Ep. 147 | Managing ADHD in Everyday Life: Focus, Work, and Relationships

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Hello and welcome to another episode of Everyday Therapy. I am Brett Cushing and here with my colleague, Doctor Karen Ryan. Hello. We are glad to be back. And today we're going to be talking about managing ADHD in everyday life. And we want to try to hone in on strategies for focus for work and relationships. So ADHD, it's one of those things, Karen, where I think that there's a bit of that definition creep where it's sort of generalized and anytime people are forgetful or they do something impulsive or they're in the middle of a thought and they kind of go on a tangent, people will say, oh, I just, I think I've got ADHD.

And so there's people that sort of, self-diagnose, but then there's people who understandably are a bit critical because they say, this is overdiagnosed, this is overmedicated. So hopefully we can dispel some of the myths as we go through this as well. And it's it's really a lot more than being just distracted. And it really also affects everything from focus at work to relational conflicts.

I've heard people with ADHD and the higher divorce rate and, creates additional strain in the marriage. So we have a lot to try to talk about in a short amount of time. Why don't we talk about like from our clinical definition? What are we talking about with ADHD? Like what is the actual definition. Like what do you mean?

Because sometimes we yeah, we'll use it kind of tongue in cheek. Right. Yeah. Yeah. So ADHD is attention deficit hyperactivity disorder is a neuro biological disorder characterized by a persistent pattern, a regular pattern of inattention or hyperactivity impulsivity that interferes with functioning or development. Right. So it's significant enough that it's really impacting your ability to get the things done that you want to do.

And so it breaks it down into kind of ways of inattention. Right. So when we think of inattention that is not giving close attention to detail. So making little mistakes, missing a project, missing a piece, missing a critical element of something. Right, right. The person has trouble holding attention on certain tasks, especially those that feel a little more boring.

Or they'll seem to not listen when they're spoken to. Right? They're kind of off, not really listening. They have trouble organizing tasks, might start things, but have trouble finishing them. Really avoid those things that require a long focus or intense concentration. Will often lose things. So app pencils, wallet, keys, cell phone is easily distracted and can be forgetful, right?

So that's inattention. And then we also look for hyperactivity. Right. So fidgeting, tapping their hand, squirming in their seat. Leaving situations when kind of being seated is appropriate or really struggling. Right. I feel like this is torture. Get me to sit here. Let me get up. Right. Kids will be like, running. Climbing. And sometimes is having difficulty participating in leisure activities.

So just that relaxation and kind of chill and mode is hard. Or the person is on the go, kind of like they've got an internal motor and an impulsivity. We look for blurting out answers, interrupting people, trouble waiting your turn. And so we have all of these different kind of criteria that we look for. And then what's helpful is that there are three types.

So as you're working with a provider or you're thinking about yourself, there's three types. So the first is predominantly inattentive. And so that's symptoms of inattention are there. But not that hyperactivity or impulsivity. There's predominantly hyperactive or impulsive. And that is again symptoms of hyperactivity or impulsivity but not the same level of inattention. And then combine type where you're having both of those experiences of inattention and hyperactivity and impulsivity.

So I noticed, in that diagnostic criteria, there was nothing listed, lazy, irresponsible pain in the butt, you know, doesn't try not intelligence like character. None of that. Right then sometimes people, attribute people with ADHD as having that. Sometimes people with ADHD have drawn those conclusions about themselves. Yeah. So we also understand there's there are brain scans that we can look at that show us the brain is different.

It's looks different on a brain scan. It functions differently. And so, it's nice to have something very empirical that we can go to because it can sound like, oh, I can't help it. I've got ADHD. I'm trying. And people say, right, so it's nice to have some more empirical, objective evidence to show that that's a real thing.

Yeah. And I think about 5 to 8% of the population does have this. And many people will say, oh, this is crazy. It's it's related to, food additives and preservatives and too much sugar and everything. And that's why there's so much more ADHD. And that's not true at all. There is. There might be some correlation. Possibly, but correlation doesn't mean causation.

