How to ADHD: An Insider's Guide to Working with Your Brain (Not Against It)

by Jessica McCabe

It is important to note that none of these tools are magic wands that will painlessly eliminate the obstacles that those with ADHD face. Everyone has go-to tools that work more often for them and a couple tools they only use occasionally. And we all have days when nothing seems to work. My hope for you is that by the end of this book, you’ll have a personal toolbox full of options.

sometimes, paradoxically, being functional means behaving in less (neuro)typical ways, so we can be more mentally healthy, happy, and generous humans for ourselves and for those we love.

I shied away from the term “disability” for a long time. Ableism is deeply entrenched in our society, and I internalized a lot of it. But the bigger issue, for me, was that I didn’t feel I was “disabled enough” to claim that identity and the protections and accommodations that come with it. It took me a long time to understand that it was my internalized ableism telling me I “should” be able to do without them.

Very few people ever knew how much I was struggling because I became a master of pretending everything was fine.

If I couldn’t meet expectations, I could try to exceed them. I could overgive, overwork, overplan. Forgot to buy someone a $30 birthday gift? Fix it with a $100 gift card.

I constantly felt like I was supposed to be doing more. My meds allowed me to do that.

I was trying so hard to force myself to fit the stencil cutout of who others expected me to be that I never got to know the person I was. I thought I was working to “meet my potential” and “be my best self,” but what I was actually doing was trying my hardest to be someone I’m not.

ADHD is a terrible name for the condition, because “attention deficit” implies a lack of attention. However, our brains can focus quite well sometimes—particularly on things we find engaging, such as our hobbies, crushes, video games, and so on. The trouble is, we can’t control the intensity of our focus or what we focus on. (We’ll learn more about this in Chapter 3, this page.) This big misconception makes people less likely to seek a diagnosis because they are able to focus…sometimes.

ADHD is a neurodevelopmental disorder, which means the nervous system, including the brain, develops and functions differently. Fundamental differences in brain development and structure contribute to differences in behavior. This is why behavior strategies that work for neurotypical people are frequently unsuccessful for ADHDers. Our behaviors happen for different reasons. In fact, research shows that—compared to neurotypical children—punishment is less effective for ADHD kids, while immediate positive feedback and salient rewards are more effective.

While individual ADHD symptoms might not seem like “that big of a deal,” the extent and consistency with which those with ADHD struggle are a big deal.

According to research, the optimal treatment for ADHD is multimodal and involves more than one type of treatment option. In fact, the National Institute of Mental Health conducted an enormous study about ADHD treatment (and gave it an equally enormous name)—the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study, or MTA Study for short. The MTA Study found that medication alone was not enough to effectively treat ADHD, and the most successful treatments combined therapy and medication.

A lot of our individual symptoms are something “everyone struggles with sometimes,” so we think what we’re struggling with is normal. Likewise, others may not realize the extent to which we’re struggling, because the behaviors they can see are only the tip of the iceberg. We’re trying so hard to meet neurotypical expectations, it might seem we’re doing okay—even when we’re not. The soul-crushing effort it took for us to meet those expectations isn’t obvious.

It’s easy to dismiss unseen disabilities, but ADHD can be incredibly disabling. If it’s not clear by now, our invisible obstacles can keep us from reaching our goals, even when we try our hardest. Even “mild”[*5] ADHD significantly impacts multiple aspects of our lives. (If it didn’t, it wouldn’t qualify for a diagnosis.)

Some people think that acknowledging your impairments means placing limits on yourself. I’ve found quite the opposite is true. Learning to recognize them and figuring out how to navigate them has made me more functional, not less. Taking ADHD seriously starts with recognition. The only way we can recognize and work with our challenges is by being honest about them, whether or not we think they’re a “big enough deal.” None of the treatments, strategies, accommodations, or environmental changes I lay out in this book will be as useful if we deny the extent of our challenges and don’t think we “really need” help.

Whenever you experience that gear-grinding feeling that tells you something isn’t working, don’t try harder. Try different.

Approaching tasks as a negotiation. What do I need to get The Thing done? What does my brain need for that to be able to happen?

success isn’t about avoiding failure—it’s about continuing despite it. Does that mean you should always keep trying to do something you keep failing at? No, sometimes we fail because something isn’t a great fit for us. And continuing to bang your head against the wall won’t get you anywhere or anything. Except a headache. But if something is important to you, you can keep going—even if you fail. Failing doesn’t make you a failure. It isn’t the opposite of succeeding, as I’d feared. It’s something that happens—and will happen—all along the way.

