One of the questions that I’ve been getting a bit more frequently recently is just trying to understand where to get started with ADHD - and I think this is a question that a lot of us have because there is just so much out there on ADHD and it’s hard to know where even to begin thinking about what you might want to be doing.
In today’s episode, we’re going to be exploring this idea by first looking at some of the areas that ADHD entails, how that knowledge can boost your ability to manage your ADHD, and also take a look another look at the Wall of Awful.
I think the easiest place we can start with ADHD is really jumping into the basics of the disorder, and I think that will also help explain why it’s so hard to figure out where to start when we’re treating our ADHD.
One of the first questions people have about ADHD is if it’s different from ADD - this is a totally valid question to have, and there is a lot of confusion around the terms. ADD became a diagnosis in the third edition of the DSM - that’s the Diagnostic and Statistical Manual of Mental Disorders, which is a tool used to help diagnose various mental illnesses - honestly, it’s mostly for insurance purposes, but it’s also one the best diagnostic tools we have. Anyway, so in 1980, the DSM-3 changed hyperkinetic reaction of childhood to attention deficit disorder or ADD. The disorder came with two subtypes ADD with hyperactivity and ADD without hyperactivity. Then only seven years later, the DSM-3 was revised, and in that revision, ADD was changed into ADHD, and then finally, in 2000, the DSM-4 added the three subtypes that we currently use, inattentive, hyperactive-impulsive, and combined type. And now in the DSM-5 term subtype has been replaced with presentation.
All right, now with that history lesson out of the way, the obvious question is, well, who cares?
Well, we can take that with us as we look at what defines ADHD - it gives us a better background to help understand the condition.
So we now know that we have the three presentations of ADHD inattentive, hyperactive-impulsive and combined - but we also want to look at understanding what those presentations actually mean. And this is important because too often, we think we know what something is without actually understanding it. This is known as the illusion of explanatory depth. It’s something that I find myself frequently running into while writing for this podcast. While I have a decent understanding of something, when I go to write out the finer details, I can find myself lacking a true explanation. All this to say that it is normal for us to believe that we have a deeper understanding of a topic than we actually do. It took me nearly a decade after my diagnosis to really look into what was going on - to actually understand how my symptoms were affecting my life.
Okay - so our three presentations, let’s take a deeper look.
An inattentive presentation is diagnosed with five or more of the following symptoms:
Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted
Is often forgetful in daily activities.
And a hyperactive presentation is diagnosed with five or more of the following symptoms:
Often fidgets with or taps hands or feet or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go,” acting as if “driven by a motor.”
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting their turn.
Often interrupts or intrudes on others (e.g., butts into conversations or games)
And then a combined presentation is when you present enough symptoms in both categories - otherwise, you’ll have a Predominantly Inattentive Presentation or Predominantly Hyperactive-Impulsive Presentation.
And just as a note, those are the diagnosis characteristics for adults; for those under 16 years of age, you need to present six or more symptoms.
Now I’m starting with this because I think that when we’re asking the question, “where should I get started with my ADHD management?” We really have to understand that ADHD is a spectrum disorder. You’re not necessarily going to have all of those symptoms I listed above - so where we get started is going to largely be an issue of identifying where your problems are manifesting. And this is also because how our ADHD affects us isn’t limited to those symptoms listed above.
For example, one area that a lot of people with ADHD struggle with is emotional management - and yet that isn’t really up there in the diagnostic criteria.
And so, one of our big first steps is simply educating ourselves about ADHD. This is a vital step because it is absolutely going to help us identify where we are having those issues with our ADHD.
What this is about here is acceptance of your ADHD. This was advice that I had frequently heard about managing my ADHD, but it took a good long time for it to actually sink in because it felt like I had accepted my ADHD. And yeah, sure, in some ways I absolutely had accepted that I had ADHD, but in many regards, I didn’t really. This is why we need to educate ourselves on what ADHD is because it’s so easy to believe that I’m just a bad person instead accepting that the reason I didn’t do that thing is actually my ADHD. So really, don’t sit on this idea. Without accepting our ADHD we cannot properly identify the problems were trying to fix and then we’re going to get anywhere with those solutions.
When were trying to solve a problem, one of the easiest steps to rush past is clearly identifying what the problem is. Don’t mistake noticing a problem for identifying what is actually the problem. The issue often arises from us identifying the symptom of the problem as the problem itself. For example, if I’m late all the time, it’s easy for me to go well the problem is that I’m being late, so the solution is I just need to get up earlier. That might be the solution, but I know that getting out the door for me usually isn’t about how much total time I have, its a lot more about realizing that 5 minutes before I need to leave that I need get all my stuff together and I have no idea where any of it is. So getting up earlier probably won’t fix that issue, what would fix that issue is finding a way for me to get my stuff together earlier so that when I do need to leave in a rush I don’t have to get it together then.
This is just about trying to figure out where our problems lay in the spectrum of what’s going on with our ADHD and we have to know how our ADHD is affecting us. Where is it creating those sticking points. But more than anything it’s about accepting that ADHD is what is creating these issues and finding solutions that are going to work with our ADHD.
And let’s slow down here and really get into this because I know this is one of the places that I slip up way to often with my own ADHD management. One of the easiest things for us to do is fall back onto the idea that we’re just not trying hard enough. That the issue is that we didn’t put in enough effort - that we were willful allies of our own demise. And executive dysfunction absolutely feels that way. While it doesn’t really feel like a choice in the moment it absolutely feels like a choice in retrospect and so when we’re looking back trying to figure out how to fix those issues, it does seem like it would have worked out if we had just buckled down and done the thing.
