Your Life Can Be Better
Using strategies for adult ADD/ADHD
Douglas A. Puryear, MD
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Smashwords Edition
Copyright 2011 Douglas A Puryear MD
All Rights Reserved.
Cover Photo Copyright 2011. All rights reserved - used with permission.
Illustrations by Juan Antonio Villalobos
All rights reserved. No part of this book shall be reproduced, stored in a retrieval system, or transmitted by any means electronic, mechanical, photocopying, recording or otherwise without written permission from the author.
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Dedicated to the disorganized, distracted and demoralized.
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“Most men live lives of quiet desperation.”
Thoreau
Acknowledgements
With gratitude to:
My wife, Martha, who has chosen to tolerate me, my ADD, and my writing, with varying degrees of patience but with constant affection.
All those family, friends and patients who have contributed to this book and allowed me to tell part of their stories.
All those who struggled to review some of the terrible early drafts, and those who reviewed and proofread the last ones, which were somewhat better.
Those few hardy souls who both contributed and reviewed.
And Juan, the illustrator.
Thank you!
Doug Puryear
Table of Contents
Section I The Basics: problems and strategies
7. First: appointment book and to-do list
9. Small steps and staying on top
Section II Simplify, organize, take charge of your life
14. Problem solve and simplify your life
21. Mind games, language, attitude
Section V Unpleasant states of mind
30. Overloaded and overwhelmed
38. Creativity and follow through
39. Hyperactivity and stimulation
Section VII Personality issues
40. Discouraged and demoralized
42. How our personality is formed
44. Self-talk and self-fulfilling prophecies
46. The perfect is the enemy of the good and all-or-nothing thinking
50. Learning disabilities and coordination problems
Section IX More of the typical problems
56. Procrastinating and avoiding
58. Short attention span and inattention
59. Impulsive, impatient, and irritable
60. Socially inappropriate behavior
Section X Interview with my friend Tom
65. Irresponsible, unreliable, and lazy
66. ADD unrecognized, unacknowledged, unhelped
67. Four S’s: Structure and scheduling, sleep, and some physical activity
2. The forgetting curve system
Glossary of the way terms are used in this book ...
Your Life Can Be Better
Life can be hard sometimes. If we have Attention Deficit Disorder, a.k.a ADD, it makes life much harder. Despite our best intentions, we’re always messing up, and people are frustrated with us. ADD causes us a lot of problems, and we’ve all devised ways to cope with them, ways that work more or less well.
I am a psychiatrist who has ADD. I’m going to share with you some of the ways I’ve learned to cope with my ADD problems. I’ll also share with you some coping strategies from my friends, Tom, Richard and Harry, and some from my patients with ADD. I will also share some of the ways that we all are still not coping so well.
Unlike most books on ADD, the focus of this book is on strategies: strategies that will make your life easier.
~ ~ ~
Section I
The basics: problems and strategies
Life with ADD is hard. Strategies make life much easier. Let me give you an example of a basic strategy and how this works.
~ ~ ~
Chapter 1
“Where are my keys?”
I was losing my keys about three times a week. I’m not good at looking for things. Actually, I’m pretty good at looking for things; I can do it for a long time. I’m just not good at finding things. If something is not where I expect it to be, or isn’t looking like I expect it to look, I can’t find it. In the refrigerator, unless the ketchup bottle is the color and shape I expect, and in approximately the place I expect be it to be, I can look right at it and just not see it. I can easily spend fifteen minutes or more looking for my keys. When I can’t find them, I usually have to ask my wife to help me. I’ll often be in a rush and a panic, and always frustrated. My wife does not have ADD, but neither does she have unlimited patience, and she gets tired of this. She figured out the solution:
The strategy is to put my keys on the table by the front door. I always put my keys on the front table. I don’t allow myself to put them anywhere else, not “just for now,” not “just this time,” not “because I’m busy.” No. On the front table. I do not leave them in my jacket pocket. I do not lay them on my desk or on the bureau top. I put them on the table by the front door. Right now. Always.
Now that is a strategy that becomes a rule. And the rule helps me make it a habit. And a habit means that I don’t have to think about it anymore.
Strategy.... Rule.... Habit....
I have a lot of rules, and I’m grateful for them, because my life is so much easier now. So that rule about the keys is a strategy, which was made into a rule, which became a habit. But to be honest, occasionally this has to work as a rule again. If I hear myself saying, “Oh, it will be alright just this once,” my rule says, “Oh, no, it won’t.” That not only saves me trouble that one time, but it keeps the habit strong.
It took a while to make that a habit. I slipped up a number of times, but I kept at it and it did become a habit. Now I don’t have to think about it, I don’t have to remember it, I just do it. Keys on table. The truth is, I lose my keys still, but maybe twice a year instead of three times a week, and even that’s getting better.
Summary:
* Identify a problem.
* Pick a strategy.
* Make a rule.
* Stick with it.
* It becomes a habit.
* Life is easier.
Illustration 1. The table by the front door
The keys go here!
