INTRODUCTION

UNDERSTANDING ADULT ADHD

Years of research within the scientific community confirms that attention-deficit/hyperactivity disorder (ADHD) persists into adulthood (Caye et al., 2016). While symptoms may change, the disorder can manifest itself in virtually every area of life: emotion regulation; work performance; family life; relationships with partners, friends, and coworkers; time management; and the ability to stay organized and achieve goals. Maybe you struggle to keep track of projects and tasks, resulting in failed attempts at advanced degrees or job-hopping. Or you may zone out frequently and forget things your partner said, resulting in failed marriages or lost friendships. You may lose things easily or lack patience, resulting in a hectic household and parenting regrets. ADHD can negatively impact nearly every facet of your life, leaving you feeling hopeless and stressed, lost and alone.

Whether you suspect you have ADHD, are newly diagnosed, or have known for years that you struggle with the disorder, this book can help you to regain cognitive control of your actions and thoughts through learning how to develop and maintain goal-directed behavior. By applying the principles in this book, you will begin to reach your current and future goals. The strategies presented are based on scientific research spanning decades, including my own and that of other experts in the field, as well as my years in private practice putting these strategies to the test with hundreds of adults, just like you. I am a clinical psychologist who specializes in treating patients with ADHD. When I earned my PhD at Florida State University, I was part of a team that spearheaded a now nationally recognized ADHD behavioral treatment intervention. I have published numerous scientific articles on ADHD in peer-reviewed journals, and I regularly give ADHD-related presentations in professional settings throughout the country. In addition to the first edition of this book, I have published a scientific manual and video on the best practices of ADHD treatment for mental health professionals. I conduct original research on ADHD, and I maintain a busy clinical practice, where I help adults develop skills to manage their ADHD.

Throughout this book, you will meet some of the adults I have had the pleasure of working with over the years, all of whom came to me out of fear, frustration, or, at times, desperation.¹ All of them went on to experience success, joy, and self-satisfaction they had thought was all but impossible. You will meet clients like Addison, who had recently turned 30 and was ready to give up after attempting college four times only to be told “maybe you just aren’t smart enough” by her professors and guidance counselor (she had a nearly gifted IQ); or Fred, whose self-efficacy had hit rock bottom after using his savings to start, but not finish, numerous business ideas and whose wife had enough of his “manipulation and deceit.” (This was actually his impulse to lie to avoid her negative reaction.)

How did they ultimately succeed? To begin, they learned that they weren’t stupid, incapable, or malicious. Their struggles could be explained by their ADHD brains rather than willful misconduct. Understanding ADHD is a critical step in developing self-empathy, self-patience, and self-forgiveness, all of which are necessary on the (sometimes rocky) path to successful goal attainment.

WHAT IS ADHD?

ADHD is a cognitive processing disorder that affects an estimated 2.8% of adults worldwide, according to a 2016 study conducted by the World Health Organization (Fayyad et al., 2017). Although the name suggests there are only two key symptoms, there are actually three. Adults with ADHD may have all of the following symptoms or any combination of them.

First, inattention (not being able to keep focus). What does this look like in adults with ADHD? Adults with inattentive features of ADHD may fail to give close attention to details or make careless mistakes in their schoolwork, work, or other activities. You may add when you should have multiplied, skip over details when reading an assignment, or add too much of an ingredient when cooking dinner. Inattention could also mean you have difficulty sustaining attention during meetings, conversations, or while reading. Sometimes, despite starting strong on a task, inattentiveness causes individuals to become sidetracked, leaving projects and responsibilities incomplete. Even your own thoughts can serve as distractions. You may have difficulty keeping your belongings in order or moving from one task to the next without becoming distracted. Tasks you find tedious or boring may get avoided altogether. Finally, inattention may lead to forgetfulness in your daily activities or losing the things you need to go about your day.

