Tips On The Management Of Adult Attention Deficit Disorder
M. Hallowell, M.D.
and John J. Ratey, M.D.
treatment of ADD begins with hope. Most people who discover they
have ADD, whether they be children or adults, have suffered a
great deal of pain. The emotional experience of ADD is filled
with embarrassment, humiliation, and self-castigation. By the
time the diagnosis is made, many people with ADD have lost confidence
in themselves. Many have consulted with numerous specialists,
only to find no real help. As a result, many have lost hope.
The most important
step at the beginning of treatment is to instill hope once again.
Individuals with ADD may have forgotten what is good about themselves.
They may have lost, long ago, any sense of the possibility of things
working out. They are often locked in a kind of tenacious holding
pattern, bringing all theory, considerable resiliency, and ingenuity
just to keeping their heads above water. It is a tragic loss, the
giving up on life too soon. But many people with ADD have seen no
other way than repeated failures. To hope, for them, is only to
risk getting knocked down once more.
And yet, their
capacity to hope and to dream is immense. More than most people,
individuals with ADD have visionary imaginations. They think big
thoughts and dream big dreams. They can take the smallest opportunity
and imagine turning it into a major break. They can take a chance
encounter and turn it into a grand evening out. They thrive on dreams,
and they need organizing methods to make sense of things and keep
them on track.
But like most
dreamers, they go limp when the dream collapses. Usually, by the
time the diagnosis of ADD has been made, this collapse has happened
often enough to leave them wary of hoping again. The little child
would rather stay silent than risk being taunted once again. The
adult would rather keep his mouth shut than risk flubbing things
up once more. The treatment, then, must begin with hope.
We break down
the treatment of ADD into five basic areas:
In this pamphlet
we will outline some general principles that apply both to children
and adults concerning the non-medication aspects of the treatment
of ADD. One way to organize the non-medication treatment of ADD is
through practical suggestions or "tips" on management. Fifty such
tips are presented below:
support, and coaching
forms of psychotherapy
- Be sure
of the diagnosis. Make sure you're working with a professional
who really understands ADD and has excluded related or similar
conditions such as anxiety states, agitated depression, hyperthyroidism,
manic-depressive illness, or obsessive-compulsive disorder.
yourself. Perhaps the single most powerful treatment for ADD is
understanding ADD in the first place. Read books. Talk with professionals.
Talk with other adults who have ADD. You'll be able to design
your own treatment to fit your own version of ADD.
It is useful for you to have a coach, for some person near you
to keep after you, but always with humor. Your coach can help
you get organized, stay on task, give you encouragement or remind
you to get back to work. Friend, colleague, or therapist (it is
possible, but risky for your coach to be your spouse), a coach
is someone to stay on you to get things done, exhort you as coaches
do, keep tabs on you, and in general be in your corner. A coach
can be tremendously helpful in treating ADD.
ADD adults need lots of encouragement. This is in part due to
their having many self-doubts that have accumulated over the years.
But it goes beyond that. More than the average person, the ADD
adult withers without encouragement and positively lights up like
a Christmas tree when given it. They will often work for another
person in a way they won't work for themselves. This is not "bad",
it just is. It should be recognized and taken advantage of.
what ADD is NOT, i.e., conflict with mother, etc.
and involve others. Just as it is key for you to understand ADD,
it equally if not more important for those around you to understand
it--family, job, school, friends. Once they get the concept they
will be able to understand you much better and to help you as
- Give up
guilt over high-stimulus-seeking behavior. Understand that you
are drawn to high stimuli. Try to choose them wisely, rather than
brooding over the "bad" ones.
- Listen to
feedback from trusted others. Adults (and children, too) with
ADD are notoriously poor self-observers. They use a lot of what
can appear to be denial.
joining or starting a support group. Much of the most useful information
about ADD has not yet found its way into books but remains stored
in the minds of the people who have ADD. In groups this information
can come out. Plus, groups are really helpful in giving the kind
of support that is so badly needed.
- Try to get
rid of the negativity that may have infested your system if you
have lived for years without knowing what you had was ADD. A good
psychotherapist may help in this regard.