~ ~ ~
Chapter 2
About the book
This chapter tells you about the book. This ordinarily would be the introduction, but when I pick up a book, I often skip the introduction and maybe you would, too. I wanted to give you a real example of what this book can offer right off the bat, rather than beginning by telling you what I was going to tell you. If you’ve gotten this far you probably have some idea what it’s about anyway, but I want to share a little more information with you. It’s probably worth your reading, but it’s up to you.
There are many books on ADD out there, many of them good, many of them similar. This book aims to be different:
1. It doesn’t go much into the history of ADD, the definition, causes, diagnosis, medications; it focuses on using strategies to make your life better.
2. It gives specific real life examples of people struggling with ADD rather than general tools or made up cases.
3. It’s personal; it could be subtitled “my life with ADD”. I hope this will make it light reading rather than hard work or study, and will make it more interesting so that you will get more out of it.
This book focuses on strategies, tried and true ways to deal with your ADD and to make your life much easier. I know they work, because they work for me and have made my life easier.
The strategies in this book deal with some specific problems that ADD causes. I’ve given you one example: my habit of losing my keys. Some of these problems are big and important, and some of them are seemingly trivial, but a day filled with minor frustrations is usually not a good day; even minor frustrations add up.
The book may help you recognize which problems and frustrations in your life are related to ADD, and you may identify some of the things you do that are your way of coping with ADD. You may congratulate yourself for having come up with these ways, or you may realize that there might be better ways. We are all different: my problems may not be the same as your problems, and my solutions may not be the ones that will work best for you. But if we both have ADD we will have a lot in common.
When we have ADD, we’re trying to live daily life with at least one hand tied behind our back. Our life will be harder than it has to be. We can use strategies and tools to make our life better. That is my hope for you. Even small changes can make a big difference. I told you how one small change, a rule about my keys, made a significant difference in my life.
This book is written mostly from my own experience. I don’t intend to push spiritual beliefs on anyone, but since the examples are real and largely from my own life, some of them will be about spiritual things. But you can apply the strategies and principles to anything you want.
I want to tip you off in advance; there’s a lot of information here and some readers have said they found it overwhelming. Just take it easy, see what clicks for you: “Oh, I know about that!” or “Hey, that makes sense; maybe I could try that.” Pick one or two things you want to work on. It will take time to master them. Then pick another. It’s taken me well over fifty years to create the strategies I use and to make the habits I need, and I’m still working on it, as you will see.
I’ve mostly written in the first person, “I,” because I thought that would make it more interesting, and maybe less threatening. You can say, “Oh, that poor devil. Thank God I’m not like him” (like many alcoholics say at their first AA meeting). And the “I” stories might be more likely to turn your focus center on. That’s the place in our brain where our problem lives, in our hardwiring, which causes us to have trouble focusing. It can also be called the “attention center.”
I also use “we”, because we’re in the same boat, and “we” might make it easier for you to pick up the similarities. But I also like the “you” approach, because I’m addressing you and hoping you will get the ideas. But then people with ADD, like me and maybe like you, don’t necessarily like having our problems and flaws pointed out to us, and don’t like being told what we “should” do. So I lean towards the “I” mode, hoping you’ll catch the points that apply to you or the strategies that will be useful to you. But I did some of each, and probably not in any organized fashion. This could be an example of my difficulty making decisions, which we who have ADD often have. Don’t you?
I want to be clear that I do not have all the answers. Some of my many ADD problems are solved by the strategies, some I am still working on, and some I don’t have a clue about. And we can only work on one or two things at a time, so it’s a long term ongoing project. I didn’t want to tell you that it’s easy.
There’s a list of typical ADD problems on page 15; you might want to glance at that and see if any of it seems familiar. Or you might not; it could look pretty demoralizing. Fortunately, there’s also an outline of coping strategies on page 18, and you might want to glance at that and see which ones you are already using.
About the term itself, ADD, attention deficit disorder: the official term is ADHD, attention-deficit/ hyperactivity disorder. I prefer ADD; it’s shorter and it best fits what I personally struggle with. So from now on, I will use ADHD only when I want to emphasize the hyperactivity aspect.
Maybe you don’t have ADD yourself, but you’re reading this because someone else does: a partner, friend or relative, a colleague or employee, a student, or even a boss. This book will help you understand them, which will help you cope with them and decrease the frustration you both share.
The symptoms and problems of ADD are pretty common in humans; many people have some of them some of the time. The difference is that those of us with ADD have most of them most of the time, and they cause lots of problems for us, both large and small problems. If you have not been diagnosed, you may find yourself wondering if you have ADD.
If it’s a strong enough suspicion, you don’t need to diagnose yourself; you can get some professional help with this. Diagnosis is discussed on page 360.
Summary:
This book is written to help you make your life better by using strategies to cope with your ADD. It can also help non-ADDers understand ADD problems.
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Chapter 3
Our focus center
Our focus center is different. This is the hypothetical spot in our brain that has to be turned on in order for us to focus our attention on something. Our focus centers simply don’t turn on like people’s without ADD.
