PDF Summary:Thriving With Adult ADHD, by Phil Boissiere

For people with ADHD, managing daily life at work and at home may feel like a constant struggle. In Thriving With Adult ADHD, therapist Phil Boissiere explains why ADHD makes it harder to navigate tasks such as organizing a schedule, maintaining focus, switching between tasks, and controlling emotional responses—and he offers strategies that can help.

In this guide, we’ll examine what ADHD looks like in the brain and how it contributes to difficulties with executive functioning (a set of skills that helps with the sorts of complex cognitive tasks listed above). We’ll also debunk some common misconceptions about ADHD. Finally, we’ll explore the main five challenges of ADHD—such as emotion regulation and impulse control—and discuss strategies for managing each one. In our commentary, we’ll further explore tools for managing ADHD and look at different perspectives on treating the condition.

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(Shortform note: Russ Harris explains why we fight certain emotions in The Happiness Trap. He says that we separate emotions into “good” and “bad” categories because we’re conditioned as children to think of some emotions as undesirable. For instance, crying children are often told to control their physiological reaction to sadness, giving the impression that sadness is unacceptable. We also judge emotions based on the sensations they produce in our bodies. For example, we might label guilt as a bad emotion because it makes us feel sick to our stomach. However, fighting an emotion signals to our brain that it’s dangerous, sending us into fight-or-flight mode and creating more negative feelings, such as anxiety.)

Instead of fighting negative feelings, Boissiere advises, simply recognize their presence and name them. Let yourself feel them fully without doing anything to alter them. Giving yourself the chance to move through uncomfortable feelings without judgment allows them to abate naturally, making you feel better.

(Shortform note: When you’re sitting with a difficult feeling, try to approach it with curiosity instead of judgment. Ask yourself questions such as, “What is this? What does this feel like in my body? What is this feeling trying to tell me?” Such mindful awareness of emotions will remind you that they’re separate from who you are (i.e., you’re not a bad person for feeling angry) and only temporary.)

You can practice this technique by thinking about something at work or home that’s been bothering you. Then, write a description of the situation in a notebook. With your eyes closed, picture the thing that’s been bothering you. As you’re picturing it, name a feeling that arises in response. Breathe in and out slowly and naturally, allowing yourself to continue feeling the emotion you identify. The longer you sit and breathe with the emotion, the more it should fade.

(Shortform note: Why do these strategies work? Research supports the idea that writing things down helps you to process both emotions and information. Therefore, writing a description of bothersome scenarios may help you clarify your feelings about them before starting the next step. Additionally, many mindfulness meditation practices similar to Boissiere’s ask you to close your eyes to increase your awareness and focus. Among other benefits, breathing deeply encourages mental clarity and balance by oxygenating the body and improving blood circulation.)

Challenge #2: Making Plans and Prioritizing

According to Boissiere, another hallmark challenge of ADHD is difficulty keeping your life organized and making plans. When you’re unable to properly plan out the tasks you must complete—work projects, household chores, and so on—they feel more overwhelming, provoking anxiety. Feeling anxious makes it more likely that you’ll procrastinate on the task, which can lead to missed deadlines, work backlogs, and a continuous cycle of overwhelm.

For example, say you have friends visiting next weekend. You need to clean your house before they arrive. You also know you’re going to have a busy week at work, and you struggle to plan time into your schedule to complete your household tasks. Every evening, you’re tired after work, so you tell yourself that you’ll do the chores the next day. By the time Friday arrives, you’re overcome with anxiety when you realize that you’ve done none of the chores and your house is messier than it was earlier in the week. Because you procrastinated, you have to spend almost all night after work cleaning, so you’re exhausted by the time your friends arrive.

(Shortform note: In The Procrastination Equation, Piers Steel advises breaking large tasks into smaller steps to avoid getting anxious and overwhelmed when planning. Each step should be something you know you can accomplish. This builds your confidence through small wins—every time you complete one of the steps, your confidence and motivation increase, propelling you toward the next step. In the above example, this could look like writing down a small chore to do each day of the week instead of planning to do them all at once.)