So that is, a real myth that this is caused by those types of things. So this is, objective. And it's something that I think for those listening, it might take some sense of relief and comfort in knowing that, yeah, a lot of this you cannot help. Right. And you when you refer to those brain scans, one of the things that we look at in the brain, we have neurotransmitters, which we probably talked about on here before, which is essentially dopamine or Barnett brand things that give us motivation, things that give us drive, things that help us focus, and what misses what we can see when we do tests is that that is different,

not worse, different. Right. And so that biological aspect of ADHD is such a helpful and important piece, because that is really like your highlighting. When we've got that logic, you can break down some of those myths, right? Absolutely. And it makes it makes starting things harder. It also makes transitioning from one thing to another more difficult. And so there's this constant searching to get those neurotransmitters, increased, elevated.

And to do that, requires a lot of things that might look like someone's being irresponsible. They don't even know why they're doing it, but they're looking for that stimulation because the brain and the biological effect of the brain and the way it's operating is all, it's off balance or just different things that. Yeah, yeah. And we, we highlight some of the different, you know, ways that can present.

Right. And we know that it can. It's a lifelong thing. Right. It's not something that we just like grow out of. Right. Because it's part of who we are. And it can vary and how it presents, you know, in children and adults. But I think it's a really helpful piece to remember, you know, that as an adult, like you deserve support on this as well.

And what I found a lot in my practice is when I have adult clients who have their kids getting diagnosed, they're like, wait a minute, I'm a lot like my son or my daughter, my child. Like, maybe I do too. And that can be a time when adults finally get diagnosed and finally, like, put those pieces together for themselves.

You find that true for you? I found that to be exactly the case. When my son had ADHD, I would watch him and I felt like I was looking in the mirror and I could see him trying very hard, earnest, sincere desire to do what's right and to work hard. And I will never forget the day I said.

I said, dude, you forgot to do this again. And I saw him stop. And he was so frustrated with himself. And I said, he's not lazy, he's not unmotivated, he's earnestly trying. And that that made me sad for him. And then I resonated with it. But I also thought of so many people with ADHD, they are earnestly trying.

Yeah. And kind of the phrase with ADHD is they have great attention, but the intention doesn't always result in action. Yeah. And there's biological, neurological reasons for that. Yeah. You got to be a little more understanding. Yeah. And I think one of my hopes as we do this podcast today is, you know, for individuals who have ADHD, if you find yourself having thought like, what's wrong with me?

Why can't I just what I hope is now when you have a response to that, it has compassion, right, and logic and understanding behind it. And so it's not we don't stay in this place of shame and like, there's something wrong with me. It's, oh, my brain works this way. That's why this is hard for me. And the solution that is not that I must kind of buckle down and do better and try harder to be better, because that doesn't work right and it hasn't worked right.

So we continually go back to that. No, I gotta try harder. It's that's not it. We need to look at it, understand it better and find different approaches to manage it. And it requires a different lifestyle. But a lot of grace and compassion, like you said. Yeah. Also, I think part of the reason we need to have greater compassion with this is 75% of the people.

Well, I know let me rephrase that. People who have ADHD three quarters of the time, they have some other diagnosis. So whether it's, autism spectrum disorder or it's very prevalent to have that or very prevalent to have anxiety be also a diagnosis and I don't know, part of me thinks the anxiety is a result of having ADHD because you kind of tune out, you forget, you get accused of being lazy and forgetful, irresponsible, and so you can develop this sense of anxiety.

But whatever it is for people that have ADHD, about 75% of the time, there is some other diagnosis. Yeah, yeah. And you highlight such an important piece and it can be hard to like I find people wondering, is this ADHD? Could this or is this just anxiety or is this anxiety? And I think there's some helpful kind of tools to think of that, right?

Where anxiety is trouble concentrating situations because they feel worried or nervous. In contrast, like somebody with ADHD will experience difficulty concentrating even in situations where their mind is calm, where there's quiet or there's no stressors. And what we find is right. People with ADHD may be worried about the interpersonal dynamics. Like did they notice they just checked out?

Are they mad at me? I forgot this my teacher doesn't like me. My mom's mad at me because I can't just get it right. And so it's the anxiety can be around how the ADHD impacts them, whereas what you'll find in anxiety, it is constant nervousness and sweaty ness. Yes, worry across the board, but like you're highlighting, they can play off one another, right?

