Tuesday, September 7, 2010

Adult ADHD and "Time Blindness": Dr. Russell Barkley's Tactics for Taming That Trickster, Time



Time.  That's one word that always makes the top of the list when I ask adults in our local CHADD discussion group to name their top ADHD-related challenges.
  • Keeping track of time.
  • Estimating the time it will take to complete a project.
  • Planning for future time instead of getting totally wrapped up in present time.
Managing time is a constant challenge for most humans, especially in our speeded-up age. Yet, for people with ADHD, time can be a particularly shape-shifting trickster


No one knows this better than psychologist Russell Barkley, a preeminent researcher, lecturer, expert, and author in the field of ADHD. And no one better explains to the layperson why this is and what to do about it than does Dr. Barkley in his new book, Taking Charge of Adult ADHD

The following excerpt, from Chapter 10, offers tips for taking charge of your time. Earlier chapters build a strong foundation for understanding ADHD neurobiology and guidelines for medical treatment; remaining chapters offer straightforward but in-depth strategies for tackling your particular issues in various areas of life. 

Of special note: "Eight Everyday Rules for Success."  Like Stephen Covey's perennial bestseller The Seven Habits of Highly Successful People,  Dr. Barkley's eight rules can help you to break the counterproductive habits so common to adults with late-diagnosis ADHD and maintain firm footing no matter what life throws you. (In fact, these rules can help anyone to live a more conscious, focused life.)

Nearsighted to the Future

Russell Barkley, Ph.D.
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.


Your lack of a sense of time has debilitating, even heartbreaking, effects. You probably don't prepare for predictable events until they are practically upon you--if at all. This pattern is a recipe for a life of chaos and crisis. You're left to squander your energies dealing with the emergencies or urgencies of the immediate moment when a little forethought and planning could have eased the burden and likely avoided the crisis. 

Dealing with Your ADHD: The Big Picture

This description of ADHD tells us that the strategies and tools that can help you most will be those that help you do what you know:
  • 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 it is likely to help you.
  • Assistance with the time, timing, and timeliness of behavior is critical.  This means arranging the particular problem setting to assist you in doing what you need to do when you need to do it.  It also means keeping your aids in place.

Fit the Solution to the Specific Problem

Chapters 7-9 described four types of self-control you might struggle with to different degrees. All of the following guidelines for designing effective treatments, strategies, tools, and coping methods can help you.

In choosing your own aids, however, you might pay particular attention to those aimed at the deficits you identified with most.  
  • Externalize information that is usually held in the mind.
This simply means putting key pieces of information into some physical form and putting it where the problem now exists.  Stop trying to use mental information so much. 


If your boss or someone else has given you a set of instructions to get something done over the next few days, stop trying to carry this around in your head and remember it over that period of time.  That won't work with ADHD.  Instead, always carry a small journal and pen in your pocket and instantly write down the task, any steps given to you to get it done, and the deadline.  Then keep this in front of you where your work is to be done over the next few days to serve as your external working memory – your reminder to get it done. 

You can even translate this plan into smaller steps and insert them into your day planner as goals for each hour of that day and the next few before the work is due.  The technique here is not what is important – the principle behind it is! 
  • Make time physical.
ADHD makes you concentrate mainly on the moment, taking your focus away from the signals and internal sense that time is passing.

Use kitchen timers, clocks, computers, calendars, and any other devices that can break time down by the hour and issue alarms when a chunk of time has passed.  The more external you make the passage of time and the way you structure that time with periodic physical reminders, the more likely you are to manage your time well.
  • 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.  

Motivational “prostheses” are nearly essential to your fulfilling longer-term projects, assignments, personal plans, or social promises. Whether the reward is to briefly check on the status of your favorite sports team on the Internet, to listen to a short tune on your music player or radio, or even just to give yourself a token, arrange small rewards for completing smaller work quotas instead of waiting until the work is all done.
  • Normalize the underlying neurological deficits in the brain’s executive system.
To date, the only treatment that shows any hope of achieving this end is medication.  The ADHD medicines (see Step Three in the book), such as stimulants or the nonstimulants atomoxetine or guanfacine, can improve or even normalize the neurological substrates in the executive regions of the brain and their related networks that likely underlie this disorder. They do not reverse these deficits permanently; they do, however, have a remarkable positive effect while they remain in your system.
  • 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
  • Make the rules into physical lists.
     