Second, hyperactivity (excess movement that is not fitting to the setting). What does this look like in adults with ADHD? While young children with hyperactive symptoms may be easy to pick out, adult hyperactivity can look a bit different. You may fidget, tap your hands or feet while sitting, or just feel generally restless throughout your day. Hyperactivity can also be verbal in adults with ADHD; you may talk excessively or very fast at times.

Finally, impulsivity (hasty acts that occur in the moment without thinking). What does this look like in adults with ADHD? Maybe you blurt out an answer before a question has been fully asked, struggle to wait your turn in line, or intrude on others without realizing they were engaged in a task or conversation. While it is not technically a symptom, adults diagnosed with impulsivity also may engage in risky or unwanted behaviors on impulse as a result of not properly evaluating long-term consequences. This includes things like lying, overspending, alcohol or drug use, sexual encounters, or pornography.

If you were diagnosed after 1980 and before 1987, attention-deficit disorder (ADD) is the name of the diagnosis you would have been given. If you have been diagnosed or reassessed for the disorder since the mid-1990s, you would have been given the diagnosis of ADHD (even if you don’t have “H” symptoms, or hyperactivity). Based on which of the previously mentioned criteria you meet, you should fall into one of three categories, subtypes, or what we now call “presentations” of ADHD (note: you do not need to meet all criteria listed in each category to qualify as having ADHD):

ADHD, inattentive presentation (no hyperactivity or impulsivity)
ADHD, hyperactive-impulsive presentation (no inattention)
ADHD, combined presentation (both hyperactivity and/or impulsivity and inattention)

Since the previous edition of this book was published, there have been some changes in the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM), which is a widely used manual listing diagnostic criteria for different mental disorders. The fifth edition of the DSM (DSM-5) was published on May 18, 2013. Although the DSM-5 revisions to ADHD criteria were far less dramatic than earlier ones, some notable changes were included for adults with this disorder. Perhaps the most helpful changes are the addition of examples of how ADHD manifests in adolescence and adulthood and a reduction to five (from six) symptoms required for diagnosis in adults. The age of onset changed from prior to age 7 to prior to age 12. This is especially helpful in diagnosing adults who, often, can’t remember as far back as age 7 or did not begin to struggle with significant impairment until they hit a period in life at which time they could no longer cope (i.e., managing multiple classes in middle or high school, living independently in college or early adulthood, and so on).

Many of these changes are based on a growing body of research being conducted with adults with ADHD. ADHD diagnoses among adults are growing 4 times faster than ADHD diagnoses among children in the United States, yet most scientists believe adult ADHD remains underdiagnosed. Adults who were diagnosed as children may find that the way the symptoms manifest and how many symptoms they experience may have changed as they reached adulthood. For example, you may have been out of your seat as a child, only to find that you’ve become a fast talker or feel restless as an adult. Or, as an adult, you find you struggle more with the inattentive and impulsive features of the disorder, such as an inability to focus on your work, pay attention in conversations, or control your emotions.

THE ROLE OF EXECUTIVE FUNCTION

There is considerable evidence that the symptoms seen in adults with ADHD (inattention, impulsivity, and hyperactivity) may be explained by deficits in executive functioning. Executive functioning (EF) is an umbrella term for various complex cognitive processes responsible for cognitive control of actions and thoughts that are necessary to maintain goal-directed behavior (in order to reach your goals; Welsh & Pennington, 1988). EF is necessary for meeting goals. How often have you set a goal for yourself and then failed to achieve it because you were unable to control your thoughts (i.e., couldn’t focus or maintain attention) or actions (i.e., couldn’t follow through with a plan)? Perhaps you had to complete a work project but were unable to get things done because you were always sidetracked by other tasks. Or perhaps you wanted to do a home improvement project, and even set out a plan to complete it, but were unmotivated to follow through with the plan. Or perhaps you wanted to plan a vacation, but every time you sat down to research destinations online, you got distracted by social media.