- Don't feel
chained to conventional careers or conventional ways of coping.
Give yourself permission to be yourself. Give up trying to be
the person you always thought you should be--the model student
or the organized executive, for example--and let yourself be who
that what you have is a neuropsychiatric condition. It is genetically
transmitted. It is caused by biology, by how your brain is wired.
It is NOT a disease of the will, nor a moral failing. It is NOT
caused by a weakness in character, nor by a failure to mature.
It's cure is not to be found in the power of the will, nor in
punishment, nor in sacrifice, nor in pain. ALWAYS REMEMBER THIS.
Try as they might, many people with ADD have great trouble accepting
the syndrome as being rooted in biology rather than weakness of
- Try to help
others with ADD. You'll learn a lot about the condition in the
process, as well as feel good to boot.
structure. Structure is the hallmark of the non-pharmacological
treatment of the ADD child. It can be equally useful with adults.
Tedious to set up, once in place structure works like the walls
of the bobsled slide, keeping the speedball sled from careening
off the track.
- Color coding.
Mentioned above, color-coding deserves emphasis. Many people with
ADD are visually oriented. Take advantage of this by making things
memorable with color: files, memoranda, texts, schedules, etc.
Virtually anything in the black and white of type can be made
more memorable, arresting, and therefore attention-getting with
- Use pizzazz.
In keeping with #15, try to make your environment as peppy as
you want it to be without letting it boil over.
- Set up your
environment to reward rather than deflate. To understand what
a deflating environment is, all most adult ADD'ers need do is
think back to school. Now that you have the freedom of adulthood,
try to set things up so that you will not constantly be reminded
of your limitations.
and anticipate the inevitable collapse of X% of projects undertaken,
relationships entered into, obligations incurred.
challenges. ADD people thrive with many challenges. As long as
you know they won't all pan out, as long as you don't get too
perfectionistic and fussy, you'll get a lot done and stay out
- Make deadlines.
- Break down
large tasks into small ones. Attach deadlines to the small parts.
Then, like magic, the large task will get done. This is one of
the simplest and most powerful of all structuring devices. Often
a large task will feel overwhelming to the person with ADD. The
mere thought of trying to perform the task makes one turn away.
On the other hand, if the large task is broken down into small
parts, each component may feel quite manageable.
Avoid procrastination. When things get busy, the adult ADD person
loses perspective: paying an unpaid parking ticket can feel as
pressing as putting out the fire that just got started in the
wastebasket. Prioritize. Take a deep breath. Put first things
first. Procrastination is one of the hallmarks of adult ADD. You
have to really discipline yourself to watch out for it and avoid
- Accept fear
of things going well. Accept edginess when things are too easy,
when there's no conflict. Don't gum things up just to make them
- Notice how
and where you work best: in a noisy room, on the train, wrapped
in three blankets, listening to music, whatever. Children and
adults with ADD can do their best under rather odd conditions.
Let yourself work under whatever conditions are best for you.
- Know that
it is O.K. to do two things at once: carry on a conversation and
knit, or take a shower and do your best thinking, or jog and plan
a business meeting. Often people with ADD need to be doing several
things at once in order to get anything done at all.
- Do what
you're good at. Again, if it seems easy, that is O.K. There is
no rule that says you can only do what you're bad at.
- Leave time
between engagements to gather your thoughts. Transitions are difficult
for ADD'ers, and mini-breaks can help ease the transition.
- Keep a notepad
in your car, by your bed, and in your pocketbook or jacket. You
never know when a good idea will hit you, or you'll want to remember
- Read with
a pen in hand, not only for marginal notes or underlining, but
for the inevitable cascade of "other" thoughts that will occur
- Have structured
"blow-out" time. Set aside some time in every week for just letting
go. Whatever you like to do--blasting yourself with loud music,
taking a trip to the race track, having a feast--pick some kind
of activity from time to time where you can let loose in a safe
your batteries. Related to #30, most adults with ADD need, on
a daily basis, some time to waste without feeling guilty about
it. One guilt-free way to conceptualize it is to call it time
to recharge your batteries. Take a nap, watch T.V., meditate.
