Managing ADHD: A Table with 4 Legs
In Part One I wrote about how I view Adult ADHD and outlined a framework that I like to use when I’m working with my clients.
In Part Two, I want to look at ADHD management and how you can make sure that your current management plan is comprehensive and balanced.
When I say managing ADHD, I mean minimizing the negative effects that it has on your life. Remember, untreated or unmanaged ADHD is the problem. If you work to take care of yourself and your ADHD and learn to work with it, it can actually be an asset.
When you think about managing your ADHD, think of a table with 4 legs. You want each of these legs to be balanced so the table isn’t wobbly.
Leg #1
The first leg is education. You want to educate yourself about ADHD because it’s complex and looks a little different for everyone. You want to be as knowledgeable as possible so you can know how it’s showing up in your life. You can’t work on strategies to manage it if you haven’t accurately identified the problem.
Education about ADHD also helps to normalize and reframe the neurologically based ADHD difficulties, and to remove the unproductive guilt and blame that end up taking away your motivation.
Education provides explanations, not excuses. Explanations help you to better understand how to set yourself up for success, rather than repeating strategies that never worked particularly well.
LEG #2
The second leg is the bio-physiological aspect of treatment, the brain and body based strategies. I used to just call this leg medication but it’s more than that. Medication is often the first line of treatment because it helps so much to level the playing field for ADHD brains. However, there are people who can’t tolerate the medication or who don’t want to take medication at all. Other strategies include adequate sleep, which is a huge factor because lack of sleep can look like ADHD. Other important factors are good nutrition, keeping up with your checkups, and preventative measures to stay healthy.
Another important strategy that I include in this leg is meditation & mindfulness. These cover a lot of bases and help a lot of symptoms but I include these here because they help to regulate the nervous system and can literally change the structure of the brain. Research shows that brains that meditate have increased gray matter density in various parts of the brain, resulting in responsible improving cognitive function, reducing stress, and enhancing emotional well-being; essentially, regular meditation practice can "rewire" the brain.
LEG #3
The third leg is therapy. Therapy for adult ADHD might focus on the problems that show up in relationships, with coworkers or family members. It might focus on self-worth and teaching you to be kind to yourself. Mood problems and anxiety often go along with ADHD so therapy addresses these.
There is often a lot of shame that comes with ADHD, especially for those adults who were diagnosed later in life. The negative feedback and problems that come with untreated ADHD can get internalized without an explanation for why you do what you do. This internalization affects how you see yourself and how you view life and your future.
LEG #4
The fourth leg is coaching.
There’s a saying that pills don’t teach skills. But coaching does! Coaching is very helpful for adults with ADHD.
An ADHD Coach or a therapist who specializes in adult ADHD works with clients to come up with specific and practical strategies to help them deal more effectively with the daily life’s challenges.
In order to come up with strategies that are actually helpful, it’s required that both the coach and client have a solid understanding of ADHD in general. It’s also important to have an understanding of the client’s strengths and weaknesses as well.
Nancy Ratey, who some consider one of the founders of ADHD coaching said that there are 5 areas where ADHD coaching can be especially helpful:
Coaching maintains arousal- it helps clients work on abstract or long-term goals by keeping them in the forefront of the mind
Coaching modulates emotions- it prevents shame, guilt, and fear from paralyzing the client by identifying the triggers, exploring more effective ways to modulate those emotions, and identifying strategies to move forward on goals. (This sounds a lot like therapy so if your coach doesn’t have a strong clinical background or isn’t a therapist, be careful).
Coaching maintains motivation- it does this by breaking large projects into smaller pieces and cheering the achievement of partial successes, which makes it easier for clients to continue moving forward.
Coaching acts as the “executive secretary of attention”-the coach keeps the client focused on priorities and helps to drive away distractions
Coaching supports the client’s ability to self-direct actions and change behavior- the coach provides daily reminders and helps break down into smaller parts the necessary steps to take, thereby modeling how to deal more proactively with challenges. (Ratey, 2022).
Coaching can be one on one or in a group. Group coaching has added benefits like learning you’re not alone in your struggles which helps to reduce shame and cultivate a sense of belonging.
