Secrets of ADHD Treatment Part II
SAY GOOD-BYE TO NON-ADHD SOLUTIONS
Pills do not give skills. If patients normalize their symptoms with medication, but continue to approach the tasks of life with neurotypical techniques that will never work for them, nothing changes. To develop confidence that they can access their abilities on demand is a two-step process.
First, they must finally and irrevocably abandon the notion that the old techniques work. Second, they must replace the failed techniques with new ones. This process takes time, after years of effort and emotion invested in old techniques. Your life will change when you truly understand the workings of your nervous system and why the techniques that work so well for neurotypical friends and family members don’t work for you.
USE THE RIGHT THERAPY TO MOTIVATE YOURSELF
If the importance of a task, and the rewards of completing it, don’t motivate an ADHDer to get things done, what can he use to move him to action? As it turns out, figuring out and embracing his deeply held values can help an ADHDer get things done and stay focused when other things have failed.
Michael Manos and his colleagues at the Cleveland Clinic have used Acceptance and Commitment Therapy (ACT) —a third-generation cognitive behavioral therapy developed by Stephen Hayes, Kelly Wilson, and Kirk Strosahi in the late ’80s for people with anxiety disorders — to help ADHDers get things done.
The subtitle of one of the ACT manuals is “How to Get Out of Your Head and into Your Life.” A big impairment reported by people with ADHD nervous systems is that they spend too much time in their heads because they are confused and hurt by the neurotypical world.
Hayes’s ACT manual works for ADHDers because it recognizes that the concept of importance - meeting a deadline or doing something that your boss considers important — is not a motivator for people with ADHD and anxiety. ACT solves the problem by helping ADHDers use their values — which give their lives meaning and purpose—to motivate them to be productive.
With ACT, patients are asked what matters most to them. What are the important things that give meaning to life? What aspect of their life has made a difference to themselves, to their family, and to their community or their profession? Some people value their family the most. For others, it might be setting a record or gaining fame. For other ADHDers, it may be faith in God. I ask my ADHD patients whether they are engaged in something meaningful that reflects their values. I ask them to ask themselves several times a day, “Am I doing something that matters to me?” This puts the person in touch with his values.
Generally, after several weeks of doing ACT, a patient has several ways to access his abilities when he needs them. He knows the paths to success.
FILL YOUR TOOLBOX
It is important to remind a person with ADHD that there is more that works about her than is broken. Given the problem-solving abilities of ADHDers, the compensations they make, and their determination to succeed, it isn’t surprising that only 10 percent or so of people with ADHD are diagnosed and given treatment.
Once newly diagnosed people are on the right medication, I ask them to make an inventory of things they do right — a list of what has worked and has gotten them this far. I ask them to carry paper and a pen with them everywhere they go. When ADDers come out of the “zone,” only then do they realize that they were in the zone. I ask them to think about their experience of being engaged, productive, and energized. When did it happen? What took them out of the zone and what got them back in it?
After a month, they will have listed 20 or so techniques that they know work for them. It is their bag of tricks to use when they are procrastinating or being frustrated by their lack of productivity.
SPARK INTEREST WHEN YOU AREN’T ENGAGED
If work were always exciting and engaging, they wouldn’t have to pay us to do it. ADHDers have to create interest where none exists to access their talents and abilities.
> A first-year medical student with ADHD was flunking gross anatomy. He saw the course as an onerous task of memorizing 200,000 meaningless names and facts. He had a teacher who saw that he was bright enough to do the work if he could engage with the subject matter.
They tried many things. Then the teacher asked him whom he admired. The student had idolized John Kennedy in his youth. It was the idealism that Kennedy aroused in him that led him to go to medical school.
The teacher asked him to imagine that he had graduated from medical school and was now an emergency room physician at Parkland Memorial Hospital, in Dallas. He asked the student to imagine that they had just wheeled President Kennedy in on a gurney with a bullet wound to the neck, and he had to know the anatomy of the neck perfectly to save Kennedy’s life.
With this technique and others like it, the young man was able to access his intellectual abilities when he needed them. He graduated second in his class. He developed dozens of ways to inject urgency into the tasks of life. He thrived in medicine as a diagnostician, because each patient presented him with a new mystery to solve.