But the issue isn’t willpower or motivation or our drive to get something done, it often falls onto our executive function - or rather lack there of. And if we’re going to be solving for issues with our executive function, well that’s a very different solution than just trying to buckle down and try harder.
For more about executive function go check out my episode on executive function, episode 106, aptly named, executive function - I’ll be sure to link to it in the shownotes.
Last part in the Wall of Awful episode
I also want to talk about an idea that just keeps coming up for me over and over again when I’m dealing with ADHD management and that’s The Wall of Awful. This is an idea that comes from Brendan Mahan of the ADHD Essentials podcast. The basic premise is that when we have simple task, like doing the dishes, and that task feels really difficult to do is because not only are we dealing with the task, we’re also dealing with our own Wall of Awful, which is an emotional barrier.
Our Walls of Awful are built through a bunch of different bricks that are attached to our emotions - so we can have failure bricks, and disappointment bricks and rejection bricks and shame bricks and all these bricks create a wall between us and doing the task. The Wall of Awful is the emotional impact of repeated failure and it makes activating on even more difficult. It’s also important to know that the bricks don’t actually have to reflect reality - take perfectionism, we can get failure bricks when we have a perceived failure even if what we did was fine. Or if say you just feel like you disappointed someone. This is because it’s an emotional barrier, it doesn’t really care about reality.
The point being that there is a reason that some of those simple tasks can feel so hard to activate on.
Now, that isn’t to say there isn’t anything we can about getting past our Wall of Awful - according to Brendan there are 5 ways that we can try and get around the wall, but two don’t work and one works but is damaging to our relationships.
So the first way that doesn’t work is just staring at it - we see the problem and we just don’t do anything. We can also try and go around the wall, but it’s a metaphor so it’s also infinitely long - and this is us just trying to avoid our task and hoping it’ll go away. Neither of these “solutions” actually get us through doing the task, but they can lead to a solution that does, which is hulk smashing our way through the wall. And we can do this two ways, one way is someone will nag us about doing the thing and we’ll lash out, going, “yeah, I’ll wash the stupid dishes” or we can smash inwards and beat ourselves up until we get on with it. Either way, the hulk smash either will damage our relationship to someone else our it will damage our relationship with ourselves.
And just as a quick note, this is our threat response - fight, flight, or freeze.
Now we said there we’re 5 methods for getting past the wall - so we have two more and fortunately, these are the methods that work.
Our first method here is to put a door in the wall and this is just about changing our emotional state. One of the easiest mistakes to make when we have something we want to do is waiting for the motivation to do the thing. But often motivation isn’t what drives us to start, it’s something that happens along the way as we are doing the thing. So to help facilitate ourselves into doing the thing, we can work on changing our emotional state.
This is something I’ll frequently use to get myself ready to do some work - before I sit down to do anything, I often find it incredibly helpful to take a walk first. That movement fills me with endorphins and when I get back from my walk I’m ready to get to work. You can also do this with things like listening to a song to get you pumped up or getting a quick snack. We’re just getting ourselves amped up and in the right mood to do the thing we need to do.
Now it’s also important to realize that putting a door in the wall can be very similar to trying to go around the wall because we are doing something else other than the task we want to do. The key here is that instead of just trying to ignore the task and hoping it will go away is that we are actively getting ourselves ready to do the task. If we find that really we’re just procrastinating, then we need to look at maybe a different way to amp ourselves up or for another solution.
And putting a door in the wall is a short-term solution and won’t always help you get past that wall in the future. We’re not always going to have all those options to help get us amped up to do the thing.
So our other option is to climb the wall and what this means is that we’re sitting with the emotion that built up our wall and understanding what's stopping us. It’s about figuring out what’s at the core of that emotional block we’ve got. And we can do this by building handholds into our wall and that’s just creating ADHD friendly strategies to help us get started. This can look like working on our time wisdom and figuring out how long something actually takes to do. One of the things I often get stuck on is the idea that something is going to take forever, so I don’t want to start the dishes because well I just don’t have the time right now. But if I can use a timer and track how long it actually takes me to unload or fill up the dishwasher then I have much better understanding of the actually time commitment it is going to take. This can also come from creating a clearer picture of what you want to complete - sometimes we fill up our todo lists with vague items that are harder to activate on, if we can really break down and define that first step it can make the whole process easier.
So this was just a real quick primer on the Wall of Awful, if you want to hear more about it go check out Brendan’s podcast ADHD Essentials or I also did an episode on the Wall of Awful with Brendan way back at episode 40.
This Episode’s Top Tips
ADHD is a spectrum disorder meaning that you are going to have a variety of symptoms to varying degrees. Your ADHD is unique to you, and how you treat your ADHD is going to be a matter of figuring out which symptoms are affecting you the most.
One of the hardest parts of ADHD is getting past our internalized messaging around who we are - if we haven’t taken the time to work on accepting how our ADHD affects us, then it is easy for us to blame our problems on ourselves as personal failings instead of accepting how our ADHD can hold us back.
The Wall of Awful is the emotional impact of repeated failure, and it makes activating on tasks even more difficult - there are 5 ways people try to get past the Wall of Awful, two don't work, and one works but is damaging to our relationships and then two that work - the two that don't work are staring at it or trying to go around it - the one that works but is damaging is trying to hulk smash through the wall - the two that work that we want to focus on are climbing the wall and putting a door in our wall.
Mentioned in this Episode