Procrastination and ADHD

Are you one of those people for whom it could be said, “I’m procrastinating right now”?
I have that. And I recognize it from descriptions of ADHD. And recall that one of the ADHD doctors (Dr. Thomas Brown, perhaps? Not going to look it up, though) has pointed out that motivational tricks used for most people don’t work particularly well with ADHD people. Instead, he finds that they respond only to actual interest, novelty, or urgency. The promise of rewards (for example) does not work for them, possibly because time sense tends to be very skewed.

The question of procrastination came up on Quora recently, and Sara Wedeman wrote a rather extensive reply, some of which I’m excerpting here. (The question is “How do I get over my bad habit of procrastinating?”)

Of the seven predictors she identified in her doctoral thesis, I found these familiar:

  • Issues with Authority Figures (“I am the boss of me” syndrome)
  • Reality Interference (having too many things on one’s plate)
  • Issues re-Frustration Tolerance (easily frustrated and/or avoid the experience)
  • Unrealistic-to-completely-absurd planning skills

Reality Interference is a consequence of the others, but it’s likely to come up after the ADHD person is old enough (like, twenty). And lots of ADHD people also suffer from issues with authority figures. But lo and behold, frustration tolerance was the best single predictor.
And who has frustration intolerance? Yeah. People with ADHD. To quote:

There are nuances.
It’s not just a question of avoiding doing something that is frustrating, difficult, and anxiety provoking: the mere anticipation of frustration prevents the procrastinator from even starting.
People who procrastinate tend to avoid things they imagine to be frustrating – even if they turn out not to be so. Typically, they begin only when the consequences of notcompleting the task become, in their minds, more painful than the consequences of completing it.
Once that tipping point (pain of not doing exceeds pain of doing) is crossed, and they actually begin the task, they are often shocked to discover it was never that bad at all.
And, in fact, we see that often in advice on overcoming procrastination. “Get the first ten minutes in; you might discover that it’s not so bad. Not pleasant, but not so bad.”

Her suggestions for potential fixes?

  • Start with the low anxiety parts of the task first. That way, when the crisis hits, you’ll at least be better prepared.
  • Set exceptionally low goals. For instance, if you have a sink full of dirty dishes, set the goal of washing one fork. You’ll be surprised at how well this works. I mean it!
  • Set a timer, for a maximum of 20 minutes. Your goal is to do the task you’re avoiding for 20 minutes. After that, you must stop. It is a requirement.
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Deep breaths, remember

My very ADHD son started high school this year, and in our area that means he’s been in school since September 3: Sixteen days. Last year they made great strides and actually got him back into a mainstream classroom, though granted it was a year behind his social grade. (I don’t know what the real term is…nominal grade?) But still: given that he had lost essentially three years dealing with anxiety and other issues and that he has his own learning style, bringing him up to a point where he could be with the other students was huge. Huge.

And now, sixteen days after the start of the school year, thirteen school days after the start of the school year, I got a call from the teacher.

He doesn’t seem to be absorbing the math. He seems okay when you talk to him about the concepts, but it doesn’t show up on the tests. We’d like to move him from the Applied stream into the Fast Forward program.

Brief digression: In our school system, the Fast Forward program is essentially where they teach skills for living and abandon all other pretense. (There might be one lower, but at Fast Forward, we have left the normal school system entirely.) Once your child has gone into Fast Forward, I suspect they never get out: It is the bourne from which no traveller returns.

My heart sank. I have been listless, depressed, angry since they called. This is a decision more far-reaching than any other we have made because we cannot turn back if we say yes.

At least, I have that impression. I feel like this is the point where the school system gives up, where they stop trying anything like a normal education for my child, and they settle. “Oh, he can add. Good enough.”

Am I right? I don’t know.

Reasons why they might be right: He does have trouble learning things. He is anxious and that will hold him back. These people are professionals who work with kids all the time: they might be seeing signs that I’m ignoring. My son would rather be active doing things than studying, reading, doing schoolwork. He is, though I am sad to say it, a prime candidate for the kind of kid who drifts into a life of…not crime, but with no direction and bad behaviour that has never been thought about.

