Inattention and Adult ADHD
From time to time, every adult may experience inattention. However, adults diagnosed with an inattentive ADHD presentation tend to experience persistent interference with functioning in two or more spaces. This can be particularly debilitating in the workspace and often presents as difficulty focusing, paying attention/listening, staying on task; being disorganised and/or misplacing work product or tools. There are a variety of strategies that can be helpful, some of which are set out below.
Adult ADHD and Type of Presentations
Adult ADHD symptomology is characterised by
persistent inattention, hyperactivity and/or impulsivity.
inattentive or hyperactive-impulse symptoms that were also present prior to the age of 12 yrs.
inattentive or hyperactive-impulse symptoms that are also present in two or more settings e.g., home, work.
clear evidence that the symptoms interfere with or reduce the quality of, social, academic, or occupational functioning.
There are three types of presentations in Adult ADHD:
Inattentive presentation (no hyperactivity, no impulsivity)
Hyperactive-impulsive presentation (no inattention)
Combined presentation (both hyperactivity and/or impulsivity and inattention)
This blog post is primarily concerned with inattention. Inattentiveness in adult ADHD is said to be the most common presentation.[1]
Causes of ADHD
The precise cause of ADHD is unknown. Research is ongoing and it is theorised that inattentive ADHD may be triggered by a combination of genetics, neurology and environmental factors (e.g., prenatal exposure and early life factors) that impact brain and function development.[2]
What does Inattention Look Like in Adults with ADHD?
Where there is a diagnosis of inattention in adult ADHD, it manifests as an inability to keep focus. An adult with inattentive symptomology might[3]:
have difficulty setting goals and objectives. That is, where there is difficulty with focus it can be difficult to identify a goal and thus plan the steps for completion and follow through. This can result in feeling overwhelmed.
experience difficulty organising tasks which impacts keeping track of multiple projects and/or deadlines.
operate in cluttered environments e.g., desks
become forgetful around daily activities.
make careless mistakes be it in work, or other activities e.g., adding when multiplying was what needed to occur.
skip over or fail to pay close attention to details when reading e.g., assignments, instructions, recipes, filling in forms.
become side-tracked whilst performing a task which can result in issues around completion and follow-through e.g., work tasks; assignments.
might misplace paperwork and/or forget assignments or to pay the bills on time.
not be able to sustain attention during meetings, whilst reading or even whilst in conversation with someone.
encounter procrastination and/or boredom with tasks rendering them avoided and thus not completed.
misplace or lose things needed across the day.
How is Inattention Manifesting in You?
Gain clarity around your particular symptoms of adult ADHD. How is inattention manifesting itself in your life?
Self-reflection is important. Consider Journalling to write about this. You might start with asking yourself the following questions:
How is my ADHD manifesting?
What are my strengths?
Where do I think I need extra work?
What patterns do I see?
How is it impacting my mood? e.g., are you more moody and/or impatient?
What Career Would be Good Fit?
Select a job or career that is a good fit for you.[4] Playing to your strengths is important but you also need a role that will allow you to grow.
If you are assessing how you feel about your current career or job and you have reflected and see that the fit isn’t as good as you might like, what can you do about it? Could you job craft and change your duties? Could you gain some extra skills via internal or external learning programs or mentee or coaching programs? Is it simply a case of changing your attitude about the career/job and if so, what might that look like for you?
If there is no fit, what can you do? Consider speaking with a career counsellor and exploring options that are a significantly better fit for you. Levrini notes that many experts in the field have recommended that adults with ADHD avoid jobs that involve sitting at a desk and doing repetitive and/or detail oriented work.[5] Rather the focus should be on a degree of variety, spontaneity, creativity and the ability to work flexible hours[6]. Be mindful of selecting too much flexibility as this may negate accountability.
Levrini notes that adults with ADHD can thrive in environments that allow them to be more high level and less detail oriented. That is, for example, an adult with ADHD may be more suited to envisioning the bigger picture, creating new endeavours and soliciting new business. It is important to then turn any follow through over to others who are more detail oriented.