Our lack of focus is our primary problem and the source of many of our difficulties, like procrastination, trouble setting priorities, trouble dealing with time, trouble finishing projects, perfectionism, and the inevitable demoralization. We have trouble starting something, staying with it and not getting distracted. We drift into dead ends and into unnecessary and fruitless pursuits and time wasters. All of this is due to our focus center not being turned on when we need it.
Paradoxically, sometimes we have extreme focus. If our focus center is turned on, we can focus - we can really focus! This can be good; we can really accomplish something if our focus center is turned on. But we can have trouble shifting to something else when we need to. Maybe I have finally gotten around to starting work on the dripping faucet, which I procrastinated about because I wasn’t quite sure I could fix it. Now at last I’m working on it. I’m focused on what I’m doing, and my wife innocently enough says, “Doug, when you’ve finished that would you please take a look at my computer?” That drives me up the wall. I’m focused, totally focused, on the faucet. I cannot deal with anything else right now.
Or sometimes when I can get started on an ongoing project, like this book, I become, as my wife unhappily says, “preoccupied” with it, obsessed. This is the opposite of the inability to focus; it’s hyper focus.
So, as a model, we say that there is a problem with the focus center in our brain. Most people’s focus center is turned on by the fact that something is important. But not ours. We understand “important.” We can acknowledge “important”, but “important” does nothing for us. “Important” does not turn on our focus center and we can be nearly helpless to try to get something done without our focus center on.
But our focus center does get turned on at times.
It gets turned on by :
1. Things that happen to be of personal interest to us. I have no interest in taxes and bookkeeping. It’s very hard for me to get the taxes done. But I’m interested in writing, and I can do that, at least once I can get started.
2. Something that is novel to us. So I get excited when someone takes me bowling for the first time and shows me how to do it. I want to go out and buy a ball and some good bowling shoes, and I’m bowling every night for a month, and then I’m done. The expensive ball and shoes go in the back of the closet, and I’m off on some other new obsessive interest, probably also temporary, because nothing can stay new, novel, for very long.
3. Something that is a challenge. When I take something as personally challenging, I want to master it, or I want to show that I can do it better than someone else. And of course, once I’ve mastered it, it not only is no longer novel but it’s no longer a challenge. So then I lose interest, and the focus is gone.
4. Something with an immediate deadline, with heavy consequences. That’s why we can finally get around to doing the assignment the night before it’s due. We stay up all night and very likely we even do a good job. And if it doesn’t go so well, still we can protect our self esteem by saying, “Well, I only got to it at the last moment.”
It’s useful to remember these four focus center turn ons: personal interest, novelty, challenge, deadline. Then we can use them to help ourselves focus and get some things done. Sometimes I use them to play mind games with myself, which I’ll discuss later. There are ways to trick my brain into focusing.
Summary:
We have trouble with focusing. Sometimes we hyperfocus. Four things will turn on our focus center:
1. personal interest
2. novelty
3. challenge
4. immediate and heavy deadline
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Chapter 4
Effects of having ADD
What are the effects of having ADD? Our life is difficult, often frustrating, often pressured, and sometimes miserable. It’s no fun spending fifteen minutes searching for my car keys, and not finding them, and then having to ask my wife to find them and then having her aggravated with me because I’ve lost them again. And that’s only a trivial problem. We have trouble with keeping appointments, being on time, meeting deadlines, organizing, getting things done, losing things. As a consequence we have trouble holding jobs or staying married. We tend to feel depressed and we have a high tendency to develop alcohol and drug problems. My personal addiction happens to be food. It used to also be computer games.
List of Problems
These are some of the ADD problems that will covered in this book. You might use them as a check list, to note which problems you have.
We have problems with:
* focusing our attention
* being able to shift our attention
* getting distracted
* finishing things
* setting priorities
* going off on tangents and dead end projects
* impulsiveness
* being socially inappropriate
* blurting things out
* irritability
* judging time
* organization
* sloppiness
* losing things
* finding things
* learning disabilities
* fine motor skills
* reading
* relationships
* jobs
* and the resulting demoralization
That does seem like an overwhelming list; it’s a wonder we survive at all, let alone function. Where would we be without strategies?
Summary:
There are many problems associated with ADD. Most basically stem from the difficulty with the focus center. But don’t despair! Life can be better with strategies. Read on.
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Chapter 5
Strategies
This book is about strategies, rules, and habits. Strategies are tools to help us deal with problems and thus make our life go smoother and easier. When we identify a problem, something that makes our lives more difficult and less productive, or that adds to the pile of minor irritations, like my always losing my keys, for example, then we come up with a strategy to help. Then we keep applying that strategy and make it a rule (except that we keep forgetting to apply it, of course, because we have ADD). But we just keep applying the strategy when we can remember, and eventually it becomes a habit. That means we don’t have to remember it or think about it anymore; it’s just a habit. Then we can pick another problem to work on. We can only work on one or two problems at a time, though.
Here is a list of the strategies that are most important to me. They will be discussed and explained as we go on. You may find that you are already using some of them.