    Post signs, lists, charts, etc., in the appropriate school, work, or social environment and frequently refer to them while you are in those situations. You can even talk out loud in a low voice to yourself and so state these rules aloud before and during these situations. You can also use a device to record and play back these reminders (using earphones to avoid distracting others!)
  • Break down any task that includes large time gaps into smaller chunks spaced more closely together.
     
    For instance, rather than accept a project that must be done over the next month as is, break it down into much smaller steps and do a step a day toward that eventual goal.  That way, each step does not seem so overwhelming.  And you can stay motivated using immediate feedback and incentives for completing each step.
  • Stay flexible and be prepared to change your plan.
     
    As with a chronic medical condition, such as diabetes, a treatment plan is made up of lots of interventions that provide symptomatic relief. But over time, symptom breakthroughs and crises are likely to occur periodically. Don't be afraid to change course--ask for help in doing so whenever you need it--and look for new ways to compensate for the deficits ADHD imposes on you. It's only what you deserve.
With these major ideas in mind, you are now ready to master your ADHD.


Never forget that with proper assistance--including education, counseling, medication, behavioral strategies, hard work, advocacy, and the support of family and friends--you can make significant and possibly dramatic improvements in your life. 


Russell A. Barkley, Ph.D., is internationally known for his career-long research into ADHD and his efforts to educate professionals and the public. He is Clinical Professor of Psychiatry at the Medical University of South Carolina and Research Professor of Psychiatry at the State University of New York Upstate Medical University at Syracuse. You can learn more about Dr. Barkley at his website.






22 comments:

  1. Thank You for this post Gina! I can identify personally and specifically with a few of these suggested strategies for things I have been trying to figure out a way to deal with.

    Russel Barkley Ph.D is a name I see every day on my living room table, written on the cover of Your book! I don't have to be a genius to know I need to see "TAKING CHARGE of ADULT ADHD" right there on my living room table also! I look forward to reading and using Dr. Barkley's new book! Your Timing (as usual) is perfect with this post Gina!

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  2. Glad you found it useful, Scott. Your timing in the garden seems to be find-tuned. ;-)

    g

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  3. I know that my son has struggled a lot in this area. It took him forever to understand simple passages of time (long past developmentally typical). When you add time-blindness to the difficulty of initiating tasks, it makes for a difficult time coping and making it in the world.

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  4. Well I got home yesterday, and there it was! My wife bought it on Amazon when I told her about it a week ago! I just started reading it this evening, and just the first few pages comfirmed what my wife had seen in me from the time she met me. How she could have fallin' in love with that, I don't know.

    Why she bought it for me is obvious though! lol. It's the title "TAKING CHARGE of ADULT ADHD" and your written praise for Dr.Barkley on the first page, Gina! I know this book will help me allready!

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  5. Oh, I know there are PLENTY of reasons your wife fell in love with you, Scott -- mainly because you're you.

    As for the other stuff, well, who's perfect? ;-)

    You know what....I think this book is great for everyone living in the 21st century and bombarded with lots of stimuli, demands, and "stuff" that needs to be prioritized, sorted, tossed, etc.

    I am using many of the tips in Dr. Barkley's book in my own life. It's all about improving Executive Functions, and it's the rare person who doesn't need some help with that these days.

    g

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  6. Thanks for posting this. This is extraordinarily helpful. Barkley is like a breath of fresh air...no...better...more like an antiseptic that destroys all the ADHD-Is-A-Gift germs while it leaves your breath minty fresh!

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  7. I'm going to need to read this again and again to soak in all the good info.

    Time really is a funny thing. I can't honestly say that I'm not satisfied with the way my brain meanders...I'm only stressed or unsatisfied with it when my "style" clashes with my environment and I a) have to get somewhere on time or b) have to attack tasks according to someone else's sense of priority. I guess that's where the definition of disorder runs up against my version of reality :)

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  8. haha! Good way to put it, Katy. Clashing versions of reality.