Boissiere explains that ADHD can also make it difficult to decide which tasks to do when, meaning that people who have it often spend their focus and time on the wrong things. When you’re not allocating your time well, you may feel like you’re constantly running behind, making it even more difficult to decide which tasks are most important. Instead, you address tasks as they come to you, regardless of how urgent they are. Thus, your most important tasks can get left behind in favor of those right in front of you.

(Shortform note: This “out of sight, out of mind” tendency may be particularly pronounced in people with what clinicians call inattentive presentation ADHD. People with this type of ADHD tend to focus on immediately relevant stimuli at the expense of other tasks and obligations—which means they may not get some tasks done because they simply forget about them.)

Strategy #2: Prioritize Your To-Dos

To help you plan and prioritize, Boissiere suggests writing down a list of tasks you want to accomplish each day. Place each task in one of the following categories:

Category #1: I must complete this task. You must do these things because their deadline is today or because another person is depending on you to complete them today. There will likely be unfortunate consequences if you don’t complete tasks in this category.

Category #2: I should complete this task. These are things you should do today because their deadlines are coming up soon or because they’ll significantly benefit you in your personal or work life if you complete them.

Category #3: It would be nice if I complete this task. These are things that don’t necessarily need to be done today, but it could be helpful or enjoyable if they were. They’re the lowest-priority tasks.

The MoSCoW and ABCDE Methods of Prioritization

This prioritization technique that Boissiere describes is often called the MoSCoW method:

• M – must do

• S – should do

• C – could do

• W – won’t do

The “won’t do” category complements Boissiere’s suggestion by providing a place to put tasks that were on your initial list, but that you’ve decided not to do that day. Including this step may create a sense of relief, as you realize that you have less to do than you thought.

Some experts recommend reserving the MoSCoW method for times when your list of tasks isn’t too long. If your to-do list is too big, you may have too many items in each category, and it will still be overwhelming.

If your list is long, try Brian Tracy’s ABCDE method, as outlined in Eat That Frog!. Categories A through C match the order and content of the first three steps of the MoSCoW method, but category D represents tasks that you can delegate. Tracy states that you should delegate anything that someone else can do—this creates time for the tasks that only you can do. Category E tasks are ones you can eliminate because you no longer have time or they’re no longer relevant.

Challenge #3: Forming Memories Through Focused Attention

Boissiere conveys that ADHD affects memory formation as well. ADHD makes it difficult for people to focus their attention consistently on the right things, and memories can only be formed when you’re paying attention. Memory begins with awareness of your subject, and then the information moves from working memory to short-term memory and finally to long-term memory.

(Shortform note: There are four components of attention required to retain information. First, you must be alert and ready to pay attention. Second, you must be able to decide what to focus on. As Boissiere suggests, this is a struggle for people with ADHD. Third, you must be able to maintain your attention over a reasonable period. This can also be challenging for people with ADHD. Finally, you have to be able to briefly shift your attention to new input and then return it to what you were focused on before. For example, this could look like removing your attention from a report you’re writing to answer a colleague’s question, then refocusing on the report. We’ll discuss how ADHD affects this skill in later sections.)

Boissiere explains that working memory, an executive function, involves recalling information about the task you’re currently doing, without which you’re unable to finish the task. For example, if you’re cooking, you use working memory to recall which steps you’ve already completed and which ingredients you’ve already put in, so you stay in the right place in the recipe.

(Shortform note: In addition to helping you complete tasks, working memory allows your brain to decide what’s important and organize information for long-term memory. Long-term memory stores important skills, behaviors, and events from our lives. People who have trouble with working memory may find that their long-term memories feel jumbled and disorganized, or they may struggle to form long-term memories at all.)

Boissiere adds that distraction and switching between tasks weaken working memory. People with ADHD often become distracted easily and thus struggle with working memory, making it more difficult to complete tasks. For instance, you might get distracted by something on the TV while cooking and forget that your food is on the stove until you smell it burning. Then, the dinner you made is ruined, your house smells like smoke, and you have to spend extra money on takeout.