Something calm, restful, at ease.
- Choose "good",
helpful addictions such as exercise. Many adults with ADD have
an addictive or compulsive personality such that they are always
hooked on something. Try to make this something positive.
mood changes and ways to manage these. Know that your moods will
change willy-nilly, independent of what's going on in the external
world. Don't waste your time ferreting out the reason why or looking
for someone to blame. Focus rather on learning to tolerate a bad
mood, knowing that it will pass, and learning strategies to make
it pass sooner. Changing sets, i.e., getting involved with some
new activity (preferably interactive) such as a conversation with
a friend or a tennis game or reading a book will often help.
to #33, recognize the following cycle which is very common among
adults with ADD:
"startles" your psychological system, a change or transition,
a disappointment or even a success. The precipitant may be
"startle" is followed by a mini-panic with a sudden loss of
perspective, the world being set topsy-turvy.
try to deal with this panic by falling into a mode of obsessing
and ruminating over one or another aspect of the situation.
This can last for hours, days, even months.
- Plan scenarios
to deal with the inevitable blahs. Have a list of friends to call.
Have a few videos that always engross you and get your mind off
things. Have ready access to exercise. Have a punching bag or
pillow handy if there's extra angry energy. Rehearse a few pep
talks you can give yourself, like, "You've been here before. These
are the ADD blues. They will soon pass. You are O.K."
- Expect depression
after success. People with ADD commonly complain of feeling depressed,
paradoxically, after a big success. This is because the high stimulus
of the chase or the challenge or the preparation is over. The
deed is done. Win or lose, the adult with ADD misses the conflict,
the high stimulus, and feels depressed.
- Learn symbols,
slogans, sayings as shorthand ways of labelling and quickly putting
into perspectives slip-ups, mistakes, or mood swings. When you
turn left instead of right and take your family on a 20-minute
detour, it is better to be able to say, "There goes my ADD again,"
than to have a 6-hour fight over your unconscious desire to sabotage
the whole trip. These are not excuses. You still have to take
responsibility for your actions. It is just good to know where
your actions are coming from and where they're not.
- Use "time-outs"
as with children. When you are upset or overstimulated, take a
time-out. Go away. Calm down.
- Learn how
to advocate for yourself. Adults with ADD are so used to being
criticized, they are often unnecessarily defensive in putting
their own case forward. Learn to get off the defensive.
- Avoid premature
closure of a project, a conflict, a deal, or a conversation. Don't
"cut to the chase" too soon, even though you're itching to.
- Try to let
the successful moment last and be remembered, become sustaining
over time. You'll have to consciously and deliberately train yourself
to do this because you'll just as soon forget.
that ADD usually includes a tendency to overfocus or hyperfocus
at times. This hyperfocusing can be used constructively or destructively.
Be aware of its destructive use: a tendency to obsess or ruminate
over some imagined problem without being able to let it go.
vigorously and regularly. You should schedule this into your life
and stick with it. Exercise is positively one of the best treatments
for ADD. It helps work off excess energy and aggression in a positive
way, it allows for noise-reduction within the mind, it stimulates
the hormonal and neurochemical system in a most therapeutic way,
and it soothes and calms the body. When you add all that to the
well-known health benefits of exercise, you can see how important
exercise is. Make it something fun so you can stick with it over
the long haul, i.e., the rest of your life.
- Make a good
choice in a significant other. Obviously this is good advice for
anyone. But it is striking how the adult with ADD can thrive or
flounder depending on the choice of mate.
- Learn to
joke with yourself and others about your various symptoms, from
forgetfulness, to getting lost all the time, to being tactless
or impulsive, whatever. If you can be relaxed about it all to
have a sense of humor, others will forgive you much more.
activities with friends. Adhere to these schedules faithfully.
It is crucial for you to keep connected to other people.
- Find and
join groups where you are liked, appreciated, understood, enjoyed.
of #47. Don't stay too long where you aren't understood or appreciated.
- Pay compliments.
Notice other people. In general, get social training, as from
- Set social
Also see: What's
It Like To Have ADD?
Edward M. Hallowell,
328 Broadway Cambridge, MA 02139