Strategies to Enhance Focus and Attention
The following strategies are not exhaustive. The idea is to try what resonates with you and find what works for you so that you can incorporate them into your own tool kit:
Medication
Consider Medication – This is a personal choice. However, research has suggested that medication can help with enhancing focus. This is something to discuss with your GP or psychiatrist (if you are seeing one).
Distractions and the Work Environment
Identify Your Distractions – What type of things distract you? e.g., telephone calls, your thoughts, being interrupted by others with questions, interrupting others to seek stimulation and/or avoid doing work, emails and so forth.
The more distractions you can identify and treat, the more productive you will become.
Evaluate your Work Environment – Can you make it less distracting? You might need to talk with your manager to implement helpful changes. If you can’t change your environment, could you adjust your working hours e.g., come in way earlier or work later when other people aren’t as present.
Limit Distractions – wear ear plugs if this can help. Use white noise to drown out distracting sounds and remove visual distractions from the field of vision. If you can’t remove a visual distraction, it is important to consider shifting your location away from the distractions. (see Move to a New Environment below).
Do Not Disturb – can you block off time in your day when you aren’t available to be interrupted and can just work on your own work tasks?
Intrusive Thoughts – consider having a journal where you jot down any thoughts of other things you need to be addressing as they come to you. In the absence of an emergency, do not simply switch to the task. Rather, make a note of them and add them to your Things to Do list later.
Devote Blocks of Time to Specific Tasks – e.g., can you allow calls to go through to voicemail and then address at key points throughout the day? The same with email – can you check and respond only at three key points across the day for example? It might be that you use these check-in points as a break from other more intense tasks. It is the variety of this structure, that might be appealing to someone with ADHD[7].
Avoid multitasking – Multitasking or switching doesn’t work. People with ADHD might find multitasking more harmful than helpful as it can offer more opportunities for distraction which can result in taking longer to get either task done than if one was doing one task at a time.
Move to a New Environment – moving to a new environment will provide a mental reset. If working from home and struggling with this, consider relocating to a library.
Adopt Organisation and Time Management Strategies
The adult ADHD individual is said to have difficulty with Executive Functioning. Executive Functioning broadly encompasses “various complex cognitive processes responsible for cognitive control of actions and thoughts that are necessary to maintain goal directed behaviour.”[8]
Inattentive presentations appear to be categorised by difficulty in filtering information and shifting the focus to only what is needed in respect of the specific task. This often presents as scattered thinking, being disorganised and having cluttered environments.
Being overloaded with information makes it difficult to create a plan and follow through with anything. However, most adults with ADHD appear to thrive with structure and routine. Productively mining one’s energy and time has numerous benefits including, less stress and fatigue and more time to spend with people you want to spend time with or more time doing those things you really want to do.
The following are some strategies to help improve any difficulties you might be having with organisation and time management:
Write things down - There are pros and cons for utilising technology over manually writing something down. Although digital technology is convenient it might not be the most beneficial type of tool when trying to create better time management. This is because the act of actually writing something down, crystalises thinking and leads to enhanced memory consolidation and knowledge recollection. However, when it comes to being organised and managing your time more effectively, you need to find the tool and/or system that is right for you.
Use Tools Like:
Planners/schedules – These are visual aids. Consider if you want to keep your professional and personal schedules separate.
Consider how you want to block off time e.g., 15 minute intervals versus segmenting your day e.g., time you start work to mid-morning break, post mid-morning break to lunch, post lunch to mid-afternoon break, post mid-afternoon break to leaving work.
Adults with ADHD can be poor estimators of how long an actual task may take. Prior to creating any schedule, it is important to consider tracking for a week or two what you did immediately after doing it. This will assist with greater accuracy in assigning time to tasks. If in doubt, consider over estimating time. You can always adjust when you have a better understanding.