List of strategies:
* Most important tools:
* appointment book
* to do list
* small steps
* positive self-talk
* reframing, attitude
* Most important rules:
* keys on front table
* check gasoline hose before driving off
* look behind me before backing down the driveway
* Most important slogans:
* Do it now, do it right, do the hard part first.
* I have as much time as anyone else.
* Most important red flags:
* “Oh, it’ll be ok.”
* “Oh, I have plenty of time.”
All of these will be explained as we go on.
Summary:
ADD causes us lots of problems, small and large. Strategies help, especially once we make them habits. We can deliberately choose problems to work on, one or two at a time, and overcome the difficulty.
The formula is: identify the problem, make a strategy, make the strategy a rule, stick with it, make the rule a habit.
Strategy....Rule....Habit....
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Chapter 6
I learn that I have ADD
I was sixty-four years old when I first learned that I had ADD. Suddenly, a lot of things made sense: Why I carry a pocket full of index cards. Why I couldn’t make model airplanes like the other guys when I was a kid. Why I killed a pregnant guppy fish. Why I made a “C” in engineering drawing in high school. Why I couldn’t study in college. Why I kept losing my car keys. And on and on.
About the model airplanes: in those days, you got a kit with instructions, some plans on tissue paper, more tissue paper, and some very light soft wood, balsa. You laid the plans on the wood and cut it, carefully and precisely, with a sharp Xacto knife. Then you glued it together precisely and carefully according to the instructions and waited patiently for it to dry. Then you carefully stretched the thin paper over it, wet it so it would shrink, and you waited patiently for that to dry. Then you put on a rubber band motor or a small gas motor and it would fly!
I could buy the kit, but what I was lacking was the “carefully”, the “precisely”, the ability to follow the directions, and above all, the “patiently”. Just couldn’t do it. So I bought ship kits and made ships instead. Guess what? They had blocks of harder wood that you had to patiently sand to the precise shape of the hull. Then you had to patiently sand the smaller parts, precisely glue them together according to the directions and then paint the ship. But it was easier than the airplanes. Since I didn’t have the patience for sanding the hull, my ships usually had a deck that was sloping up in front instead of flat. Still, some of them looked pretty good.
The guppy was about patience too. She was beautiful and pregnant, brought home from the pet store in a plastic bag of water. I was putting new water in the aquarium for her and the water had to be boiled to drive the chlorine out. I boiled it, waited a while and felt the water. It was still too hot, but I said “Oh, it’ll be alright” - and put her in. She came to the top belly up and died. “It’ll be alright.” - dangerous words.
This was my ADD in childhood. Like for many of us, it continues into adult hood.
Summary:
When I finally learned I had ADD, a lot of things suddenly made sense. I could understand many of the difficulties I’d had all my life, and also many of the habits I had developed which, it turns out, were strategies to cope with my ADD.
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Chapter 7
First, the appointment book and the to-do list
I’ve read a number of books on ADD. They vary significantly but all agree on one thing: when you find out you have ADD the first thing you need to do is actually two things: get an appointment book and make a to-do list. Maybe you make a to-do list first, and then the first thing on it is to get an appointment book! But you need to do both. Of course, just doing that isn’t enough; then you need to learn how to use them.
Appointment book
All of my shirts have a pocket, and my appointment book fits in there. It has a celluloid cover; in the front is a religious picture and on the back a photo of my grandsons. The inside covers have flaps where I keep photos of all my grandkids (so that I can easily share them with anyone who might have the slightest interest), a copy of my weekly standing appointment schedule, a list of principles of living that I need to review regularly, and my favorite poem. But the main thing in the appointment book is the monthly appointment schedule. I need a month at a glance type, so I can look at it and orient myself in time. Otherwise, I become lost and confused, and things come up that I should have known about but was thinking were way way off; if you don’t have ADD you may not know what I’m talking about here.
I’ve made a habit of recording every appointment, carefully and correctly and legibly. I’ve made a habit of looking at the book about six times a day, like whenever I’m not actually doing something. When I’m sitting with my wife, this bothers her. I explain that I need to see what’s going on, but she doesn’t have ADD so she doesn’t understand and she feels neglected. I don’t just look at the book, I study it. Sometimes I just orient myself. Sometimes I find a mistake that I’ve made (I have ADD, you see), or I see something that’s coming that I need to prepare for. And I need to fix a pattern in my mind of what tomorrow will look like, and what needs to be done and when. So it’s not just a glance, it’s a real look, and it’s at least six times a day. My life has gone much better since I started to do this, and now it’s a habit. I never hear myself saying, “Oh, I forgot to look at my appointment book.” It doesn’t happen.
I keep my appointment book with me everywhere I go, even if it doesn’t seem to make sense. I’d feel naked without it. Ok, I don’t sleep with it or take it into the shower, but everywhere else. Have I made it clear that the appointment book is vitally important and that you not only need to have it, you need to use it, and it needs to become a habit?
To-do list
And my to-do list. Very necessary to have it, but there are tricks I need to do to make it work. I’ll tell you about the whole system later, but right now let’s focus on the red card. It has the major things to do that I’m working on right now. Like the appointment book, it is always with me.
