8 Goals and Tips for Addressing ADHD Symptoms

Hey there everybody and welcome back to addressing ADHD part two goals and strategies. I'm your host, Dr. Donnellice Snipes. In this part we're going to identify symptoms and issues for people with ADHD and possible interventions. Other videos if you want to know more in depth information about ADHD include diagnosis of ADHD with the DSM 5 trigger ADHD treatment strategies and this is a more general treatment strategy approach than the videos that that you're watching right now. Addressing ADHD Part one Motivating the Person With ADHD and Addressing ADHD Part three More Goals and Strategies so the first thing we're going to talk about is punctuality. People with ADHD often structure struggle with time management. Chronic lateness is a problem. So you may set the goal. Remember, goals should be specific, measurable, time, limited, relevant and and we want to look at these things. Be the goal is to be on time to work or your appointments 90% of the time. So that gives you a goal line, if you will, to figure out am I achieving my goal? You're going to be on time or you may even say be five minutes early to work or appointments 90% of the time. Interventions which may help scheduling these things with Push notifications if you know that you need to start getting ready 30 minutes ahead of time, set that push notification to remind you to start getting ready and then set another notification that reminds you, hey, you need to be walking out the door right now. So two notifications at the very minimum, set alarms that require movement. If you've got a passive notification on your mobile device, it just kind of does a pop up or something that may not get you to quit walking what you're doing. People with ADHD can get laser focus on things that they're actually interested in and they feel successful with and have difficulty focusing on other things. Alarms that require movement, an alarm that's across the room or setting the alarm on the stove in your house so you've actually got to get up and turn it off or it's going to keep beeping and annoying the crap out of you. That is going to be more helpful because it actually forces you to adjust your attention. Address your reasons for procrastination. If you are chronically late to things, why if you're chronically late to work, why is that? Is it that you have difficulty organizing things and getting ready to to go in time? Or is it because you really hate your job and there's a lot of anxiety and stress about and dread about going to work kind of Drag your feet. Sometimes you may be tardy because it takes you so long to get ready. If you start getting ready and then you look in your closet and you get distracted by all of the different potential outfits that you could wear, or you get distracted by the fact that the one thing that you wanted to wear is not there and it's triggers you to spiral or triggers you to get distracted, then that can be another issue. I find that for people with adhd, oftentimes having their preparation area organized and then planning ahead of time on Sunday, for example, putting together their outfits for the week can be very helpful. And then if they need to do something like in the morning, like shave or put on makeup or whatever it is they do, everything is right there. That can be very helpful. Procrastination gets started on tasks within five minutes of chosen or scheduled time 90% of the time. Tardiness is often caused by procrastination. So we need to look at what's causing the procrastination. Identify procrastination as a lack of motivation and or a response to fear or feeling out of control. If it's a lack of motivation, how can you turn this should into a want? And how can you. If you're procrastinating because you're afraid of getting started and not being able to do it, or if the task is too overwhelming and you just don't feel like you can manage it, you know, what can you do to address that? How can you break it down into manageable goals? How can you address your fears so you feel more confident and confident? Identify the most common things you procrastinate on and why. Now, some of them may be reports, some of them may be chores that you're doing, but you want to look at those things, figure out why you're procrastinating. I know I procrastinate on trimming the hedges a lot of times because when I do that I'm holding that hedge trimmer up and often my, my shoulders and my back hurts so much afterwards. Well, so what's an adequate solution? Only trim a few of the hedges at a time or work out before that for a few months before it's time to trim the hedges. But it I don't have to go out there and spend an hour and a half trimming the hedges in one day and make everything sore. You know, there are options. Develop strategies to increase your motivation. Address your feel of failure or feeling overwhelmed. Forgetfulness or or improving your memory is another goal. Improve your memory by reducing your forgetting to Less than two times per week. There aren't a whole lot of strategies for this. You. The biggest thing on with forgetfulness is having some sort of calendar push notification, something that's right there in your face. Now, putting a note on your bathroom mirror is great the first day, maybe even the second day, but by the third day, you're probably not even going to notice it. So it's helpful again to have push notifications on your mobile device or on your computer that actually like, get up in your way, get up in your face. So you have to do something to clear them. You can't