And I think that really underscores why it's important to have professional diagnosis too, because it can it can look a lot like anxiety. And it also can look a lot like PTSD too. For people who have trauma, they can be very hyper attuned to their environment. Yeah. And people who have ADHD very much the same people who have had trauma and have a lot of anxiety, too.

They can also be kind of forgetful. And people who've had trauma are just sort of, lacking that follow through. And maybe they dissociate. Yeah. And so that's the where there's in my head kind of checking out these different ways and reasons and methods in which we do that. Yeah, I was and I did all through grade school, I think through college, I dissociated by daydreaming.

Yeah. Just to get through because it was so stinking boring to me that I would daydream. And that is a form of dissociating. So it can look a lot like PTSD or anxiety. And it really underscores why it's important to have a professional diagnosis of this, especially because the treatment, the most successful treatment is going to be medication.

Maybe we'll talk about that in a minute, but we don't want to be gone on medication for ADHD. If our issue is trauma state. Right. And that testing really allows that professional to ask you those nuanced questions of like, how does this present and how does this present? So when you're distracted by a thought or worry based thought, what's the word like?

They can help you kind of dissect that. But there's also standardized testing that's computerized. That is meant to kind of rule in and out and help really assess if it isn't. And that's a really helpful part that can come in. A lot of people, I think will have that have had that experience of, getting recommended to have testing, to have the diagnosis.

I remember this little anecdote, kind of funny, but I remember getting I got tested here, Sergeant Behavioral Health and it was, Nystrom and I got tested and I boy, I think it was maybe six years ago. I thought it was a lot longer. It's only about six years ago, and I thought, this is the easiest test in the world.

This I thought it was going to be a hard test and it was boring and it was easy. And I realized that I was just checking out because it wasn't stimulating enough for me. And I was bored. And I thought, this, I'm going to pass this, you know, super easy, but no moderate, ADHD. So yeah, it really is important to, to get a professional diagnosis.

Yeah, it really is. And one of the things that I is helpful to talk about is how it can be different in women, how women can experience it, and in girls. And this is not always the case. Right? So we don't want to just stereotype genders, but it can be where what we find is boys tend to be diagnosed at a higher rate than girls, because girls will sometimes experience that inattentiveness and they'll experience it more internalized.

So they might be kind of characterized as shy or quiet or that daydreamer like you referred to, but they're really having this internalized emotional dysregulation. So they're feeling really like upset or activated. And instead of acting that out externally, they're doing that internally to themselves. Right. And that has an impact on their shame. They can feel this turmoil and again, that idea of like, what's wrong with me?

So you see this in girls where they might kind of check out socially withdraw and then that kind of reinforces things. And then you think about moms right in adulthood and moms trying to complete tasks like, what's a main job of moms, right? To help keep family organized, right? Help things kids get organized. And if that is a challenge for you, this is not accurate.

But that core belief is I am failing in this role, which is not the case. Organization is hard. I am probably killing in other ways as a mom here, but that societal beliefs about what makes somebody good at certain roles as a student, as a mom, as a caregiver can be there. And so you can just and it's unfortunate, too, is I think a mom or anybody, a male female who has ADHD.

A lot of people don't realize how hard they are actually working on things and how exhausting. They put on so much more effort into things and so they can get rather exhausted from that. And so I think that it kind of reminds me about medication and how do we how do we treat this. And so there is there is no cure necessarily for this.

Our brain does typically it's that frontal lobe where we do our executive functioning, where we kind of have our rational thinking. We kind of have this ability to govern our lives. And through this. So that's our frontal lobe. Let's think typically that will start developing at about age 26. However, for people with ADHD, even though their brain is fully developed, there is this difference in their brain and how it's wired and how it gets activated, etc..

So there's no cure, for this and symptoms can be managed. The most effective way to manage ADHD is through medication. So it's one of the more, heavily studied diagnoses disorders. And it's also one of the most easily effective. And I don't know about you, but I find that encouraging and frustrating because I see so much resistance to the medication.