These to-do’s are the major, non-routine things that really need to get done, probably today or tomorrow. They may be steps that are part of a larger project. For example, right now I’m working on my taxes for the year. That is a major project and will take me over a month to complete. I don’t have “taxes” on my red card; I have “get charity info,” which is the step of the taxes that I need to do next.
In order to make the red card work, I need to look at it as often as the appointment book, at least six times a day. Second, an important rule: I cannot have more than five things on my to-do list. I call this “The Power of Five.” If I have more than five things there, what happens? I start to feel overwhelmed and confused. I don’t know where to start. I wind up not doing anything. If that sounds familiar, you may have ADD. But there are a lot of things I need to do. Every time I turn around a new one pops up. So it’s just natural that I would quickly pull out the card and add the new thing to my to-do list. Then before I know it, there are twelve things on there. Then I feel overwhelmed and confused, get stalled and I’m not doing anything. So I’ve been trying to learn to actually keep the list down to five. And I’m getting better at that.
Summary:
The foundation for coping with ADD is to have an appointment book and a to-do list, to have them with you at all times, and to learn how to use them. I need to review my appointment book and my main to-do list frequently, about six times a day. And I need to keep my to-do list down to five items or I will get overwhelmed and stalled.
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Chapter 8
Other cards and lists
Three to-do cards
I keep three to-do cards in my pocket: red, orange, and yellow. The red is the five things, priority. On the orange card I put the other to-do things that have any priority or urgency, that I need to get to reasonably soon. On the yellow card I put anything that I might get to someday. I don’t use this system perfectly; it requires some self discipline, which is something I don’t have a lot of (I have ADD, remember?). But I’m getting better at it. It helped a lot to add the orange card. When I only had the red and the yellow, I always tended to write everything on the red, because everything seemed urgent, because I’m not good at setting priorities.
When I can cross something off on the red card, it makes me feel good, increases my morale. I feel like I have some control and like I’m on top of things. Then I can move something off the orange card to the red, as long as there are no more than five things there. It helps to number things on the card in the order I plan to do them, and to keep it neat and easily readable.
The red card, with the list of five, is the key. The three colored cards are always in my pocket. When something comes up or pops into my mind I can put it on the appropriate colored card. But things are not that simple. I have a whole card system in my pocket, and I have other lists.
The working list
I live with my appointment book and cards in my pocket, and I’m surrounded by lists. Most of my work is done in my office, at my desk. There I keep another list, the working list, on the back of an envelope, right in front of me.
I get a lot of mail: bills, of course, ads, even payments sometimes. I save the envelopes that have blank backs for scratch paper. They’re in a stack under one corner of my computer monitor, out of the way, but handy. I use envelopes for the working list, but I also use them for other things: Spanish conjugation I’m trying to learn, ideas for this book, new guitar chords to use, random thoughts, whatever. These other envelopes sit in a stack to the right of the working list, so they’re handy and I can find what I’m looking for.
Illustration 2. The Desk
From left to right: Top - stack of papers I’m working on, envelopes under monitor, to-do list, other envelopes: finances, Spanish, book ideas, etc. Bottom - stack of papers I refer to sometimes, keyboard and mouse.
Using the lists
The to-do cards are always in my pocket, but in the office I work more from the working list. This list has the list of five on it, but also all the routine and less important things I need to get to today or perhaps tomorrow or the next day. These might include routine phone calls, or other routine tasks, like typing up my patient notes. If I’ve gotten behind on a routine or non-urgent task, it might wind up on the
list of five because then it has become more urgent, but those are usually just on the working list. I keep redoing this list throughout the day, as I get some things finished and other things come up. If this list gets long, I’ll underline the few things I want to focus on next or I’ll just make a new and shorter list.
For example, today in the kitchen my wife said her knives need sharpening. She was clear that there’s nothing urgent about it, so I put it on the orange card. I could do it today or tomorrow or the next day. Later I also put it on the envelope working list, so if I find some down time, I might get to it. But if I don’t have it done in three days, then she’s waiting too long. Then it becomes urgent and I will put “knives” on the red card. However, since it’s on the working list, I probably will get to it without it ever reaching the red card.
The list of five has priority, but I don’t always do the things on it immediately. Some things take preparation; sometimes something needs to be done before I can do something. Some things can only be done at certain times; I can have “call the insurance company yet again” on my red card, but I won’t be able to do it on a weekend. Or sometimes there’s suddenly a very convenient time open to do something else that’s only on the bigger working list.
Right now on my red card I have “organize taxes.” I started working on the taxes, but then I got stalled, so now I need to stop and write out the steps that I need to do for the task. That’s what “organize taxes” means. Once I organize and have all the steps written down, I can pick one to start on. Maybe first I’ll choose to collect all the information on charitable giving for the year. That step will go onto the red card. Thus I will be moving forward on the taxes. Only one step at a time will make it to the prestigious heights of the red card. The others will be on the working list.
