decide how to assign aspects of that week’s sub-goal to the daily task lists for the entire week. During each daily planning session, plan the details of the assigned task that will be performed that day.


“Some adults with AD/HD may find that even the step-by-step approach outlined here is difficult to follow. If you find that you cannot adhere to the guidelines given here, don’t give up. You may need to have the learning process broken down into even smaller steps. You may need assistance overcoming emotional barriers based upon a lifetime of failure experiences before you can successfully use a day planner. You may need strong support systems and the guidance of a trained professional. Consult a professional, such as an AD/HD coach or a therapist familiar with adult AD/HD…. The professional will be able to tailor the steps to your particular situation so that you can experience success managing time through the use of a day planner.”

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Gaming for Fun and Mental Health

Reading Shakesville, a feminist internet safe-space that I eavesdrop on every once in a while, I found this fun idea for recording and rewarding healthy behaviors.  It’s designed by a gamer (i.e., at least one generation younger than I am) and the comments have lots of great ideas too.  Give the whole post a read.

I picked out five habits that I want to follow each day: drink at least 3 large glasses of water, sleep 8 hours, exercise for 30 minutes, eat at least 5 fruits and veg servings, and write down all my non-water beverages. For each one I achieve in a day, I get a point. I’m tracking everything on a big calendar, or, as I call it, “the game board.” Once I have achieved 35 points (7 days of “perfect” habits, 12 days of 60% habits), I get to spend $15 on games, books, or music.

The rewards system not only keep me motivated, it also helps me with another, larger goal: making sure to give myself small treats now and then, as I’ve a bad habit of not treating myself so long that I inevitably binge and buy ALL THE THINGS when I do finally allow myself that visit to the game shop or used bookstore. I’m letting myself “bank” each set of 35 points until I’ve achieved the next one, if I want to save for something bigger (i.e., there’s an Arkham Horror expansion for $30? Two sets of goals and it’s mine!)

But what’s a game without leveling, right? Once I’ve achieved 105 points (35 points x 3), I LEVEL UP! Woot me! This means I’m going to re-set my goals, making 1 or 2 more challenging, but also upping the rewards for achievement. So, I’ll probably increase my exercise minutes and set a specific limit on caffeinated/alcoholic beverages next time around, but also up the rewards for achieving my 35 points to $20. That means Lego LOTR in no time! Not to mention, it gives a specific framework for periodically reviewing and adjusting my goals… but “leveling up” just sounds way funner.

Finally, just to keep it fun, I thought I’d throw in achievements, or some one-time rewards for specific accomplishments. Just for keeping the game going for two weeks, I get ACHIEVEMENT: Fortnight of Fixitude (which gives me an extra $5 to spend on my next 35 point reward). And sometime in the next couple weeks, I want to unlock ACHIEVEMENT: Office of Cleanliness. I’m writing these down as I think of them (which is pretty fun, actually), and turning them into stickers I can put on my life-game calendar when I “unlock” them.  source

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Psych Research Again Proving the Obvious: We Need Each Other

A meta-analysis of multiple studies coordinated by researchers at BYU found that

social isolation…, loneliness…, and living alone.., correspond[ed] to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. [The researchers] found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality. source

Or, as the clickbait headline from the Huffington Post blares: “Loneliness and Isolation are as Bad for You as Obesity.”

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Gun Violence Trends in the US

A new report in the Annual Review of Public Health on gun deaths was just released and is making its way through the news.  My husband and I will be in the UK and Europe again this spring, and I remember how inexplicable Americans’ affection for their firearms seemed to people living there, given how dangerous our gun culture is.

Here are some of the findings of the report:

Mortality rates for traffic accidents are now only slightly higher than for firearms.

While deaths from firearms declined dramatically in the mid-90s after a 30 year surge in the late 60s, the percentage of yearly deaths from suicide as compared to homicide has risen to 64%.  Suicide is increasing; homicide is decreasing.

The four biggest mass killings of the century resulted in a total number of 84 homicides.  But there is an average of 82.3 deaths from guns every day: 32.5 homicides and 49.8 suicides.

Homicide risk is highest among black males.  Suicide risk is highest among white males and is increasing.  Suicide risk for white males increases with age.

Owning a gun is the major risk factor for dying by firearm.

1.4% of firearm deaths are due to “legal intervention” – police shootings (2012 data).

Americans have low rates of assaultive violence, as compared to other industrialized nations, but uniquely high mortality rates from firearm homicide and suicide.

While I was still in graduate school, I learned that two former patients had shot themselves.  A significant minority of patients throughout my career have had parents, grandparents, lovers, or children do the same.  Dealing with the aftermath of suicide is uniquely messy and painful for everyone left behind.  Jonathan Browning was one of my ancestors – it is a legacy I am very ambivalent about, to say the least.

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Mindfulness and Depression Relapse

An article from the latest issue of the APA Monitor says about depression,

Depression is not only the most common mental illness, it’s also one of the most tenacious.  Up to 80 percent of people who experience a major depressive episode may relapse.

A recent study – one of a growing body of research as noted in the article – shows that one form of mindfulness training can be as effective as antidepressant medication in preventing a recurrence of depressive symptoms.

Here is a TED talk by Zindal Segal, PhD, one of the leading researchers in the area.

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Book (p)Review: Depersonalization Disorder

I remember, at the funeral of a loved one, shaking hands, accepting hugs, saying “thank you” – when suddenly my brain gave way.  I couldn’t speak, couldn’t think, had forgotten how to respond to comfort.  It was the lowering of The Bell Jar, a glass wall between me and the rest of the world (including my husband and children), and lasted sporadically for about 8 months.

For me at that time, and at occasional stressful times since, depersonalization has descended.  I felt numb and separate. I felt no joy, no connection, and no interest.  For me it was a part of grief or depression – for others it can be a part of panic or anxiety disorder.  Some develop depersonalization as a result of trauma.  Most inexplicable are those instances in which depersonalization begins for no apparent reason, and stays for weeks, months, or years.

Common Symptoms

  • Derealization – feeling like you’re living in a dream or that everything is 2-dimensional
  • Detachment from surroundings – feeling indifferent to situations and people around you
  • Detachment from personal relationships – feeling emotionless towards others
  • Robotic – feeling like you are a robot, like your body isn’t your own
  • Body distortion – feeling like your body or parts are distorted (smaller or larger)
  • Fear of going crazy – having a phobia or constant fear of “going crazy” or “losing your mind”
  • Lack of sensation – lacking normal feelings of sensation and pain
  • Spontaneous OBEs – having spontaneous moments of “floating above one’s own body” and seeing oneself act without having control over one’s actions

Here is the American book: “Overcoming Depersonalization Disorder: A Mindfulness and Acceptance Guite to Conquering Feelings of Numbness and Unreality” by Katharine Donnelly & Fugen Neziroglu (2010)

Here is the British book: “Overcoming Depersonalization and Feelings of Unreality: A Self-Help Guide Using Cognitive Behavioral Techniques” by Anthony David, Dawn Baker & Elaine Hunter (2013)

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Here’s my son Chris, with Matt and Landon in their band Coral Bones, and their first official music video.

Here’s another video that’s a little less formal.  Enjoy!

Because Chris has Bipolar I Disorder, the band decided to contribute all proceeds from the Queensway single to NAMI.  If you’re interested in more of Coral Bones’ music, check out their website here.

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