I understand it, it's just unfortunate because it's incredibly effective, right? Right. Because there's no other way we can will ourselves to have our brain be at that spot that we know helps us thrive. And I and I think the empowerment lies in knowing, as a person, right, experiencing ADHD or a parent and trying to think about with your child.

I really invite them to just have conversations with the medication provider. What are the options, right? What are the pros and cons? And I think that piece of we can always try. And that doesn't mean we have to continue. It's one medication that is actually easier on the body to stop right or decrease. And so that it's just helpful to be just encouragement to have those conversations and ask the questions.

Express your concerns because they're valid and exploring, like, how could this be a fit in? Why might this help? I remember the first day I tried medication. Do you? I'll never forget it. Yeah. What happened? I was I was reading and I sat on a couch and I read for four hours, and I didn't even realize, no, I would read every word on a page and have no idea what I read, and I would.

I struggled through grad school, all that I can't imagine. It was so frustrating. It was emotional. I'm not ashamed to admit what I have said. I said to myself, oh my, this is this is how normal people are, quote unquote. You know it. Yeah. Wow. In other words, I said, this is I could have gone through all of my education like this.

And I almost had regret, too, because I could have done more, had I had the medication. I heard one person put it this way when I began my medication, it felt like I had been wearing really foggy, dirty glasses and someone gave me the right prescription with very clear lenses and I could see everything. And I so resonated with that.

Yeah. And I recently had a colleague who I told her, I said I think he had ADHD, get tested, just try meds. And within like two hours of trying meds, he texted me with very much the same kind of experience. And I was elated for him because I know that sense of relief. Yeah, what a powerful life story.

Thank you for sharing. Just that moment of like, just recognizing, right, and how powerful that was and super validating. Yeah. And, you know, you hear a lot from people too. Like not at that focus but also that like that chatter, that chatter of ideas and thoughts and the challenge of picking out what is the most important thought or what is the right thought.

Yes, there's no right that. But what am I supposed to be focusing on and what will help me and how I can quiet that chatter right? Absolutely. Chatters creative is not bad, but it's just like driving on your computer. 20 different windows open at the same time and keeping track of them. Now, I don't have to do that as much.

All that time prior, I had been really relying on routine. And having very strict regiment routine drove my wife nuts. I because, you know, if you got off track, that would kind of throw you off and so it was protective, right? I can understand why you would be protective of it. The weekends for her relaxation. We don't do anything.

We don't plan anything. That's horrifying for me. Yeah. Because I won't do anything that. And so I would say, well, here's my thought for the weekend, and this is no lie, I would have everything lined up in a list with time slots. So we'll go grocery shopping from 12 till 1246, you know. And she looked at that.

She was horrified. You don't run into anybody in the dairy section, right? Yeah. So there's a you know, there's freedom for me in that. And I think inherent within, for people with ADHD, you can get into this are nothing thinking when you're trying to stay to your routine. It's it's really important to understand, okay. Got to have some flexibility here too.

But keep coming back to the routine. I never lose my keys. I don't lose my keys. Yeah. This is because of my routine. Yeah. You have built in that technique. I go on vacation, don't care, and where do I put my keys? I have a little bit of anxiety because I have to establish a new routine. Right. And so what you're highlighting is a really important piece of one of the skills is having a set place for important items.

I always put my cell phone here. I always put my keys here. And that valid that anxiety that of like I'm out of my normal routine. How do I do this? Because you've developed these beautiful coping mechanisms. Yes. To help you thrive, right? Yes. Routines. Take a load off because I don't have to remember anymore. Yes. And as we're thinking about those, like, tips, you're sharing things that really have helped you, I think we can share some other things that we know can be helpful for individuals.

And like you highlighted, kind of a schedule or routines are helpful. So, are having intentional like time frame. So when you're trying to work, you're doing something setting alarms to check in with yourself. We have this thing called time blindness that people experience with ADHD. So some of those times you're like, Holy cow, I just worked on this for three hours.

I don't know what I did or you get like in the things that are just or is really hard and you're jumping from thing to thing, right? Right. When the tasks are not interesting to your brain. And so I work with clients to say, let's set an alarm every hour where that's your time to like, take a break, stand up, stretch, check in, whatever I'm working on.