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  9. By the way, I am researching the topic of ADHD and sleep. Lots of studies in the past 10 years.

    RE: time. It seems that, for some people with ADHD, the "internal clock" (or cirdadian rhythm) is out of synch with the natural world. Perhaps a question of messages being sent "on time" or in sufficient supply to manufacture/release hormones such as melatonin.

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  10. Just about finished with Barkley's book and I have marked it up with so many margin notes you can barely find the actual pages! I wish someone had presented this information twenty years ago. WOW!

    Drew

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  11. Glad to hear it, Drew. I find it a really useful book for EVERYONE -- like Seven Habits of Highly Effective People.

    That reminds me....part of my New Year's resolution will be taking those principals, one at a time, and applying them to my life.

    I'm hoping to develop some workshops around them, too. They are just so on the mark. I'm glad to hear you agree.

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  12. Time. Time, and time again, I mess up time. Or it messes with me. I used to wear a watch that went "ding!" every hour, just to remind myself that Time Passes. After awhile the novelty of that fact wore off and the reminder became an annoyance, a kind of pointless, demoralizing admonition. So I ditched the hourly signal.

    While I did notice on the very first day I took stimulant medication that my awareness of time changed, I can't say it improved. I looked up at the clock and said, "Wow, it's only 2 o'clock!" while up until that day I had looked up at the clock and said, "Holy moley! It's five already!"

    But my ability to manage time -- or, more accurately, to manage my SELF in time -- has never improved that much. I read years ago that time is one thing that medication doesn't have much impact on. That was bad news, but it took a little pressure off in terms of my unrelenting effort to maximize, maximize. I decided to turn my attention to maximizing some other function.

    I do not know the source for that tidbit, but if anyone can find it, I'd like to know about it.

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  13. Thanks for sharing that, Betsy.

    I haven't heard about medication not helping with time, so can't help with the source. Maybe someone else will weigh in.

    In preparation for writing an article on sleep for CHADD's Attention magazine, I read MANY research papers and talked to several research scientists studying ADHD and sleep.

    These researchers are discovering some interesting neurophysiological underpinnings of the sleep challenges many people with ADHD have, and some are related to Circadian rhythm. And the Circadian rhythm seems to be affected by a lack of signaling between the environment and the brain as well as between the brain and the rest of the body.

    The medication can help improve "signal quality" (that is, the body's ability to pay attention to inner and outer phenomenon) but to recalibrate Circadian rhythm, it's important to also stick to a routine that reinforces the light-dark patterns that cue the body when it's time to sleep/awake.

    Look for the article in the December issue of Attention!

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  14. Good post. I've moved away from using a journal/planner for various reasons and am realizing that I really have to get back in the habit. Thank you.

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  15. Hi Gamma,

    Thanks for stopping in. I find it hard to stick with one "system" because my work schedule is so variable, and so are the tasks set out before me.

    When I was working on the book, for example, my life centered almost solely on that. It was pretty easy to schedule my day when I planned to write and edit for 8 hours.

    Later, as I started traveling more and conducting webinars, etc., I had to adapt my system--currently a hybrid of Outlook calendar reminders and a physical planner.

    At least there are many options for us these days. :-)

    g

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  16. Hello Gina (and everyone),

    I'm over fifty and presently I'm still somewhat angry and very disappointed that I've just recently been diagnosed with ADD/with a bit of the "H" thrown in as well. I wish I could focus enough to read Dr. Barkley's book, but I can only hyperfocus on a couple of things that greatly interest me (no offense intended). I would just be constantly backing up to re-read paragraphs over and over again. I got the "bi-polar thingy" diagnosis instead and I thought I'd just have to resign myself to being from Mars rather than born on Earth like everyone else.

    Lamictal was the prescription given years ago, together with trying RX's that never helped the crux of the matter (and I quit taking). Then there was the change up of almost every antidepressant in the book. The Lamictal did help with depression and it still does, but when my second marriage to the same man 10 yrs. apart (yeap) started heading in the same direction as the first 8 I wanted to pull my hair out and throw in the towel. I told myself that if I didn't soon get to a psychiatrist just so he could confirm that "time, thoughts that never gear down and attention spans" were different on Mars than on Earth, that I'd end up in the Mental Tank anyway!

