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ADD Adults and Executive Function In Everyday Life: Symptoms, Diagnosis and Treatment 


By Paige Tangney, M.Ed., LMHC

Research on Adult ADD [Adult Attention Deficit Disorder] is increasingly stressing "impairment of executive function" as a hallmark of Adult ADD. Executive Functions are a set of cognitive abilities that control other abilities and behaviors including the ability to start and stop actions, to monitor and change behavior and to plan and carry through future plans--all necessary for a successful adult life and more difficult for ADD adults.  Adults with Attention Deficit Disorder often spend all day working and, at the end of the day, realize that they didn’t accomplish any of their goals for the day.  They have difficulty prioritizing tasks, organizing time and materials all because they lack the necessary degree of executive functioning. 

In plain terms, executive functions are necessary for getting through everyday life and accomplishing what needs to be done for their life to run smoothly.  Any time we make a plan to do anything we are using executive function.  The simplest tasks require us to make a plan to do an action, initiate the action, see the action through to completion, put the materials back in an orderly fashion, be aware that we have completed it and deal with interruptions.  Brushing your teeth in the morning is a simple example.  You walk in the bathroom, make a plan to brush your teeth, initiate the task by picking up your toothbrush and putting the toothpaste on, carry through with brushing your teeth, put the toothpaste cap back on if you didn’t already, put tooth brush and tooth paste back and remember later that you actually did already brush your teeth. 

Now imagine you are just starting that task and you are distracted by the telephone.  You have to prioritize.  Should you finish brushing your teeth and let the answering machine get the phone call or put down the toothbrush and answer the call?  Oh right, your boss was going to call this morning.  You put down the toothbrush and answer the phone.  Your boss told you about changes at work that could be challenging to deal with.  What were you doing before that?  Oh yes, brushing your teeth… 
You look around your house.  What a mess.  Piles of mail that you were going to sort, clothes that need to be put away, and then some day you will get to the dusting under all of that…   A person with good executive function skills can then do the following: decide cleaning this up is a high priority, figure out how much time that task is going to take, find the time in their calendar, make a plan to clean the house, initiate the plan at the given time, sort through and organize the clothes and the mail, complete the cleaning including the dusting and make sure that a structure is left in place so that the room will stay clean. 

Adults with ADD also struggle with executive function deficits at work.  Prioritizing tasks, initiating and finishing tasks, organizing work and materials all present challenges. Then there is difficulty with reading others nonverbal cues, inhibiting inappropriate comments, and regulating their own emotions. 

All of these challenges make everyday life for ADD adults challenging at work and at home.  The good news is that executive function skills can be learned and ADD adults can learn to understand and manage their gifts as well.   ADD adults tend to be people who can think creatively and see problems and solutions in a way their co–workers can’t.  However for those brilliant ideas to be realized, they have to learn how to use executive function.  

The key is learning to build structures and supports around everyday tasks.  Understanding natural rhythms--when are the most productive times--is critical.  How are those times structured so that the maximum work is produced and distractions are reduced?  Sometimes simply deciding to work for 30 minutes and then taking a “green break” where you look at something green like a tree, is effective.  Other times, setting a meeting date to increase a sense of urgency gets tasks initiated.  It also helps to begin the task by visualizing what the end of the task will look like when it is completely done, as opposed to part way finished.  How can the workspace be organized so things can be found easily and put away easily? 

Sometimes having a “clutter companion” work with an ADD adult can help them sort out what to keep, and what to give away to reduce clutter and streamline organizing. Judith Kohlberg and Kathleen Nadeau in their wonderful book, "ADD Friendly Ways To Organize Your Life," discuss dividing tasks into bites, gobblers and munchers and how to use “clutter companions”. 

“Bites” are tasks that can be done quickly, like putting the breakfast dishes in the dish washer.  “Gobblers” are tasks that require more of a time commitment, such as cleaning out a closet. “Munchers” are tasks that require a weekly time commitment over a month for example or several weeks like cleaning out your basement or garage.  

The reality for ADD adults is that they frequently use what Judith Kohlberg and Jean Nadeau refer to as the “EAST Strategy”, Everything At The Same Time.”   An ADD adult will be looking for that jacket they love, get upset at how messy the closet is, and decide on the spot to take everything out of the closet.  Problem is now they are late for work, still haven’t found the jacket and now have a huge mess in their bedroom.  Plus since they are overcommitted they are not going to be home in the evening because they are committed to doing something they really don’t have time to do anyway so the mess will stay there for a while making life crazier than it already is. 

Counseling for ADD adults can help them achieve the life they want instead of feeling trapped in this cycle of unfinished work, not enough time for their priorities, clutter, impulsive spending and always feeling overwhelmed.  Working with a professional counselor, ADD adults define the scope of the problem, take stock of their strengths, build on previously successful patterns and learn new strategies to take control of their lives.  Through counseling, ADD adults can create the life they want by learning to understand and utilize executive function strategies. 

An ADD adult who has learned good executive function will realize they do not have time to find the jacket, choose something else and make a mental note that the closet really needs to be cleaned out.  They will schedule time on Saturday when they know they have 2-3 hours for a “Gobbler” task, find a “clutter companion” to help them sort out the clothes and then tackle it on Saturday. They will sort clothes into “keep”, “give away” and “throw away” with help from their “clutter companion”, organize the closet and dispose of everything that does not belong in the closet.   The task is completed, clothes will be easier to find, and the ADD adult feels a tremendous sense of accomplishment which will make tackling the next task easier. 

At work, the ADD Adult who has learned how to use executive function will learn how to apply the same time management strategy to work site tasks and build their work day around “bites”, “gobblers” and “munchers,” beginning with the end objective in mind and be able to find time to utilize all of their creative ideas.  Because ADD adults crave stimulation they frequently gallop off on new ideas without thinking through how they are going to be able to execute them.  Judith Kohlberg and Kathleen Nadeau recommend using a mental “cooler” to place these ideas into.  Keep a file, then make time in your schedule to take these ideas out and sort them through with colleagues or just flesh them out a bit more and build a solid plan for execution of the ideas. That way required tasks are addressed at work and there is still room for developing and executing those creative ideas. 

The better ADD adults learn to utilize their executive function skills to organize their time, home, and work tasks, the more successful they will be at creating the kind of life they truly want.  Adults with ADD have a lot to offer the world and learning how to use executive function enables them to do it more effectively. 

Paige Tangney, of Ground Note Counseling, Seattle, Washington is a certified school psychologist and Licensed Mental Health Counselor Associate in Seattle, King County, Washington State. 

See also:  
Test for Attention Deficit Disorder (ADD)

Natural Alternatives & Over the Counter Substitutes for ADHD


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