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Key points
- Adults who have undiagnosed or untreated ADHD often struggle with anxiety and depression.
- What seem like other mental problems are often byproducts of the ADHD itself.
- The keys to managing ADHD are developing good organizational skills and considering medication.
I see a lot of adults in my practice who have attention-deficit-hyperactivity disorder (ADHD) but are either undiagnosed or untreated. What brings them in is usually not the ADHD itself.
Often when they come, they talk about depression and/or anxiety. They feel like losers: Compared to their high or college friends who have successfully moved ahead in their lives and careers, they haven’t gotten any traction. While they’re energetic and bright and have started many projects, there’s no follow-through. They’re in trouble at work because they miss deadlines, or get fired for always coming in late. If they come in with their partners, the partners complain that they feel like they are living with a 15-year-old who is unreliable. They’re frustrated and burned out from doing a lot of the heavy lifting.
Here’s what ADHD often looks like in adults:
Procrastination
If you have ADHD, you were probably the one in college or high school who was always doing that paper at 3 a.m. on the day it was due. Paying bills or cleaning out the garage or any other variety of not-done tasks are sitting piled around your house for weeks at a time. Why? Because tasks that seem overwhelming or boring always sink to the bottom of the to-do list.
The driver here is the brain tends to do what’s easy and put off the hard because the hard seems hard. You may have found over time that, under the gun of a next-day deadline, you can focus better and get it done.
Start but never finish
You have a great idea for a new marketing strategy for the business, but a week later...wait, you have a better idea. Stimulation feeds the ADHD brain, but that enthusiasm eventually fades when you get bored and restless or scattered. The old goal gets dumped, and you move on to the latest and greatest—the result: good starts, no finish line.
Forget, always late
Your partner reminds you that you need to pick up the kids from school, but you got busy and forgot (leaving your partner understandably upset). You find yourself running late to work because you got distracted looking at a YouTube video just before heading out the door.
Get hyperfocused
You start watching the video, and the next thing you know, you’re binge-watching some series. You look up cheap dog meds, and 5 hours later, you’re still online trying to track down the lowest possible cost.
Trouble regulating your emotions
You can easily blow up. One of the characteristics of ADHD is impulsiveness—acting before thinking it through—because your executive functioning, the rational part of your brain, is struggling. Not only do you decide it’s a great idea to drive to Miami now, but you also can quickly flare up with anger or irritability when you feel criticized or hurt.
What To Do
The two prongs on treatment are medication, which can help you focus when you have to work through that boring or overwhelming spreadsheet at work, and building organization skills through behavioral therapy. Here’s where to start:
Get an evaluation, check out meds
Some primary care doctors are comfortable doing this. Some are not and want a more formal psychological evaluation. Talk to your doctor and see what next steps she recommends. Medication can help with impulsivity, help get your rational brain back online, help you focus when dealing with difficult tasks.
Map out tasks and deadlines in advance
Sit down on Sunday night and figure out the five things, not 50, that you need to get done that week; this will help you set priorities and counter the emotionally-driven brain. Then sit down on the night before each weekday night and map out the three things you need to get done that are part of those five; this will help prime your brain for the next day. The other challenge is to stop your natural all-or-nothing thinking by not stopping at 2 p.m. Keep moving until your three talks are done. Creating your structure and routines is a challenge but key to staying on track.
Learn to do hard before easy
This is a big one. Here you tackle that overwhelming, boring spreadsheet first thing in the morning. Set a timer, work on it for 45 minutes. Take a break to re-center your brain, but time the break, so you don’t go wandering off looking at dog meds and never come back. Do another round of 30-45 minutes. You’re done. Give yourself a reward—a nice lunch, play Suduko. Now move on to the two easier tasks. Don’t stop till you’re finished.
Use prompts
Because you can forget, get scattered, you need prompts—a whiteboard right in your face that you write down the three things you need to do; multiple alarms to let you know you need to get dressed for work, so you don’t get lost and forget that it’s time to drop off the kids. Don’t think you don’t need it or that you shouldn’t need it. You need it.
Get a sideline coach
All this can be difficult to do on your own. Another person helping is a case of two brains making one. The key here is explaining how the other person can best help you in concrete ways: a reminder tomorrow morning about picking up the kids. You’re trying to break bad habits and autopilot, and as with all bad habits, accountability helps.
What you’re working against here is a brain that is different from others. You need to rewire it by changing what you do. The danger is that you won’t feel like it or want to give up, or that you simply can’t change.
Don’t entertain these thoughts for long. You have a disability, that like any disability you eventually need to better deal with if you want to be successful in your life. Push back and don’t put this off. Your life can be more successful and you can be more effective.
To find a therapist near you, visit the Psychology Today Therapy Directory.