You know how lizards can’t internally regulate their body temperature? ADHD brains have difficulty regulating their focus (and emotions, and sleep, and…okay, yep, we’ll get to that later). The ability to control our focus—also called top-down attentional control—relies on the prefrontal cortex. It is the last part of the brain to develop, and it develops even more slowly in those with ADHD. And even once it is fully developed, it’s still impaired.

You can’t have metaphorical shower thoughts if you don’t make time for metaphorical showers.

The truth is the opposite of what most of us were told: the reason those of us with ADHD have trouble functioning isn’t because we haven’t found the right system yet and/or don’t “stick to it.” It’s actually the other way around. The reason we have trouble sticking to these systems—and why our stuff, time, actions, emotions, and words “spill over” onto those around us—is because we have trouble with executive function.

Many people, regardless of whether they have ADHD, make choices that aren’t exactly logical when their hot EF system is dominant. But as research has demonstrated, tapping into our cool EF—through reflection, contextualizing, and analyzing abstractly—can make it easier to make logical decisions, even when our emotions and motivation are pulling us toward impulsive ones. And these are skills that can be learned.

While we can’t change the fact that we have these differences in EF, the impairments we face as a result can be minimized. There are many things we can do to help compensate for our EF differences.

If you want to do more, do less.”

Simplifying your systems so they’re easier to maintain can make it more likely to be—and stay—functional in the long term. An example of this is “books go on the bookshelf” as opposed to “books need to be put on the correct bookshelf, sorted by color and size.”

The stuff that’s lasted beyond the new and shiny phase is often worth adapting (as needed) and trying again because it’s more likely to stick.

Sleep problems are so prevalent with ADHD, they used to be part of the diagnostic criteria.

Dr. Patrick LaCount, “If you need to pick between exercise and getting enough sleep, sleep.” This is coming from someone who researches the positive impacts of exercise on ADHD. However, prioritizing sleep doesn’t mean getting as much sleep as possible, or even getting eight hours. The amount of sleep we need varies from person to person and changes over our lifetime. According to experts, you should aim to sleep long enough to fulfill your intrinsic sleep needs. In other words, we should be aiming for enough sleep so that we feel refreshed and alert, not dull and sleepy.

According to Dr. Barkley, 8 percent of the general population has difficulties with time management. And those with ADHD? Ninety-eight percent.

projects, tasks, and events exist either “now” or “not now”—and anything “not now” can feel as if it doesn’t exist at all. We often live in the moment, responding only to what’s in front of our face and needs to be done now[*3]—and have trouble planning for events later than the next day, unless they’re particularly exciting. This makes it difficult for us to learn from our mistakes (we’ve already forgotten them!) or plan for the future (it doesn’t feel real!).

Difficulty regulating our attention means there are vast differences in our productivity levels. Some days, we might end up in hyperfocus and get a lot done; other days, we’ll be distracted by everything and we won’t accomplish much at all.

When you plan, work backward. Start with what you want to accomplish (and by when), and go backward from there.

Sequence instead of schedule. Doing things in a particular order is far easier on our brains than doing them at a particular time.

I usually understand why I should do (or avoid doing) a thing, but that understanding in and of itself doesn’t translate into usable motivational fuel. It doesn’t matter if the task is critical to something I care deeply about, or entirely irrelevant and a giant waste of my time. What matters is whether or not my brain feels like doing it. Sometimes I really can’t do something unless my brain cooperates. It feels like a hostage negotiation. Sometimes I can push through a task with my brain kicking and screaming “I don’t wanna!” and actually get the thing done. But there’s a trade-off: it takes three times as long, I’m less effective, and there’s a good chance it’ll be harder to complete the task the next time around. Sometimes I can excite and engage my brain, only for it to completely lose interest, forget what I was doing, or get stuck at the first confusing obstacle.

So, what does motivate an ADHD brain? Things that are: urgent new or novel (the right level of) challenging of personal interest In other words, stimulating. This is due to fundamental differences in the reward system of ADHD brains.

Evidence suggests that ADHD brains don’t release anticipatory dopamine the same way neurotypical brains do. Reuptake—the reabsorption of the dopamine—may also happen before it makes it to a receptor.

This is due to temporal discounting, where we perceive a desired result in the future as less valuable than one we could have now. Temporal discounting happens for everyone, which is why you might often hear suggestions to reward yourself for a successful week rather than a successful semester. But along with temporal discounting, those with ADHD also have shorter time horizons. A reward that will come next week isn’t going to be motivating in the same way because, to us, next week doesn’t even exist

we end up in crisis after crisis trying to get things done at the last minute. And this behavior is reinforced: when we pull off getting something done at the last minute, our brains release a ton of dopamine, which tells our brains, “That felt good. Do it again.” To break out of this cycle, it’s crucial to add extrinsic rewards that are immediate (or exciting!) enough that they’re actually, you know, motivating. Like, eating cookies while you work.