The power of lists
I make lists over and over, all day long. It’s not just about having the list; there is also benefit in making them. Writing down what I need to do is somehow calming and organizing, and therefore motivating. When I write things down, it’s as though I’m on top of them. Then I can make another shorter list and it seems doable, and I don’t have to think about any of the things on the long list. This is related to the rule of five. When I get a few things crossed off of one to-do list I throw it way and make another one. This gives me a sense of accomplishment, which help me stay motivated and keep going.
The time used making lists is well spent, because it keeps me focused, organized and motivated. I can stay aware of what the day needs to be looking like, and I’m not keeping all these things in my head. They’re right in front of me within reach of my hand. When I’m in my office, the red card is in my pocket, but I’m relying more on the envelope list. Everywhere else, I keep looking at the red card.
Summary:
Since the red card to-do list needs to be limited to the five top priority things, I need auxiliary cards for other to-do’s. The cards are available wherever I am. In the office I also have an evolving working list. The act of making the lists is a helpful organizing activity. It’s helpful to break tasks into small steps, and then a step can be one of the list of five.
~ ~ ~
Chapter 9
Small steps and staying on top
Riddle: How do you eat an elephant?
Answer: One bite at a time.
(Courtesy of Jim Bracken, educator and proofreader)
Small steps
Small steps is a major coping strategy for dealing with ADD. It has many uses; it helps deal with inertia, procrastination, distractions and with getting things finished. Let’s talk about the to-do list and small steps; this will apply to all the difficulties I just mentioned.
After “The Power of Five”, the next biggest trick for using the to-do list is to write down only small steps. I would never write “ Do taxes” on the red card . That would be overwhelming and it offers no organization. I would just never get started.
No, I would write down:
1. Get last year’s checks.
2. Call accountant for appt.
3. Buy paint for porch
(Note: not- “3. Paint porch.”)
See, I can’t “Do my taxes.” That’s an impossible job, totally overwhelming. I would just stall. But I can find the checks. Actually, I might have needed my wife’s help, but that’s old history. Now I know exactly where the checks are, because I have one place for them and I always and only put them there. Like the car keys. When I retrieve the checks, I can cross that item off with a sense of accomplishment, control, and relief. That’s a reinforcing reward. Then I can write the next small step on my to-do list: “1. Sort checks”.
If there’s a big task coming up, but it’s not time to work on it yet, I might put the whole task on the orange card -“paint the fence.” But when the time comes, I will break it down into steps - “buy paint.”
Occasionally, I can’t see the small steps ahead of time; I may need to get into a project first. But that’s OK. I can just start on the first small step - “What is the first thing I need to do to get started on this project? Well, I can turn on the computer for starters” - and then break it into small steps as I go.
So, it’s small steps, and no more than five. One or two steps might relate to the taxes, but no more. There are things beside taxes that need my attention, too, and if all five things are about taxes, it will start to look overwhelming again. I pick one step and focus on that for the moment, on what I need to do now. I forget about the other things I need to do in that project until I get that one done. It’s kind of like the Buddhist thing of “living in the moment.” One thing at a time.
Summary:
Break tasks into small steps. Limit the to-do list to five things. Focus on one at a time. You never have more than that one thing that you need to do at any given moment.
Staying on top - the dog poop principle
It’s my job to clean up the dog poop in the yard. I perform this moderately unpleasant chore every week. (Everybody has to be good at something.) Actually, more recently I’ve started performing it about three times a week, and it really isn’t that unpleasant anymore. It may take a little more time than before, but not much anyway. I haven’t let things pile up.
This is a three part principle:
1. Don’t let things pile up. If they pile up, they become overwhelming and harder to do. Stay on top of them.
2. Break tasks into small parts.
3. If somehow you still get behind (and like me, you probably will), then break the task into manageable small steps. If I’ve let the poop pile up, so to speak, I might clean the one half of the yard today and the other half tomorrow.
Staying on top of things means not letting them pile up to the point that the prospect of dealing with them seems overwhelming. This can apply to paying bills, or to keeping up with my patient notes, to homework or studying, or dog poop. So we’re not letting things build up or hang over our heads. Who wants dog poop hanging over their head? Ugh!
The strategies, rules and habits I describe contribute to making my life go better. They are ways of coping with problems, like the dog poop problem. But they also eliminate some problems entirely so that I don’t need to deal with them at all. Like losing the keys.
Summary:
A major tool for dealing with many ADD problems is to break every task into small steps. Then the task doesn’t seem so overwhelming or difficult or unpleasant, and it’s easier to get myself to start on it. If I don’t fall behind and let things pile up then they don’t seem so overwhelming either. But if I’ve let something pile up then small steps is the key to getting started on it. And again, if I can identify something as a problem, like the dog poop task being unpleasant, then I can come up with strategies to cope with it, and my life gets better. Yours can too.