Reasons why they might be wrong: He is not stupid. This teacher is new for this kind of Special Ed work. I am not certain that he studied for this test–he was at the house of one of his classmates and I have no idea if actual studying happened. It has been thirteen school days: this first test should be a chance to be mistaken and then rectify it.

Heart-sick. That’s how I feel.

Even if we say, “No, you can’t put him in Fast Forward yet,” there is clearly work ahead of us, going through the math every night, and finding a way to make him successful.

The return of bad habits

It’s been a while since I posted…six months.

Ahem.

See, I haven’t made a habit of posting. And habits…are <em>tangentially</em> related to what I wanted to talk about. (I have Charles Duhigg’s <cite>The Power Of Habit</em> sitting here as an audiobook, waiting to be listened to, but I haven’t done that yet.)

You might have heard somewhere that it takes three weeks to establish a habit. I can tell you that it is not true for me. Six weeks might work, but there is still the chance that I will backslide.

If it’s a particularly unpleasant task, after years there is the chance I will backslide.

Now, the current speech I hear is that ADHD is related to problems or underdevelopment of the executive functions portion of the brain, such as inhibition. Those can grow or shrink or be otherwise modified through practice. (In fact, I suddenly suspect this is part of the practice of meditation: the need to exercise control over the self might lead to the encouragement of those functions, especially if they’re located in one or two section of the brain. I digress.) Habits increase the inhibition areas of your brain, at least in areas related to the habit. You inhibit behaviours X, Y, and Z until your habit is complete.

Except as I’ve always practiced it, creating habits doesn’t necessarily carry over to other areas.

I have also noticed that bad habits never go away: they’re always lurking there, waiting to re-establish themselves. I think this is probably something to be aware of: when everything is going well, you can’t abandon what has made your life go well. (Yes, there’s an edge condition where following the new behaviour is magical thinking; those are rare.)

So: in times of great stress, you might fall back into old habits. And, perhaps equally importantly, when everything is going well, you might also fall back into old habits.

I have Charles Duhrig’s Habit here on audiobook, so I’m going to give it a listen.

ADHD medication and avoiding tolerance

Not the social kind of tolerance, the medical/pharmaceutical kind.

One of the things we noticed about our son is that the dose of Vyvance he’s been on for about three years seems to wear off sooner: before it was good until after school (we used to call dinnertime the Arsenic Hour), and now we’re getting reports that he becomes his unmedicated self while at school in the afternoon. The temptation is to ask for an increased dosage, but tolerance is a known side effect for some people taking methilphenidate drugs. (There’s also an interesting thing that a doctor on some podcast mentioned, which is that changed life circumstances can affect how much you need. That doesn’t apply in this case, but I figured I’d mention it to lay the groundwork for pointless theorizing in some future post.)

Anyway. What my son’s pediatrician prescribed is alternating Concerta and Vyvance. The boy was on Concerta before, and for reasons related to anxiety, we switched to Vyvance, which has been good for several years.

As he explained it to me, a moderately-educated layman (I have a rusty B.Sc.Hons. in biology) is that the tolerance is in how well the liver processes the drug. Essentially, and I know I’m anthropomorphising here, the liver “knows” the stuff from familiarity and has become really good at eliminating it from the bloodstream.

So, just like switching up your exercise program when you plateau, what he’s doing is switching up medications. The liver isn’t as familiar with the form of the Concerta, it switches, and it “forgets” the shape of the Vyvance molecules. In our case, we’re alternating every two weeks. The pediatrician said he’s kept patients on this regime for as long as 11 years and has seen no increase in tolerance from either. (Given that he’s a pediatrician, he might only see a patient for 18 years, so 11 years is the longer end of testing regimes.)