    Thank God that I humbled myself enough to just pour out every thing that was "wrong" with me since I can remember! I threw it all at him, of course I had it typed up and printed off from a word pad document--because there was no way I could find it in my head when I needed to explain it all to him in person... :) It's the sense of humiliation and feelings of being an abject failure, even though you feel that you're relatively intelligent and very creative, that was the biggest obstacle to overcome. When I had at the top of my list, "TIME IS MY ENEMY" with "I'm always frustrated" coming in second, "My husband is fed up because I have a million projects that I start and few that I finish"; and on and on I went, he took out a questionaire and had me answer it. He then related to me that I wasn't crazy (or from Mars) and neither was I bi-polar. He strongly suspected I was ADHD! I'm still on the Lamictal as that's the only thing that ever helped with depression but we're trying out Vyvance right now. I've noticed I sleep better, even falling asleep without taking Ambien some nights (unheard of!), I eat lunch more often and I don't fidget as much when I do sit down for a bit. Unfortunately the other symptoms are still very much present, but I feel so relieved to be on the right track and it's given me a refreshing sense of hope that was always out of reach for me before.

    I'm so glad I stumpled across this blog because I no longer feel like an alien! I understand the "time as my enemy" problem from Dr. Barkley's post as a symptom rather than a personal failing and the phrases others always used to describe me, such as, "a body in motion" and "a hummingbird"; well, the set of symptoms that I've read about here are as if someone came to my home and wrote down everything about me! What a relief. The greatest is to finally know I'm not alone and I'm not crazy or hopeless.

    Thanks so much for your open forum for adults with ADD!

    Sheila (from Earth) :)

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    1. MY husband has ADHD so I was looking for more info to help him ...found this blog and your post above Sheila and I really enjoyed reading it. Your honesty is refreshing actually.. normally I see a long post like that and skim through it but yours..nope that was very good to read and helps me understand more what my husband is probably thinking as well.Thank your for taking the time to tell your story.. it helps more then you probably know.

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    2. Hi Sheila,

      Thank you for sharing your story. Of course it leaves me gobsmacked, as it always done when I hear decades-running stories of the wrong diagnosis and the wrong medication. But it does remind of why I do this work, and why I continue to try reaching out to healthcare professionals who are skeptical of the ADHD diagnosis. It's just too important to remain ignorant!

      best,

      Gina

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    3. Thanks C Komart and Gina for your replies.

      Sorry for being so long winded! I'm glad it helped you though, C Komart, in considering the state of mind your husband may be in as well. I wish you every success in working together, I'm sure he'll be relieved and that you'll both benefit greatly from a right diagnosis!

      Sheila

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  17. This is by far the most helpful information I've read yet about ADHD. I can't wait to apply this so I can turn around and teach my clients also struggling with ADHD. THANK YOU!

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  18. After being in relationship with him for nine years,he broke up with me, I did everything possible to bring him back but all was in vain, I wanted him back so much because of the love I have for him, I begged him with everything, I made promises but he refused. I explained my problem to someone online and she suggested that I should rather contact a spell caster that could help me cast a spell to bring him back but I am the type that never believed in spell, I had no choice than to try it, I mailed the spell caster, and he told me there was no problem that everything will be okay before three days, that my ex will return to me before three days, he cast the spell and surprisingly in the second day, it was around 4pm. My ex called me, I was so surprised, I answered the call and all he said was that he was so sorry for everything that happened, that he wanted me to return to him, that he loves me so much. I was so happy and went to him, that was how we started living together happily again. Since then, I have made promise that anybody I know that have a relationship problem, I would be of help to such person by referring him or her to the only real and powerful spell caster who helped me with my own problem and who is different from all the fake ones out there. Anybody could need the help of the spell caster, his email is (priestolokun1@yahoo.com}tel.+2347051841955) you can email him if you need his assistance in your relationship or anything.Margareta

    ReplyDelete

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