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Chapter 10
The list of three
There is yet another important list. One of the ADD books says that we ADDers are creative, right brain creatures with good visualization skills. It recommends starting each day by visualizing ourselves actually doing all the things we need to do that day. That’s a good tool, but it doesn’t work for me. Instead, I do the list of three, which is kind of related to that and does work for me. This is a schedule made from the to-do list, of the next three things I’m going to do. It includes the one I’m doing right now. I say these three things in my head: “OK, right now, I’m writing about the list of three, and then I’m going to check my e-mails, and then I’ll catch up on my patient notebooks.” Next, “OK, finished the writing; now I’m checking my e-mails, and then the notebooks, and then I’ll go get the mail.” And so on, through the day. This is the list of three. This process helps me keep on track and keep organized as I work down through the written list of five on my red card. It helps me to avoid suddenly and impulsively starting off on another track that just popped into my head and isn’t on the red card. It helps me remember, as I walk down the hall, the reason why I’m walking down the hall, where I’m going and what I need to do when I get there. In other word, it helps me stay focused.
This sounds like it violates the rule of focusing on one thing at a time and not worrying about the rest, but it doesn’t seem to. I say the list of three to myself, start working on the first thing, and I do forget the rest until I’ve finished the first. But then I’m able to recall the list of three, update it, and start anew, without having been thinking about it while I was working. I know what I’m going to do next.
My friend, Tom, has a similar tool, a list of one. He calls it the “What’s next?” tool. When he starts a project, and while he’s doing it, he asks, “What’s next?” Then when he finishes the project, he knows what to do next. He’s not going to wander off into a timewaster, get captured by a distraction, or become bogged down in indecision; he already knows “what’s next”. You’ll read more about Tom and his story and his strategies in section X.
Summary:
We can have a plan for what we are going to next, to help us avoid distractions and stay on track. Somehow we can file this in the back of our mind so we’re not thinking about it until we need it.
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Chapter 11
The card system
All my shirts have pockets, which always contain my appointment book and my index cards. You might develop a different system; this is what works for me. I had developed these strategies and habits years before I realized that I had ADD. I didn’t know that I was coping with ADD; I just knew that these things made my life go better.
My index cards are colored and there is a system. I am still training myself to follow it better, so that it will be even more effective.
The red, orange and yellow cards are for to-do. The blue card is “memory”, with information that I need available: phone numbers, names I forget, bible verses, sayings, etc. The white cards have everything else: a song I’m memorizing, some music theory I’m learning, some Spanish conjugation and vocabulary that I can pull out and study, etc. It’s a collection of things in general, usually things I’m working on. I just added a new card, purple, so that at any moment I can jot down an idea for the book and won’t be tempted to clutter up the red card with it.
Illustration 3. The cards
The red cards on top, then the orange, the yellow, the white, and the blue.
Summary:
The red card with the list of five is one of the most important tools I have for helping me cope with my ADD. The other cards substitute for the memory that I don’t have. But wait! There’s more!
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Chapter 12
Other tools
White boards
On my desk to the right are two erasable white boards, a large one and a small one. They’re actually not important, but I like them. I have no real system for using them. I can write in something I want to remember, like to do my Spanish course first before I start something else, or else I will procrastinate on it - “Sp 1st!” I can put down things I need to do, maybe large things not broken down into steps yet -“Taxes coming!”, or something I want to do fairly soon but not urgent enough for the red card - “clean desk”. That’s something I might do when there’s a bit of time free and I see it on the white board. On the back of the white boards I put a list of my most needed numbers and computer passwords, so they’re handy. As I said, I have no real system for using the white boards. They’re in my view there on my desk and just useful for anything at all that I might want to put there to catch my attention. I can use all the help I can get.
So I’m surrounded by lists in my office. They’re right there, in my face and under my hand; that’s the way I like it. The red card is the master list, the one that overrules the others, but it’s good to have the more flexible working list handy when I’m in my office, which is where I do most of the work that is on the lists. Other lists serve as memory and reminders. Works for me.
Electronic devices
I love books, newspapers, and medical/psychiatric journals. I enjoy holding them and reading them, and I like owning books. It’s hard for me to read things on the computer or on an electronic book. On my cell phone I have many of the documents from my computer, and some great programs, especially Spanish and the Bible. I take the occasional photograph with it. But I don’t use those things very much. I don’t take my phone with me everywhere I go, and I don’t have the internet on it. Maybe I’m getting old and hopelessly out of date.
But I can imagine how you can use these new electronic marvels to be part of your strategies. Someone, maybe you, is going to get rich designing some applications specifically for people with ADD. There’s a lot of technology available already just waiting for someone, someone smarter and less technologically challenged than me, to figure out ways to apply it for coping with ADD. You will read about my friend Tom’s Personal Information Manager. It’s a program for scheduling and for handling all kinds of personal information. It sounds like a step towards helping with ADD, but it may not work too well the way it’s designed right now. Clearly it was designed for just regular people, without ADD. You will also read about my friend Richard’s FOFA gadget with tags and a buzzer for finding lost items. Amazing!
For various reasons my wife and I seem to buy new phones frequently. After we bring one home it often don’t have all the features we want, so we exchange it, again. I’ve just realized how important it is to me to have a phone with a screen that shows the number I just dialed, before I push the ‘talk’ button, so I can check what I dialed and cut down on the wrong numbers.