I didn’t ask whether this has been tried only with Vyvance and Concerta, or whether it’s a general strategy for all of the slow-release methylphenidates. And I trust the man (I send my son to him, after all) but the most I can recommend is that, if you or someone in your household is experiencing tolerance problems, you should talk to your health care provider and see if it’s a strategy that would work for you.

Some basic ADHD strategies

With a recent diagnosis, now the majority of people in our house have ADHD, which drives the remaining person crazy. But. I need to write down the ADHD information for reference. Maybe this will be useful for others.

Dr. Ari Tuckman (More Attention, Less Deficit) suggests these six strategies as the ones that underlie the hundreds of strategies he’s run across. Sometimes you have to give the specific strategy because the underlying one here seems too diffuse to you, but with practice you can apply these. There are basically two strategies for each flavour of ADHD:

INATTENTION

1. Reduce distractions. So if you have the TV going, shut it off while you’re having a conversation. If you have a cool neato program running when you’re supposed to be doing something else, shut it off. You can always tape the show and watch it later, or play the game later. Your friends will probably be on FaceBook later, too.

2. Make what you’re supposed to be doing more attractive. Sometimes that’s as simple as new pens or Post-Its for the novelty. Novelty isn’t a bad word; just make sure that the novelty makes you want to do the thing you’re supposed to be doing, and isn’t itself a distraction. (This would apply to those ADHD sufferers who have to have something else going on, like the fellow who had to have a movie playing on his laptop while he wrote his thesis.) Know yourself!

HYPERACTIVITY

3. Find a way to fidget legitimately. This involves maybe having a fidget toy, or scheduling some time after school or work for some punishing exercise to try and get it out of your system for a while.

4. Avoid situations where you can’t fidget at all. If you have a choice (and sometimes you don’t), don’t go to the opera if you have to sit still for three hours. Don’t hang around with the friend who sits on the couch doing nothing if that’s all they do. (Everybody has bad days, so that might be what they do once in a while, but if you find they’re sitting still and you can’t more than half the time, well, maybe you should restrict your time with them and find people who want to do things.

School is tough, but usually they’re helpful about fidget toys if you just ask.

IMPULSIVENESS

5. Try not put yourself in situations where you know you’re impulsive. If you know you spend too much money at a store, try not to go there; if you know you spend too much time at a web site, try not to go there. When I went to the World Fantasy Con, for instance, I left my credit and debit cards in the car in the glove compartment, and took a certain amount of cash. I was trying to limit how much I could spend.

6. Limit the damage of an impulsive action. For instance, if you spend too much money at a store, don’t take your credit or debit card, and decide how much you can spend–and then take that much cash. If you spend too much time at a website, don’t use it as your reward for doing 45 minutes of good work, because you know yourself and you’ll spend more than ten minutes there. So instead, visit the website as your end-of-the-day, it’s-all-finished reward. You might still spend too much time there, but at least the other stuff got done.

So for instance, my son frequently loses track of time at the bike park: so maybe he sets it up so a parent will come at the predetermined time, so he can’t miss the deadline. Or he sets his iPod to buzz him at 5:00 so he comes home. (He keeps losing his watch; he loses the iPod less often.)

My daughter spends a lot of time on Tumblr. Maybe she puts a time lock on her computer so that she can only open certain programs at certain times, or that they are up for only a little while before the program complains. (Actually, there are add-ons like that for Chrome and FireFox; there might be something for other browsers, too.) Sure, she can beat them (it’s her computer) but that takes time, and that gives her the chance to figure, "Should I be doing this?" Maybe she rewards herself for piano practice by playing some song that’s she’s really good at, so she gets that reward of "Yeah, I am good at this," because when you’re learning a new piece, you spend a lot of time making mistakes.

Making something into a habit is about reducing distractions. You don’t have to think about it, it just happens: I go into the bathroom in the morning and take my medicine just before I brush my teeth. If I don’t brush my teeth in the morning (which sometimes happens on a weekend) I usually forget to take my medicine until later, because the two usually go together for me. Often I don’t remember doing something that’s a habit (but that’s a different issue).