The results of recent studies suggest that EF consists of two broad domains (Barkley, 2010). The first is inhibition, which is the ability to control motor, verbal, cognitive, and emotional activities by suppressing extraneous or impulsive thoughts or actions. Adult ADHD symptoms likely arise from a fundamental neurological impairment in both motor and cognitive inhibition (Ossman & Mulligan, 2003). In turn, deficits in inhibition contribute to deficits in the second domain of EF, metacognition. Metacognition includes working memory, planning and problem solving, and emotional self-regulation. In adults with ADHD, lack of inhibition leads to dysregulation of self and overall EF, whether attentionally, by becoming distracted and off-task easily, or emotionally, by being quick to angry outbursts or saying something hurtful on impulse. The strategies presented in this book will help to address these deficits in executive function.

WHAT’S IN THIS BOOK?

This book presents evidence-based, tried-and-true strategies to help you better manage your adult ADHD. Sections are concise with straightforward language and explanations. In each chapter, I have included relatable examples and practice exercises, as well as recommendations for the most common adult ADHD struggles, including emotional regulation, time management, organization, academic pursuits, navigating the world of work, and relationships. Most important, I aim to help you personalize the lessons of this book, so that you may successfully achieve your goals and manage your life.

One of the most consistent comments I received about the first edition of this book was how user-friendly and practical it was. Many individuals with ADHD find that they cannot handle the intensity of some self-help books. Because lack of attention and focus is a cornerstone of the disorder, lengthy or jargon-filled books can be too overwhelming to read. To help make this new edition just as easy to read, I have included several means of support. First, you will find this book organized into manageable, easy-to-digest 10- to 20-minute reading segments. The visual reminder to “check your focus” will cue you to check in with yourself to make sure you are still engaged. If you see this symbol and realize you’re off track, stop and take a break, then rewind and try again.

I also recommend the use of highlighters and notes in the margins. Active reading tools such as these will help you commit ideas to memory and reference your favorite parts later.

The book chapters were selected on the basis of my now 20 years of experience coaching, counseling, and conducting research with adults who have ADHD. I selected 10 topics that are most important in helping you to live a healthy and productive life. Topics that were covered in the previous edition contain new and improved strategies. Other topics are brand-new. The book remains divided into three parts.

In Part I (which includes Chapters 1–4), I teach you how to envision goals for yourself and make realistic plans to achieve those goals. Setting realistic and measurable personal goals is one of the most important strategies you will learn. Everyone’s lifestyle and needs are different, so my philosophy in this book is that managing ADHD is about creating a plan that works for you. You might decide that you want to be more focused at work, learn how to organize your office, be on time for appointments, improve your social skills, or improve your academic functioning. There are different ways of achieving each of the goals you might set, but the key is to make them your goals, so that you will be motivated to attain them.

Chapter 1 is on how to interpret your behaviors in a healthy and helpful way. Maintaining a positive outlook is imperative to succeeding with adult ADHD. Chapter 2 is on long-term goals and weekly objectives. I teach you how to initiate change by setting effective goals and then breaking them down into small, achievable steps or objectives. Chapter 3 is on motivation. I show you how to apply rewards and consequences to increase your motivation to follow through on the goals you have set. This includes a discussion on how to use metacognition to better understand your behavior and what works best for you. Chapter 4 is about metacognition—thinking about thinking—perhaps the most critical step in obtaining lasting results. In order to create sustainable change in your behavior, you must learn how to gain (and retain) proper insight into how and why certain strategies work or do not work for you.