Keep the planner/schedule visible if possible. Consistently use and stick to the order and timing within the schedule as much as possible to create routine and structure. This predictability can reduce stress and can help to keep you task focused.
To-Do-Lists – If you are using these, keep them visible and, keep the task list short so that the To-Do-List isn’t overwhelming e.g., 3 – 5 critical tasks per day. Check off the items completed as you go. Build in breaks and buffer periods between tasks to account for unexpected delays. Consider building in end of day rewards.
Apps – these can be helpful if used correctly and don’t lead to distraction. There are easily accessible, can also build in alarms but they can also be overstimulating or confusing to some adults with ADHD.
Reminders – Build in reminders. this will help to ensure tasks are not forgotten. It allows one to keep deadlines in mind and can motivate actions and help in meeting goals.
Leverage Organisational Strategies e.g., use colour coded systems as a way of reducing time spent searching for items or as a way to prioritise tasks e.g., red for urgent, blue for longer range tasks. It’s recommended that you use no more than 4 – 7 colours so as to avoid confusion.[9]
Set Time limits and Use Timers - Timers can subdivide task work e.g., Work for thirty minutes followed by a 10 min break might allow the individual with ADHD to recuperate and be ready to work for the next 30 minutes. It is up to the individual to set their time limit.
If you are looking for more structure, the Pomodoro Technique requires using a timer to break down your work into 25-minute intervals, separated by 5 minutes of break time. After four pomodoros, you could take a longer 15- to 30-minute break. The benefits include increased focus, productivity and reduced procrastination and fatigue.
Be Realistic with goal setting to reduce pressure to meet excessively high standards.
Break Down Tasks – The individual with ADHD needs to set themselves up for success and not overwhelm and thus procrastination. They way to do this is to break down tasks and/or large goals into smaller, realistically achievable objectives and set appropriate deadlines for completion. Start with small time segments and as the self-efficacy increases gently build it up.
Remain Flexible – adaptability is key. There will be things that come up that can derail a schedule. It is also important to remember that notwithstanding your best efforts to manage your ADHD symptomology, you may still have the occasional bad day where you may be unable to complete your set tasks. Don’t beat yourself up. Instead, regroup and resume tackling your Things-to-Do list.
Avoid Overcommitment – when taking on something new, consider what you need to complete and what you could let go.
Utilise Memory Prosthetics e.g., place keys, phone sunglasses in the same bowl or drawer making location and retrieval easy.
Set-up Automatic Payments – set-up online automatic payment of bills.
Practice Mindfulness – deep breathing exercises and being present allows one to better manage one’s thoughts and improve attention and memory.
Boredom – recognise that you might at some point become bored with the system that once worked so well for you. This doesn’t mean the system or tools weren’t correct. It simply means that although the system and/or tools worked for a certain period (and may work again at a subsequent time) they don’t currently and thus you may need to find a new system and/or tool.
If you are experiencing boredom whilst at work, consider taking a short break or doing some physical stretching.
Declutter
Declutter Regularly – this can significantly simplify your spaces, reduce your stress levels, decrease distractions and improve your focus.
Follow the Process – before decluttering and making the space more organised consider doing the following:
Identify your Why – be clear around why you want to organise and declutter your space. What is your motivator?
Create an Organisational Plan – identify all the spaces you might want to reorganise and declutter – not just your workspace. Prioritise and number the list – i.e., most important to less important areas you want to address. Tick off each area as you complete it. Consider building in a reward for achievement and effort.
Challenge and Relinquish Fears – write all your concerns down then for each one identify a more rational and thus more accurate response. A helpful strategy is to also consider how you might advise a friend with the same concern. We often give really good advice to people we care about. The more positive your thinking is the more likely you will be to follow through with the task/goal.
Note: There are 6 Unhelpful Thinking Styles common to adults with ADHD:
Mental Filter (i.e., focusing only on one part of a situation and filtering out the rest – often what is good about a situation is filtered out in favour of the negative).
Catastrophising (i.e., awfulizing; blowing things out of proportion).
