The ADHD Algorithm Part 2: Understanding the Algorithm
Welcome back to The ADHD Algorithm blog series. My hope in writing about this topic is to grow in my understanding and ability to help others overcome ADHD’s difficulties. In part one, I outlined what ADHD is and common misconceptions around it, some that I carried with me into my psychotherapy career. I described how the Diagnostic and Statistical Manual’s fifth edition (or DSM-5) delineates ADHD, and I tried to uproot several incorrect stereotypes surrounding focus, laziness, procrastination, and more resultant from the ADHD experience. This next installment of The ADHD Algorithm will expand upon best practices for managing ADHD as offered by my own experience and experts in the field. The purpose of blog post two is not to solve the ADHD algorithm…something I cannot do…but instead point readers toward repositories of tools that can aid with the executive functioning struggles common to ADHD symptoms.
One reason I titled this series The ADHD Algorithm is because, in working with one long-time client, he explained a thought that revolutionized my way of conceptualizing his inattentive ADHD. He described a cognitive, emotional, and behavioral chain reaction that occurred for most of his life before ADHD recovery. During a normal day, he would become triggered, at which point the reaction started. He would then flow through the rest of the algorithm steps (whether they were thoughts, feelings, or actions) almost mindlessly. This led him to many difficult circumstances: lost jobs, broken relationships, and more. For years, he assigned blame to the final step of the algorithm, but treating that step alone rarely helped. In our work together, he shifted to using tactics to treat the early steps in the algorithm right after getting triggered, and he started to see results. It has been amazing to watch him thrive since! I want to sketch the algorithm below, as it will be an outline for this blog post, helping me lay out tools to optimize life with ADHD.
Without further ado, here is the chain reaction that would occur in my client’s life:
ADHD > Disorganization > Frustration > Shame > Resentment > Rage
Defining this was powerful because my client thought his anger and rage were his primary issues, but these were effects rather than causes. When he began working on treating the disorganization (i.e., executive functioning challenges) and emotional dysregulation (common for those with ADHD), his rage shifted dramatically. I found out for my other clients that substituting “hyperactivity” for “disorganization,” or “numbing/avoiding” for “rage,” maintained the integrity of the algorithm. For instance, two other clients described the algorithm this way: instead of manifesting shame and resentment into rage, they would utilize video games, pornography, cigarettes, or alcohol as negative, compulsive coping mechanisms to manage their internal conflicts. This arose because their experiences in early childhood taught them it was important to be organized, efficient, productive, and performance oriented. When their ADHD caused major issues in meeting those expectations, it led them right down the rabbit trail of compulsion and addiction. [Note: if you are struggling with ADHD and addiction, reach out to a licensed clinician today.]
Treatment basics: medication
Now comes the encouraging part. Each step of the algorithm can be managed, thus providing off-ramps from the chain reaction superhighway; these off-ramps provide preventative action so that unhealthy reactions are no longer resultant. I will begin with some prevention for disorganization/hyperactivity. In this area, I am the student versus specialist, so I refer to industry experts who work primarily with this diagnosis. Because ADHD is a neurobiological disorder, most providers encourage neural stabilization through FDA-approved medication for clients above age six (1, 2). The American Academy of Pediatrics recommends starting with behavioral interventions for those less than six years old (3). Often, my clients must discern whether to use stimulant, non-stimulant, both, or natural medications. In this situation, natural medications are non-prescription remedies like caffeine or supplements. When researching this topic, I appreciated Dr. Larry Silver’s article on the differences between the medication options and why to use each.