When we do a “simple” task—say, making a phone call—we’re not just dealing with that task. We’re also dealing with an emotional barrier that has been built from past failures with the task. Brendan Mahan, ADHD coach and founder of ADHD Essentials, calls this barrier a “Wall of Awful.” The more we’ve struggled with a task in the past, the more failure, disappointment, rejection, and worry we’ve experienced as a result. The more of these negative experiences we have endured, the higher that wall. We don’t just need enough motivation to complete the task. We also need enough motivation—and often time—to climb the emotional wall in front of it.

all our working memory “slots” may be taken up by trying to figure out (or remember) what we need to do and how we feel about it right now. As a result, all we see is that Wall of Awful. We can’t peer over it. We don’t get any windows to show us what might be on the other side. According to Brendan, there are different ways we deal with this wall. We might get angry enough that we can Hulk-smash through it to get a task done. Unfortunately, that often hurts our relationships, because we’re not always nice about what we say to ourselves (or to others) when we bust through the wall. Sometimes, we can put a door in the wall. We might change our mood with music, turn on a favorite TV show in the background, or work somewhere new to distract ourselves long enough to get the task done. But often, we need to climb the wall. Before we can face the task and effectively engage with it, both now and in the future, we need to do the emotional work of gearing up for it, facing our anxiety, and preparing ourselves to do The Thing.

we don’t need motivation to take action. In fact, it often happens in reverse: action can generate motivation. Here are some examples: Picking up our phone often motivates us to check our email, text messages, or social media. Sitting on the couch motivates us to pick up the remote. Planning a road trip motivates us to make music playlists. This is the idea behind what psychologists call behavioral activation. You don’t have to feel like going for a bike (or motor scooter!) ride to go for a ride. You just put on your gear. You check the air in the tires. You get on the dang thing. And then see how you feel.[*2]

Motivation is just one part of a bigger “get stuff done” system—and it might not be where the problem is. Consider these possibilities: A skill gap: You don’t entirely know (or remember) how to do The Thing or the steps involved. A lack of resources: You don’t have what you need to get The Thing done. For example, you might not have enough time, supplies, or energy. Perfectionism: Perfectionism, and the anxiety that goes hand in hand with it, can keep you from getting started or keep you stuck in mental loops.

Add urgency. Invite a guest over if you want to get yourself to clean. Sign up for a class with a friend if you want to get started exercising. Set up a “get stuff done” meeting with a co-worker. Turn a marathon project into a series of mini sprints so you can get started before it’s almost due. Adding a sense of urgency to tasks now can keep them from becoming a crisis later. Find the right level of challenging. If something is too easy, it might be too boring; if it’s too difficult, it can be too frustrating and discouraging to keep going. If it’s something you’ve already mastered and you’re having trouble doing it, add some challenging elements to it. If it’s daunting, take it down a notch—and if you’re having a bad brain day, take it down a couple more notches. Lowering the bar can help with perfectionism, too![*3] Tie a task to a personal interest. When you’re doing something you don’t want to do but need to do, ask yourself this: Is there anything interesting about this? You can also incorporate your personal interests into a task. You might have to make the final draft of your paper sound professional, but who says you can’t exclusively use Dungeons & Dragons metaphors to get the first draft done? If your interest is in turtles, maybe you check off items on your to-do list with turtle stickers instead of check marks. You can’t always choose what you need to do, but you have some control over how you do it. Add novelty. Doing boring or repetitive tasks in a new locat...

Do what you can ahead of time. Sleep in your gym clothes, book classes in advance, or make yourself a checklist. Doing what you can ahead of time means there is less to do—or get stuck on—when you need to get going. Remove physical obstacles and other barriers. If something is in the way of the piano, it’s going to make it harder for you to play the piano. If a task is overwhelming for sensory reasons—for example, there’s something about it that is too bright, too noisy, or too icky—find a tool that helps you avoid the unpleasant experience. Use gloves while washing dishes, earplugs for noisy trips, or sunglasses for running errands outside.[*4] Invest in tools you enjoy using. Many of us have negative associations with tasks partly due to the tools we associate with the task. Choosing ones that feel good and look nice is a great way to “grease the wheels” toward doing The Thing. Plus, it can make or save us money in the long run. For example, how much have we spent on takeout because the “nice pans” or tools that might make cooking easier are “too expensive”? Tap into your “why.” There’s a reason you’re doing The Thing. What’s the reason? It might not be about the task itself. There’s a sweet example of this in an episode of The Simpsons. When Homer went back to work after Maggie was born, he papered pictures of her over a foreboding sign from his boss that read “Don’t forget. You’re here forever.” The baby pictures covered enough letters so the sign now read “Do it for h...