(Shortform note: In Eat That Frog!, Brian Tracy asserts that multitasking isn’t ideal anyway, even if you don’t have ADHD. What seems like multitasking is just switching your attention back and forth between different things. After being interrupted, it takes 17 minutes for the average person to refocus on the task. The more interruptions you experience and the more often you switch your attention, the more mistakes you make and the less you get done. (For people with ADHD, this could be compounded by the fact that their working memory isn’t as adept at storing information about their current tasks.) The tendency to start and stop a task repeatedly can increase the time needed to complete it by up to 500%.)

Strategy #3: Tell Yourself the Story of Your Task

According to Boissiere, one way to prevent distraction and keep track of the steps of a task is to tell yourself a story detailing what you’re about to do before you begin. Practicing this technique can improve your working memory in general.

Choose a relatively simple task or chore, such as cleaning off your desk. Then, narrate the task using a beginning, middle, and end. This narrative should include every step it takes to finish the task. You can write it down if you find that helpful. Once you’ve created the complete story of the task, actually do the task.

For example, before cleaning your desk, you might say to yourself, “First, I’m going to gather all the papers that can be thrown away and put them in the trash. Then, I’m going to file the papers that I need to keep. After that, I’ll remove the other items from my desk and dust them. Finally, I’ll wipe the surface of my desk with a cleaning solution and put everything back in its proper place.”

Why Narratives Help With Memory (and What You Can Add to Them)

The narrative structure for storing information suits the brains of neurotypical and neurodivergent people alike. Some neurology research suggests that our brains naturally store memories and organize information in a narrative structure because it suits our brains’ love of patterns. Narratives create a clear map onto which our brains can overlay new information, using the structure of beginning, problem, resolution, and ending. We also learn this structure early on when our families and teachers read or tell stories to us.

Along with telling yourself the story of your task, it may help you to also visualize completing the task before you begin. In Decoding Greatness, Ron Friedman states that visualizing your performance of a task assists you in several ways: It allows you to lock down important details, prepare for stressors and challenges you’ll likely encounter, and strategize potential solutions for these challenges. He suggests imagining your performance as specifically as you can, including the time and place, the sensory details you expect to encounter, and the nuances of the behaviors you’ll need to perform.

Challenge #4: Pausing Before Acting

Boissiere names poor impulse control as another common ADHD challenge. Impulse control involves stopping, considering your options, and choosing the best action in a given situation. Executive functions are necessary for this process to work, which is why people with compromised executive functioning (as in people with ADHD) struggle to manage their impulses. This can become problematic, as impulsive behaviors aren’t the best responses in most circumstances.

Impulsive behavior typically looks like this: Something happens that provokes an emotional response. You react immediately without considering the possible consequences of your actions. Then, you must face those consequences, no matter how unpleasant they are.

For example, say you get a notification that your favorite clothing brand is releasing a limited-edition jacket. Without considering the cost, you immediately order the jacket using your credit card. A couple of days later, you see the charge on your credit card statement and feel overwhelmed by how much money you’ve spent. Now your budget for everything else this month needs to be overhauled, and you have several hundred dollars more debt than you did before.

(Shortform note: Some experts point out that impulsive behavior has some advantages along with its negative consequences. Some of the best examples of art and creativity come from impulsivity, which allows for a unique kind of spontaneity. Impulsivity can also make you a quick decision-maker who doesn’t let valuable, time-sensitive opportunities slip away.)

Strategy #4: Examine the Consequences of Your Actions

Boissiere states that this strategy prompts you to examine your role in recent situations that resulted in a negative outcome. In doing this, you practice creating a mental connection between your actions and their consequences, which helps to reduce impulsivity.

(Shortform note: If you want more help understanding your actions, consider reaching out to a trusted loved one or a therapist for feedback. Both professionals and people who know you well can offer valuable perspectives on your behavior and its effects.)

Think of three recent scenarios when your behavior led to an unpleasant outcome. In a notebook, write down each scenario’s outcome. Then write down how the results of your actions made you feel.