Treatment basics: behavioral intervention
The next off-ramp from the algorithm can be tricky: behavioral intervention. Because individuals with ADHD have a hard time performing non-novel tasks, prioritizing small tasks like taking daily medication can be difficult. There are several important behaviors that help. Referring to my client who helped me uncover the algorithm, he referenced the following daily activities to keep his mind clear: 1) a balanced diet, 2) daily exercise, 3) mindfulness, and 4) accountability/support from others, particularly from an ADHD community or coach. Beyond these, other behavioral hacks can be advantageous when mental fatigue or procrastination creeps in. For example, some of my clients place sticky notes around the house, while others utilize ADHD apps on their phones as reminders. Overall, for hacks to work, I am learning that it is more about connecting the mundane task to inner motivation and a workable external method. I really like the idea of integrating this article on the 5Ws, and this ADHD-Proof Productivity infographic, to craft a personalized system with ADHD best-practice principles. Remember: creativity, a natural gift for those with ADHD, can be an experimentational tool to find what works in your system!
Treatment basics: emotional regulation
This brings me to the next off-ramp. Emotional regulation through mindfulness makes or breaks one’s ability to manage the difficult emotions that follow disorganization or hyperactivity. Frustration, shame, resentment, and anger can be friend or foe; for those with ADHD, they are dastardly when unmanaged. To help in this area, I teach most of my clients a tactic known as mindfulness because a scattered mind is a survivalistic mind. Our emotions are processed in the amygdala, limbic system, and other areas that focus on survival (i.e., fight, flight, or freeze). When we are concerned with survival, we cannot utilize the rational part of our brain called the prefrontal cortex. Thus, being mindful shifts the brain back from the emotional center to the prefrontal cortex making goal execution possible. There are many ways to begin mindfulness practice, from YouTube videos to phone apps like Calm or Headspace. Here is the best part; it does not take a qualified professional to teach mindfulness. It can be self-led! When one is mindful, it is difficult to enter the final step of the algorithm: rage, numbing, or avoidance. In fact, when we soothe our body and brain, humans use emotions as motivation. It is amazing!
A note for parents
Lastly, I want to talk to parents. Many readers may not struggle with ADHD but have a dear loved one in the household who does. For those who have spouses with ADHD, I will address this in the next blog post. For those parenting a child or adolescent with ADHD, this can be tremendously challenging, and I empathize with you. I recently spoke with parents experiencing a child who was restless, lying, risk-taking, running away, and breaking rules simultaneously. These are all normal symptoms for the neurodivergent brain, although that does not make them any less impactful, destructive, or hard to handle. The parents were understandably overwhelmed and confused. My greatest encouragement for caregivers in this situation is to get connected with great ADHD parenting resources and plug into a community of people who can encourage, support, and lift them up. What I love about ADDitude Magazine’s resource repository for parents is their focus on positive parenting. Positive parenting is a clinical specialty of mine, and I am accredited through the Positive Parenting Program (a.k.a., Triple P). It has been a powerful tool for me to use in reassuring parents to use non-intuitive methods that provide great results in children with or without ADHD.
Let’s wrap up. In this second installment of The ADHD Algorithm, I outlined an algorithmic chain reaction that describes what many of my clients go through when they have unmanaged ADHD. I used this as an outline to describe some tips, tricks, and hacks via best practices to overcome the algorithm’s unmanageability. I called these off-ramps. Using off-ramp tools like medication, dieting, exercise, accountability, applications, mindfulness, and more, individuals and parents can move closer to the journey of living their best life with ADHD. Finally, for those encouraged readers: come back soon for my final blog post of this series to learn about ADHD nuances surrounding Rejection Sensitivity Dysphoria, how ADHD interacts with other diagnoses, and stigmas in diagnosis/treatment. You will not want to miss it!
- Center for Disease Control and Prevention (CDC). (2020, September 3). ADHD treatment recommendations. CDC.gov. Retrieved from https://www.cdc.gov/ncbddd/adhd/guidelines.html
- De Crescenzo, F., Cortese, S., Adamo, N., & Janiri, L. (2017). Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review. Evidence-based Mental Health, 20(1), 4–11. doi: 10.1136/eb-2016-102415
- American Academy of Pediatrics (AAP) Subcommittee on Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. (2019, September 30) ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of children and adolescents with attention‐deficit/hyperactivity disorder. Pediatrics. Retrieved from https://pediatrics.aappublications.org/content/144/4/e20192528