If you have ADD, and you’ve gotten this far in the book, please take a deep breath and congratulate yourself. It’s a challenge to stick with things like this. I’m hoping that as you read you’re thinking about some of the problems that make your life frustrating and difficult. I hope that you will consider some of the strategies that I bring up, and think about how you might use them or modify them so that they’ll work for you. Then you can try them out and if they don’t work for you, adjust them so that they will. You can certainly come up with your own strategies. You can find creative ways to use electronics to do some of this. Depending on your age, for one thing.
Summary:
My cards and envelopes work well for me, but there are wonderful new options for people with ADD. I predict that new devices and programs will become increasingly popular and will be even more effective in helping people cope with ADD. Each one of us is different, although we share many of the same problems. I hope you will find what works for you.
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Section II
Simplify, organize, take charge of your life
Your first reaction to reading this title - simplify, organize, take charge of your life - might be that that is exactly what you are unable to do. Maybe you’re saying, “Yeah. Right. Sure.”
Trust me, you can do it. I have, so I know that you can. But we need the strategies and the tools. That’s what’s coming. Let’s assume you already have the appointment book and the to-do list, which are the foundations for coping. Here I want to give you some more tools to help manage things and stay out of messes. We don’t have to feel overwhelmed, which just makes it harder to function, which makes us feel even more overwhelmed. We need to set goals, stay out of traps, be aware of the red flags that warn us we are about to get into a mess, focus on one thing at a time, and learn to simplify. We can be in control of our life.
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Chapter 13
Simplify
Avoid over committing
I’ve learned to be very careful about agreeing to do anything. I try hard to stay off committees and boards. I’ve been to too many meetings in my life. They are giant time absorbers. I don’t go to any meetings if I can help it. I still do things that contribute to the community, but I can usually find ways that don’t involve meetings, and I’m extremely selective about the things that do. I also used to do more extra things for my patients - “Oh, I’ll just give your doctor a call.” I’ve learned that some of those things aren’t actually necessary, and if they are, often the patient can do them at least as well as I can. So I think twice before volunteering to do something extra.
My wife pointed out that I had signed up for a lot of e-mail programs - for Word of the Day in Spanish and in English, free guitar lessons, news, political movements, and more. My inbox was quite crowded every morning. So I kept the ones I really like and use, but I was able to eliminate many of them and save time and simplify.
I’ve also learned not to make promises. Now it’s “OK, I’ll try,” or “OK, I’ll do my best.” No promises.
Learn to say No
In order to avoid committees and boards and other projects, I needed to learn to do a better job of saying “No”. That’s hard for many of us, especially those of us that tend to be “people pleasers.” We want everyone to like and admire us. That is not a healthy condition. It partly comes from low self-esteem, which can often come from having ADD. Fortunately, therapy can help with the “people pleasing” problem. Willpower, if we have any, helps too. I’ll tell you later on about Ms. B, a patient who learned how to say “No”. I will also tell you about my famous colleague, Dr. John Rush, who has no problem at all in saying “No”, and who became a role model for me. Hang around.
“Is this a good use of my time?”
I need to pause occasionally in the middle of whatever I’m doing and ask this question. This is a form of “awareness”, which I’ll also discuss later. This is also a good approach when I’m being asked to do something. Will the benefits justify the use of my time? For example, occasionally I’m asked to volunteer for a good cause. Sometimes it’s clear that it would be more effective to just give money. Someone else can be hired to do the work; that will benefit them, benefit the cause, and save my time. I do put a dollar value on my time and that helps me make some decisions, such as when to hire someone to do some work in or around the house and when to do it myself.
Minimize decisions
I’m not great at making decisions. I can ruminate for a long time over the pros and cons and still wind up on the fence. Part of the reason is that with ADD, I have trouble prioritizing. Everything looks important. One strategy for this problem is to realize that if the decision is that hard to make there must not be a “right” answer, or else it would be obvious. So it is a guess, a coin flip. We can’t know how something will come out, so we can only play the odds, and sometimes they’re about fifty-fifty.
Strategies for decision making help, but if I can minimize decisions it simplifies my life even more. One way to do that is to have rules. My grandson, Michael, is nine years old. He lives here in Santa Fe and spends a lot of time with us. He likes me to play games with him. As part of my grandfatherly responsibilities I’ve taught him to play poker and chess; he can’t beat me at chess yet. Michael’s growing up fast. About six years ago I paused and thought about my priorities and I was blessed with a great revelation. I had not been a great dad. They grow up fast. Before long they won’t be wanting you to do things with them; they will be out on their own. I work a lot at home: record keeping, book writing, repair projects, etc. But I made a rule: if Michael asks me to play with him, I will stop whatever I’m doing and play with him. If Michael asks me to do something with him, I do it. Not “later,” not “in a little while,” or “wait ‘til I finish this.” Just, “OK. Let’s go.” My priority is playing with Michael. What can I be doing that is more important than spending time with my grandson? So the rule eliminates the need for decisions, and in this example, gives a better result, too.