For example, “My partner interrupted me while I was trying to focus on work and I snapped at her without thinking. This hurt her feelings and we got into a fight. Afterward, I felt ashamed that I upset her, and I could no longer focus on anything.”

(Shortform note: As you’re thinking about each of your three scenarios, you can use the following questions to guide and add to your reflection: First, ask yourself what decisions you made and why. What actions did you take based on those decisions? Why? What was the outcome of your choices? Then consider the other decisions you could have made. How might the outcome of the situation have been different if you had made a different choice?)

Additional Tips for Reducing Impulsive Behavior

If you’re having trouble identifying three specific scenarios to reflect on, consider trying these two tips for reducing impulsive behavior from other experts in ADHD:

1: Identify environments, triggers, and circumstances that are likely to drive you to act impulsively. For example, you may act impulsively when you drink alcohol or go to a shopping mall. Then do your best to avoid these triggers.

2: Insert time buffers before you make decisions. For instance, wait 24 hours after you have the urge to buy something before purchasing it to ensure it’s a good decision.

Challenge #5: Being Cognitively Flexible

Finally, Boissiere names low cognitive flexibility as a common challenge for people with ADHD. Cognitive flexibility is what enables you to move between different tasks, jump from old to new ideas, and engage with multiple concepts at the same time.

Shifting your attention from one complex task to another requires a lot of cognitive flexibility. People with ADHD commonly struggle with this, especially if they’re emotionally invested in the original task.

(Shortform note: Because of their issues with cognitive flexibility, people with ADHD may struggle to take breaks during the day. Breaks are an important way to cope with the demands of adult life, though, and people with ADHD can incorporate positive breaks into their day with the right constraints. Typically, a helpful break has boundaries that come from a set time limit or a set task. Boundaries prevent you from getting lost in the break-time task. For example, you may find it easier to switch from your break back to work if you set a timer at the start of your break. Or you might find it easier to return from a break that lasts the length of time it takes you to complete a short exercise, like a yoga video.)

To illustrate the challenge of low cognitive flexibility, let’s return to the scenario in the previous example: When your partner comes in, you’re working on a project for your job that’s due the same day. Doing well on this project could get your supervisor’s attention and set you up to take on more responsibility, which is what you’ve been working toward all year. You train all of your focus and attention on the task of finishing this project and your hopes for it. When your partner interrupts, they introduce a new task, whether they’re asking you to do something or they just want to talk. Your brain struggles to shift between your project and your partner’s task, and this struggle manifests as irritation.

Low cognitive flexibility can also make everyday problem-solving difficult. If you have ADHD, you may struggle to think of multiple solutions for a problem because your brain gets stuck on one idea.

(Shortform note: Because of low cognitive flexibility and difficulty with emotion regulation, people with ADHD often get easily frustrated or upset when faced with a problem. This heightened emotional state then makes it even more difficult to think of possible solutions. To get around this feeling, you must accept that finding solutions to problems is a complex process. Solutions may not come to you easily, and that’s all right. You can pause and come back to the problem when you’re less overwhelmed.)

Strategy #5: Solve a Problem From Multiple Perspectives

According to Boissiere, one way to improve cognitive flexibility is by frequently considering ideas and problems from different points of view. To practice this, start by asking yourself a question that poses a simple problem. For example, “How can I crack an egg?” Then, come up with an answer. You might say, “Tap the egg on the side of a bowl.”

After you come up with your first answer, consider how another person would approach the same problem. Make the other points of view as specific and interesting as you like. For instance, how would a world-class chef crack an egg? How would an engineer? How would a magician? By considering alternatives to your first thought, you expand your brain’s ability to come up with multiple solutions in any situation.

(Shortform note: There are many additional exercises you can try to practice considering perspectives that are different from your own. For example, choose a photo every day of a person or animal in an unfamiliar situation and imagine what their day would look like. Or choose a topic you’re interested in with multiple sides and try to make an argument for the side you don’t agree with.)