Part II (which includes Chapters 5–9) gives you specific strategies for managing parts of your life in which you likely have goals. In Part II, you can find chapters on time management, academic skills, relationships and social skills, organization, and job or employment skills. Chapter 5 is on time management. I give you tools to keep you from procrastinating, help you to prioritize your tasks, and plan when and how you will accomplish things. This chapter is a must-read for those who have trouble with starting, continuing, and finishing tasks. Chapter 6 is on social skills, including the ways inattentiveness, impulsivity, and distractibility can get in the way of your social relationships. I help you figure out if you are realistic in your self-perception of your social skills. The how-to part of this chapter gives you suggestions for paying attention in conversations and teaches you how to make a listening plan. Chapter 7 is on organization. This chapter helps you begin to organize your environment in a way that makes sense to you as an adult with ADHD. It includes detailed plans for getting ready, actually organizing, and staying organized once your new system is in place. After reading this chapter, you should be able to develop your own personalized organizational plan. Chapter 8 is on learning and study skills. I give you very specific strategies for studying, memorizing, paying attention, taking notes, reading without your mind wandering, writing a paper, and taking tests. It also addresses test anxiety and ways to manage it. Chapter 9 is on employment. I guide you through a process of identifying your strengths and weaknesses, and then provide specific coping skills to help you with organization and time management at work. I provide suggestions for dealing with distractibility and lack of focus during the day and give you information about workplace accommodations to which you might be entitled.

Finally, Part III (Chapters 10–12) has three chapters focusing on getting additional help. Some adults with ADHD also struggle with anxiety, depression, or just increased stress. In addition, the medication used to treat ADHD can be confusing to understand or can cause frustrating side effects.

In Chapter 10, I give you advice on dealing with conditions such as anxiety, depression, and stress on your own, and on how to figure out when and how to get outside help. In Chapter 11, I discuss the pros and cons of medication and how to make the most of prescription drugs if you choose this option. In Chapter 12, I cover alternative treatments that you might consider to help with your ADHD, such as healthy lifestyle options, ADHD coaching, or counseling. At the end of the book, you can find a list of resources if you want more detailed information on any of the topics covered in these chapters.

Each chapter is broken down into short, distinctive sections that offer many perspectives on each topic. Specifically, chapters may contain one or more of the following features:

Quiz Yourself—Does This Sound Like You? “Yes” or “No” questions that will allow you to gauge if that chapter is for you
What the Experts Say. A short, nontechnical interpretation of the latest research on ADHD to help you see the scientific rationale for helping yourself
Can You Relate to This? Case examples of adults with ADHD that help you learn from others’ experiences
Quick Tips. Suggested tips or checklists to help you apply what you have read
Try It! Exercises or ideas to do on your own at home
Getting Back on Track. Detailed explanations for how to overcome ADHD-related difficulties. New to this edition—suggestions emphasize cognitive features (change in thinking) as well as behavioral ones (change in actions)
Chapter Summary. A checklist of ideas to take away from the chapter. After reading each chapter, use the list to note areas you have thoroughly studied and those you may want to revisit.

The past decade of client feedback, technological advances, and societal shifts has brought new insight into the strategies presented in the first edition of this book. While many of the original tools remain effective, this new and improved edition teaches readers how to reach their emotional and social goals in addition to their behavioral ones, creating a more complete picture of mental health. Social skills and relationships in a post-COVID society are more important than ever. Perhaps you are part of the “Great Resignation,” and it’s time to reevaluate your career path as an adult with ADHD; or, perhaps, quarantining so long with your spouse put a spotlight on problems within the relationship.

As I explain in the following chapters, the goal of this book is to help you create a personal “toolbox” of strategies so that you may lead a healthier and more successful life. You can hang a picture with a hammer and a nail, or with a drill and a screw. Similarly, you can create a schedule from paper and pencil or computer software. I will present pros and cons of using one tool over another, but there is no one “right” way to do anything, and I encourage you to bring a personal touch to the ideas presented. Your individual toolbox will help you lead a life that is more fulfilling and productive, all while maintaining your sense of uniqueness and originality.

Finally, I want to let you know that all of the worksheets in this book are also available in 8.5 × 11 PDFs, which you can download for free at https://www.apa.org/pubs/books/succeeding-with-adult-adhd-second-edition. If you find it easier to complete worksheets on standard letter-size pages, you may prefer to print out the worksheets and keep them in a binder for your easy reference.

YOU’VE MADE IT THROUGH THE INTRODUCTION—GOOD FOR YOU! TAKE A BREAK AND THEN JOIN ME IN THE NEXT SECTION!