Has this been like a do I feel like I've been effectively working on this? Do I need to take a little break, wake myself up, do something different, and then come back to it? Or oh, nope, I'm been on track. This feels good. I'm going to give it some more time. And so having those alarms helps you kind of check in on how I'm doing, check in and being mindful.

I think of we've talked in the podcast in the past about being mindful and those kind of exercises get us back to the present moment, because we will lose track of time. And what I find very validating is people who don't have ADHD are actually experiencing a hint of this when they start scrolling on their phone from Facebook or Instagram or something, and they're just scrolling, scrolling.

Yes, they lose track of time. And I'm like, yeah, that's ADHD. Now, you know, a little bit of what that feels like. Yeah. And highlight how do we the skill of keeping distractions at bay. So can we set our phone in the other room? Can we have it face down. Right. I will sometimes leave it in the other room when I'm trying to do something because I'm tempted right, to go on and scroll.

Yeah. Body doubling. What do you mean by that? So it is where you are doing a task and somebody else is doing a task next to you. It can be the same task. And then it's called body doubling. But it helps when you have somebody working alongside you just to stay a little more focused, a little more grounded.

Yeah. No more accountability, right. Because you know, that person's going to notice if they stand up. And it's with compassion. Right. And that big C word of compassion is a huge technique to that. I think we would both really highlight right out of the goal. When you notice yourself experiencing a symptom of ADHD, instead of getting mad at yourself, having compassion and shifting how you're thinking about it and what you're saying to yourself.

Yeah, it's essential because we're so used to and we could become very accustomed to beating ourselves up, and we're always kind of walking with guilt and shame. Even if we have anxiety, we always going to have that guilt and shame. And our solution is, like I said earlier, we just keep beating ourselves up. And so, it's going to be really hard to manage ADHD and be happy in life.

And that really, I think is tragic because one of the things I, I find with people who have ADHD is they can be a lot of fun and they like to have a lot of fun. And there's a whole lot of great strengths. I saw something on a LinkedIn post. I think I even reposted it, and it showed not just the challenges of ADHD, but all these wonderful strengths that go along with it.

They can be gregarious and creative and fun, and they bring a positive energy and such. So we need to have a very balanced perspective of ourselves. Yes. Yeah. And catching those critical condescending that might be your best friend. Be nice to yourself. Yeah. And shift kind of the way you're thinking about that. Like you're the creative, you're the explorer.

You're the critical thinker. You're the one who's able to come up with ideas because you're not just listening to the rote lecture. Your mind is able to think creatively. And so validating that I think with that too, is that you can get to a point where I've been able to say, I've got ADHD. Yes. And it's very, disarming, like for other people.

And it frees me up because I accept myself. Yeah, I like myself. And there are people who don't have the same kind of brain as I do, and they have strengths and weaknesses or challenges as well. So, yeah, I think it's good just to say, yeah, I've got this. Yeah, there's some really great things about it. And the interpersonal nugget of if you find yourself distracted or somebody says something and you've lost track, that person is not going to be mad at you if you look at them in the eye and say, oh, I'm sorry, I was just zoned out for a second there.

Could you say that again, please? Right. Just put it. Yes. And that's really speaks to sincerity too, because I think people with ADHD sincerely really want to do well, be successful. They there's great intention to connect with people, especially their partners. And if they say just own and say, yeah, I checked it out for a second. Yes. Can you say that again?

Yeah. What's kind of fun is I have clients that do that and they'll say, I have no idea what you just. Yeah, that's great. I love that they can advocate for themselves that way. And then it stops the person who's checked out from worrying. I just checked out. Did they notice? Did I catch everything? Did I miss something?

Because then when you can directly assess it, it quiet those worries, thoughts. The pressure's off. Yeah, yeah. Well, we covered a lot. Well, you know, we could probably talk about this for another two hours here, but we hope you took some nuggets out of this. Yes. And if you have ADHD, you might have forgotten and tuned out so you can listen again.

And we're glad you can do that. And glad you all joined us. So look forward to connecting with you again soon. I'll.

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