just ignore them or swipe, swipe them away. Poor organizational skills. Well, so we want to help people become more organized. The goal would be to reduce the number of times per day you cannot find something to less than one time a day. Now think about your keys. That's one thing I lose a lot, or I used to lose a lot. Interventions Find what I call a natural place for everything. When I come in from work, putting my keys in my purse, putting my purse on the foyer table, that is a natural place. I, I noticed where is it that I typically just drop stuff and that's what I call the natural place. So instead of working against it and trying to set up this new place to put my stuff, I say, well, this is where I usually drop it anyway, so let me make a habit of putting it there and figure out how to do it in a way that doesn't look like, you know, a hurricane just blew through. Conversely, don't over organize. Sometimes people may decide that, okay, I'm going to get organized, and they have everything filed too much and too organized. So it's overwhelming to think about, okay, where does this one thing have to go? And it's so structured, it actually works against you. Bins are wonderful. If you have a bin in your mud room or in your foyer or an area in your foyer where you can put your stuff, it's not seven bins where one for the keys, one for your briefcase, one for your shoes, blah, blah, blah. If you have one bin or one locker where you put your stuff, that can make it easier to keep track of. Same thing for the bills. For example, if you have a basket where you put all of the mail and then you can sort it in one sitting and finally minimize clutter. And it is important, you know, once a week, once every couple of weeks, go through those bins and make sure that you're getting rid of anything that is unnecessary. All that junk mail that you're Getting same thing in your email box, for example. Minimize the clutter as much as possible. If you don't want to delete stuff right away, move it. I have a special file in my email that is just for advertising and promotions. So things that I get that are about sales or promotions from companies that I buy from, they get automatically filtered there and then I can go look over it or when I have time. Distractibility. The goal would be to stay on task with two or fewer reminders. So increase attention. Now, the reasons for losing attention can be many. So the first step is to identify and address what I call your pace vulnerabilities for distraction or lack of attention. Vulnerabilities, remember, are things that make you more likely to have the problem. So more likely to be distracted physically. A lot of times if you're in pain, if you're sleep deprived or if you're hungry or for some reason, you know, if you're, if you're sick, you may be more distractible. Okay, if any of those conditions are present, then what are you going to do? If in order to address the fact that you know that you're more likely to have attention issues that day affectively, if you're angry, if you're grieving, if you're depressed, if you're anxious or stressed out, you're going to have more difficulty paying attention, you're more likely going to be hypervigilant. All right, if you know that you're feeling distressed, dysphoric, then what strategies can you use to help you with your attention span? That may mean shortening things. That may mean for a lot of people, it means writing more things down during those times and, and taking more frequent breaks. Cognitively, if you are feeling overwhelmed, if you've got too much going on and your mind is just kind of racing that day for some particular reason, or you're having difficulty with focus, you're feeling spacey or foggy. Okay, it happens sometimes, you know that that is means that you're more likely to have difficulty with attention. What can you do to address those things? And I'm not providing solutions here because the solutions are going to differ for each person. Think back to times when you were distressed or foggy headed or in pain in the past and you were able to pay attention for a short period of time. What did you do? All right, that's a strategy that works for you. That's a strength. So let's put that in the let's use that again strategy or let's use that again column and finally, environmental vulnerabilities. And these are huge for people with adhd. Because of the sensory gating issues and because of potential trauma histories and hyper vigilance, you tend to be more distractible in environments that are busy. Whether it is a lot of colors or a lot of activity or for some reason you feel unsafe, People with ADHD often are more sensitive to smells, to flickering lights, to sounds. Knowing what things in the environment might add stress might make you more stressed out. Will help you identify things that you may need to address in order to be able to pay better attention. So recognize your individual differences. Improve mindfulness. And I know that sounds like a huge ask for people with ADHD. I'm not asking you to be mindful for 30 minutes. Improving mindfulness just means becoming aware of your thoughts. And while you're doing things, if you notice that you've gotten distracted, non judgmentally, accept that. Say, all right, I got distracted. Come on back over here, thoughts and refocus your attention. Don't get angry about it. When you get angry, you trigger your HPA axis and you actually increase your distractibility. So just noticing it, think about it like a child or a puppy or something else that just kind of wandered away. All