Accountability alone isn’t enough, because, again, motivation isn’t always the issue; in these cases, adding accountability can make things worse.[*5]

Decide on what you’re doing—and not doing. Sometimes, all we need in terms of accountability is to get clear on what we’re doing and what can wait. If you need support with figuring this out, coaches, therapists, and even a friend or co-worker can help you make (and adjust) a plan to ensure progress on things that are important to you. Find productivity partners. There are a lot of groups designed to help people connect and support each other toward specific goals; you can also ask someone to “body double” with you—sit quietly in a room with you while you work. This can include going to public places where others are working or studying, because there’s low-key social pressure for you to do the same. Shorten the feedback loop. Sometimes we have trouble finishing a project because we get stuck on one part of it; sometimes it’s because the deadline is too far away to kick our brains into gear. Either way, asking for shorter deadlines and/or more frequent check-ins can help. Those check-ins can be with your boss, colleagues, or random friends: “Hey, this Friday, can I show you what I’ve got on my project so far?” Make it a competition! There are apps, programs, and competitions that gamify productivity, but you can also keep it simple. Challenge a friend to work with you on building a habit (like making your bed in the morning): the first person to text the other a picture of their beautifully made bed wins.

how you procrastinate matters. Research suggests that those who engage in what is called active procrastination—the “wait until your brain kicks into gear” or “put off homework until the night before it’s due” form of procrastination—experience similar performance and outcomes as non-procrastinators. On the other hand, those who engage in passive procrastination—the “head in the sand” form where you avoid even thinking about The Thing—are more likely to experience negative outcomes such as poor grades, missed opportunities, and—I don’t remember what else.

Pick a reward that is meaningful to you. Different people respond differently to different rewards. Maybe the best reward for you is something you don’t often let yourself have or something that’s related to the steps you’re taking to reach a goal. I like to buy myself fitness gear as I keep working out, and soft cozy sweaters to write in as I make progress. If a reward is personally meaningful, it’s more likely to motivate you. Scale a reward strategically. Think economics. If a reward is too big, it floods the reward market and inflation happens. If you reward yourself with sushi for emptying the dishwasher, that is now what emptying the dishwasher costs. Good luck trying to convince your brain to do the same task tomorrow for less. At the same time, if it’s not big enough, it won’t be motivating enough: “Okay, I am not emptying the dishwasher for five minutes of video game time. Emptying the dishwasher takes me longer than that!” Make the reward more immediate. A reward that happens right away is one that is more salient. Immediate positive feedback is a great example. You can also try rewarding yourself as you go, or pairing something rewarding with the activity itself. If a reward is “stuck” in the future—like an upcoming trip you have planned—make your progress more tangible by posting a picture of your destination and marking off days on your calendar. Tap into your excitement! Give yourself the reward for doing The Thing. Rewards don’t work as motivational fuel if ...

Instead of expecting we’ll magically be able to stick to things despite all past evidence to the contrary, it’s often more helpful to plan for the variability in interest and motivation inherent to ADHD. Cycle through hobbies, jobs, and interests. When the novelty of one thing wears off, it’s fine to switch to something else. Stepping away from something gives it the opportunity to feel new again. Be a bumblebee. Carry what you learned from one experience and use it to “pollinate” your next venture. Those with ADHD are often referred to as a “jack of all trades, master of none,” but have you heard the expanded version of that quote? It says, “A jack of all trades is a master of none, but oftentimes better than master of one.” There’s value in building a diverse skill set. Set a date to reevaluate. Agree to stick to something for a set amount of time, whatever feels reasonable for you to commit to. When you reach your end date, see if it’s worth continuing with what you’re doing. That way, we don’t keep putting time and energy into something that isn’t working for us. This strategy also helps with the ADHD tendency to give up on a project, system, or task at the first sign of failure.

The ability to remember depends on three processes: encoding information, storing it, and, finally, retrieving it. A meta-analysis of long-term memory in adults with ADHD suggests that our difficulty remembering things long term is actually a learning deficit that happens at the stage of encoding. In other words, we can’t remember what we never actually learned.

While cued recall and serial recall aren’t impaired in ADHD brains, studies done on ADHD children and teens suggest that free recall is. Free recall, also referred to as uncued recall, is the ability to spontaneously remember something without a cue to prompt us. For example, we know we brought a jacket to school, and maybe even remember where we put it, but we’ll probably forget to grab it on our way out the door unless something (or someone) reminds us.