Fortune Telling (i.e., you predict a future outcome and that it won’t be positive).
Black and White Thinking (i.e., here there are only extremes
and no grey area e.g., wrong/right, good/bad).
Emotional Reasoning (i.e., you believe something to
be true simply because you feel it to be true,
sometimes even if there is evidence to the contrary).Mind reading (i.e., here there is an assumption
that you know exactly what the other person
is thinking or what their intensions
might be without them ever being verbalised).
Organisation Improvement – the whole point of seeking to declutter your space is to not only free your space up physically but to improve how it is organised. Let go of achieving perfection and rather aim for progress.
Organise in Sections – do not try to organise the whole space at once. Instead divide it up into sections and work on one section at a time. Use a planner and timer to stay within small chunks of time.[10]
Psychological Scaffolding
Join Support Groups - Adult education and support groups can be extremely helpful. For example: Adult ADHD groups | Focused Foundations
Consider Coaching - This can be beneficial if looking for ongoing support in specific areas, for example:
· Structuring your daily routine.
· Seeking feedback and recommendations around problem solving.
· Seeking practical advice around goal setting.
Core Practices
The following are not exhaustive but are key to good health and well-being:
Get sufficient Sleep – Quality sleep is an overall component of good health. Creating appropriate sleep hygiene practices that include setting a structure around when you want to go to sleep and when you want to get up each day and maintaining this as consistently as possible along with a good winddown routine before bed is thus conducive for sleep.
Where this occurs, benefits include improved energy levels, improved mood, improved cognitive functioning which can lead to enhanced problem solving and better decision-making skills, improved cardiac functioning as during sleep the heart and vascular system are able to rest, and reduced blood pressure. Good quality sleep is also associated with less risky behaviour, reduced stress, lowered anxiety and/or depression levels. Ultimately, we cope better when we have had quality sleep.
Exercise – there are numerous benefits to regular exercise such as walking, going to the gym or swimming, for example regular exercise can tire the body out and prepare it better for sleep as well as provide increased energy levels, bone and muscle strength, better bone density and less muscle loss, cardiovascular health, improved skin health, improved mood, improved self-esteem.
Eat healthily and regularly – it is important to establish a sustainable mindful routine. Just like with exercise, there are numerous benefits to eating healthily and regularly. These include improved digestive functioning, enhanced immune system functioning as there is a steady nutrition supply, improved blood pressure regulation, stabilised blood sugar levels which aids mood regulation and strengthens bones.
Moderate caffeine intake – an over indulgence in caffeine can result in sleep difficulties, irritability, frequent urination, chest pain, rapid heart rate and/or altered heartbeat rhythm called atrial fibrillation, increased blood pressure due to the stimulatory effect on the nervous system, anxiety – it triggers the release of adrenaline; high doses well in excess of 250mg might result in caffeine intoxication ( DSM – 5 – TR) where symptoms such as restlessness, nervousness, excitement, insomnia, psychomotor agitation, gastrointestinal disturbances might occur.
Hydrate – when we regularly hydrate with water across the day, we garner multiple benefits some of which include improved cognitive functioning, improved energy levels, improved mood, improved physical performance, supportive of kidney function and detoxification, helps with body temperature regulation, healthy hair and skin and, it helps with waste elimination.
However, it is important to work out what is the right amount for you. Your need for hydration will depend upon things like the climate where you live, your age, your weight, your diet and how active you are.
Just like any habit, consider building a hydration habit and view it as an act of self-care. Consider carrying a water bottle around and setting alarms to remind you to take regular sips of water. You could also consider tracking your intake via an app or journal, if that would be easier for you.
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References
[1] Inattentive ADHD: What It Is, Symptoms & Treatment
[2] ibid
[3] Levrini, A. P
[5] Ibid pg 200
[6] Ibid pg 200
[7] Ibid pg 202
[8] Ibid pg 8
[9] ibid pg 109
10. Ibid pp 141