right, you're not going to get angry at it. You're just going to say, come on back over here. Let's get refocused on what we're doing right now. Improve your mindfulness. Eventually you'll find that you don't wander quite as much. Write it down. If you know that you tend to be distractible, write it down. Some people are more distractible when they've got, you know, two or three or five things that are important that they quote, need to remember. All right, well, instead of trying to juggle that in your brain, which is going to make you more distractible, write it down so you don't have to worry about remembering that and you can focus on the issue at hand and ensure adequate quality sleep. There is a direct correlation between poor sleep quality and poor attention. Controlling anger and low frustration tolerance. Anger is a response to threat. When you feel threatened, whether it's physically threatened or your self esteem is threatened, or you feel out of control, you may respond with anger. Low frustration tolerance is kind of related. When people have had a history, especially when they've had a history of failure or rejection, then they may not have a good frustration tolerance. They may start doing something, they get stuck and they're just like, screw it, you know, I know how this is going to play out. All right, so let's recognize that. Let's recognize that prior experiences have not helped you build your frustration tolerance. Just like, you know, working out at the gym lifting weights, you don't start out doing 35 pound bicep curls. You start out with five pounds and you work your way up. Frustration's the same way. If you watch children, small children may not have a very long frustration tolerance. Think about a child working with one of those little toys that you're putting shapes into a a, into a box, but you have to match it to the right cutout. Some children will sit there for hours doing that. Other children, they'll try it. And if the square peg doesn't fit into the round hole, they'll bang it a couple of times trying to make it fit. If it doesn't, they move on to something else. All right, so then let's figure out, how do we help that child learn frustration tolerance? Now, the same sort of thing is true for people with adhd. They may have experienced frustration and not had the caregiver intervention to help them develop that frustration tolerance. So the goals are to reduce your anger episodes to less than one per day. And what we're talking about is that extreme, extreme anger. You know, you may get mildly irritated here and there, but ideally, reduce anger episodes to less than one per day. Recognize when you get frustrated, it almost always leads to anger. So that means also working on that frustration tolerance. You also want to reduce the intensity of anger episodes from a 5 on a scale of 1 to 5 to a 2. 90% of the time. Now, sometimes the anger episode is going to call for a five, but most of the time it's probably actually a two. So you want to reduce the intensity of the anger episodes. In order to do that, you need to be able to feel safe. In order to do that, your HPA axis, your stress response system, is going to need time to heal. If you are already experiencing emotional dysregulation, you go from 0 to 250 like that. That is often the result of emotional dysregulation and a neurological changes that happen in your brain. So it's going to take time for your brain to recognize that, okay, I don't have to send out the tsunami of stress. You know, I can just, you know, send out a little, little tidal wave interventions. Learn about anger and your anger triggers what causes you to feel threatened or out of control and start addressing those. As you start addressing those, as you start addressing those threats, as you start feeling safer and more empowered, your HPA axis is going to start to heal. Identify your anger or frustration vulnerabilities and we already went through those with attention. What physical conditions make you more likely to be irritable and have low frustration tolerance? What emotional or affective conditions? You know, if you're already anxious, then you're probably going to have a lower frustration tolerance and be more likely to get irritable and angry with people. So what are your emotional vulnerabilities? What are your cognitive vulnerabilities that make you may make you more likely to get frustrated or angry, like feeling overwhelmed. You've got too much to do and 17 different things and not enough time in the day. So that may make you more likely to get angry and frustrated with yourself or with other people. Identify common and preventable anger triggers and ways to address them. So you're learning about anger and your anger triggers, but then you need to identify. You're not going to be able to identify every single one. But what are your some of your common anger triggers and how can you address them? And then what are some preventable ones? For example, if driving in traffic causes you to get irritable and stressed out and angry, well, that's often preventable. If you don't use the main roads or if you travel at a slightly different time, for example, the more you can do to reduce unnecessary stress, the faster your stress response system, your HPA axis, will heal and the easier it will be to regulate your emotions. Reflection and schema revision is a tool that you can use to improve your problem solving. Adults with ADHD have difficulty drawing on past experiences to guide their actions, possibly due to HPA axis hyperactivation. When you're being bombarded by all the stimuli constantly. When you're not feeling safe, you're going to tend to be more hypervigilant. When you're hypervigilant, you've got stress hormones coursing through your brain. When that's happening, when that HPA axis is activated, it is much, much harder to focus, to call on those higher order cognitive processes because your brain is in fight, flee, freeze, fauna, forget about it mode and not solve the problem mode. People with ADHD are often not good at recognizing the subtle aspects of problems and the various tools that might solve them. Because they're in that fight or flight mode, they are reacting instead of acting or being proactive so they're not noticing the subtle aspects of the problem. Think about, imagine being on a tennis court. If you've ever and you've probably seen it in movies, if you've never Played tennis and having a one of those machines that throws the balls at you, all of a sudden it starts malfunctioning it and it just starts shooting tennis balls at you every every which way. Are you really going to think about different ways to solve this problem right now, or are you just worried about not getting hit by all those tennis balls? Okay, so for a person with adhd, sometimes it feels like life is those tennis balls coming at them and they're not noticing the nuances of the different tennis balls. They're just trying to figure out how to get the heck out of there. With the advent or the popularity of video games in this particular era, it can be helpful for people with ADHD to picture a video game that they like playing and imagine the last time they were in a situation like this in their game, or imagine this situation being part of a video game. Thinking back to the last time you've been in a situation like this and envision it playing out in your video game, what did you learn from that experience? What were some of the details that made it similar to and different than the current situation? What are other ways it could have played out? And how would you like to respond the next time? Now, most people who have played video games can relate to this. Even something like pac man or Ms. Pac man, which, you know, from my generation, I can think about, okay, when I played this time, and then the little ghosty thing started chasing me, I could have turned right or left, but I did this and it was successful or it was unsuccessful. So the next time this happens, because we know that that scenario is going to play out again. So the next time this happens, how do I want to respond instead? What do I think would be a better response option? And finally, safety. A lot of times people with ADHD will engage in unsafe behaviors like when they're crossing the street, driving or cooking, they get distracted. So the goal is a self report of getting sidetracked from activities less than two times per day. Interventions. Verbal narration can be helpful when they're cooking or or driving, narrating what they're doing, narrating what they're seeing. Now, obviously you're not going to be doing this if you're in the middle of the grocery store, but that is something that helps people stay grounded and in the moment and can help keep them from getting as distracted when you're cooking. Making sure to set timers. If you put a pizza in the oven, set a timer so you don't forget about it and get distracted. If you take medication or your child takes medication. Having a checklist on the refrigerator or even on on the bottle where you can check off as soon as you gave it to them. So you can look. If you think, oh my gosh, did I remember to take that medication? You can look and it's actually right there. And don't multitask. Despite the fact that it seems like somebody with ADHD should be really good at multitasking, not so much. So put the phone down when you're doing something. Focus on what you're doing. Don't be texting while you're crossing the street or cooking or whatever else. And if you're in the car, if you're driving Some people find it helpful to turn off the radio, even if it's just songs. If they're singing along and bebopping with the song or messing with the radio station, they may get distracted from what they're doing and Develop mindfulness To help you stop being impulsive, make a list of the inappropriate situations in what in which you're most likely to behave impulsively. For example at Thanksgiving dinner or at church, or in a work meeting. Identify and address triggers and vulnerabilities for impulsivity in those situations, and then identify and implement triggers and strategies for mindfulness. You can have triggers that remind you to focus. You can have triggers that remind you to think before you act. Some people will put a a bow on their finger or a bracelet on, or something that reminds them to think before they act. Before you go into situations where you're likely to be impulsive, envisioning it Envisioning what you need to do while you're in that situation can also be helpful. Addressing procrastination, disorganization, carelessness, poor problem solving, and unsafe behaviors can reduce anger and frustration and improve the health, relationships, and success in achieving goals of people with adhd. The person with ADHD benefits most from a trauma informed, strength based approach. Instead of asking why did you make that mistake? Or why are you doing that? Asking, you know, what skills did you not develop? How did we get to this point? And then figuring out how to make the environment make the situation more amenable to the individual's needs, talents, and abilities.