ADHD Executive Functioning Tools – Part 1

Tools and Tricks to Improve Your Executive Functioning

Part 1: External Memory

Would you like to get better at managing your attention and daily choices?

In this and my next post, I will describe practical tools and tricks that can help you manage your time and tasks better, especially if you have ADHD. I’ll explain why these practices are particularly essential for people who struggle with ADHD symptoms. However, many of these self-regulation tools are also good practice for everyone else.

Some Misunderstandings About ADHD

In order to understand how people with ADHD might benefit from specific tricks and tools, let me first address some common misunderstandings about ADHD.

1. The Scope of ADHD – a Deficit in Executive Functioning

The label “Attention-deficit/hyperactivity disorder” (ADHD) has long been criticized for being misleading and insufficient at best [47]. It highlights two specific symptoms, but falls short in describing the core or scope of ADHD.

While our understanding of ADHD as a complex phenomenon is still developing [16, 22, 26, 30, 35, 47], a big part of its core problem seems to be a deficit in self-regulation, or “executive functioning” [7, 13, 41]. This includes inefficient use of working memory, and poor engagement of reward circuits, especially for delayed rewards [39, 44, 45, 47].

Executive functions can include the following aspects [3, 6, 23], all of which ADHD can disrupt to varying degrees:

1. self-inhibition, or self-restraint
2. nonverbal working memory, or visual imagery
3. verbal working memory, or self-speech such as your mind’s voice
4. emotional self-regulation and motivation
5. planning and problem-solving, or mental play
6. self-managing with regard to time; anticipating and preparing for the future

2. The Cause of ADHD – Mostly Genetic

Individual differences in executive functioning are almost entirely genetic in origin, in fact it seems to be one of the most heritable psychological traits [18, 31]. ADHD, too, is highly heritable, although there are also some environmental factors, mainly of the biohazard type (such as brain injuries or toxins during pregnancy) that contribute to the risk of developing ADHD [36].

Contrary to popular belief, there is no evidence that ADHD is caused by social or other environmental factors, such as modern technologies, lifestyle, poor parenting, or not enough “rough and tumble play”.

3. The Spectrum of ADHD

Lastly: ADHD is not a pathology, in the sense of a qualitatively distinct category from neurotypicality. Instead, the differences between those who do and don’t have ADHD are quantitative and come on a spectrum. As such, there are also people on the other end of that spectrum, who have exceptional abilities to self-regulate (motor, cognitive, and emotional). A cutoff within the spectrum is needed only for practical purposes, such as qualifying for disability benefits.

How ADHD Affects All Areas of Life

If we consider how essential it is in our adult lives that we are able to manage our thoughts, as well as our emotions and behaviors, it is not surprising that poor self-regulation has far-reaching consequences throughout all areas of life.

An abundance of studies shows that people with ADHD experience more negative outcomes across many domains, including:

• academic and professional underachievement [1, 17, 24, 27]
• financial distress [10, 24]
• higher divorce rates [10]
• lower ratings of their friendships, social and leisure activities [10]
• driving accidents and citations [5, 8, 17, 34]
• substance abuse [1, 11]
• arrests, convictions and incarcerations [32]
• psychiatric disorders, including antisocial, addictive, mood and anxiety disorders [11, 12, 46]
• recent negative life events as measured with the “Life Experience Survey” [20]

Furthermore, ADHD severity seems to be associated with negative life events, even when adjusted for – in other words, independently from – confounding factors such as psychiatric comorbidities, substance use, education, and income [10, 20].

As reflected in these studies, people with severe ADHD struggle in ways that are hard to even imagine for the rest of us, even though I’m sure we are all familiar with some degree of struggles with self-regulation. I trust we all know what it feels like to be distracted or disorganized, to be overwhelmed by a task or by too much information, to cope poorly with strong emotions, to run late for a meeting because we have misjudged or lost awareness of time, or to disappoint someone because we forgot about a commitment we made. For the luckiest among us, those are rare occurrences. For people with severe ADHD, this is every day, all day long.

But since probably all of us would prefer to become better – rather than worse – at regulating our own thoughts, emotions and actions, many of the skills and habits that make life with ADHD more manageable are good practices for all of us.

What Practical Tools and Tricks Can Help You Improve Your Executive Functioning?

ADHD Hacks – Part 1: Get Yourself a Bionic Memory

People with ADHD often experience deficits in working memory [2, 25], which is the ability to actively use or process information held in short-term memory. This impacts many everyday tasks, such as problem-solving, understanding and following instructions, or organizing and prioritizing to-dos.

Working memory capacity also suffers as we get older [14, 43], and it seems safe to say to say that we would all prefer our working memories to be better, rather than worse.

Therefore, the practice of externalizing memory as much as we can is good advice for everyone. Instead of relying on your brain, it is good practice to offload and organize all task-related information outside of our minds – on paper or electronically. If we don’t do that, we are all prone to forget things, lose clarity of what we’re working on, and become chronically stressed by all the “stuff” in our minds.

Here are some practical examples of how to externalize memory.

Calendars

You are probably already using one, or several. Are you already maximizing its usefulness, or could you put more things out of your mind if you put them into your calendar?

Physical reminders

Sticky notes or actual objects in strategic places can remind you what you of need to do when you see them. If you want to make sure you won’t leave the house forgetting that it’s trash day tomorrow, you might stick a note to the door saying “take out trash”. Make sure to remove those physical reminders as soon as you don’t need them anymore, otherwise you will very quickly stop noticing any of them.

Worried you might forget to clear out the fridge after a night in a motel? (It’s happened to us. Oh, the sadness!) To avoid that, put an ultra-cool beer-cooler – but really anything works – as a place-holder in front of the door, to serve as a physical obstacle/reminder.

Writing things down

This one is obvious, but it goes beyond writing to-do lists. For example, one of my clients had troubles staying focused while reading. She already had made good experiences with journaling in the mornings to clear ther mind, so she decided to also try journaling right before reading. She was happy to report that this enabled her to stay focused on the plot and enjoy a novel in a way she usually couldn’t.

I also find that writing down intrusive thoughts helps many of my clients put those thoughts literally “out of their minds”, and enables them to re-focus on the task at hand.

Decision tools

For important decisions, use decision support tools that help you visualize the problem, rather trying to juggle all your thoughts and feelings in your head. This might be particularly beneficial for people with ADHD, because in tasks that measure analytic decision making competence, adults with ADHD show deficits that are no smaller than their attention deficits [28, 33]. Importantly, low analytic decision competence truly matters in real life: even when measured with hypothetical decisions, low decision-making competence is related to real negative life events [14a]. Therefore, learning how to make good decisions seems like a very worthwhile skill to acquire, not only for people with ADHD.

Task management systems

A classic example is David Allen’s “Getting Things Done” method, which proposes a system of how to offload and organize all task-related information externally. There’s no shortage of other books, programs and apps with similar purposes, and no particular system that I would recommend over any other. Try whichever you find appealing, or create your own system. Keep using whatever works and fine-tune what doesn’t. Don’t try to find the perfect app that will solve all your problems at once. Also, don’t use too many apps, especially if their purposes overlap.

You can go very high-tech, or very analogue. Whatever works for you, as long as it’s outside of your own brain.

Alarms

Again, you’re probably already using those. However, could you use a larger variety of them to start and end different kinds of tasks? If the word “alarm” sounds harsh, choosing a pleasant sound or motivating song can make a difference. But perhaps more importantly, consider how wonderful it will be to NOT have to pay any attention to the clock at all in the meantime. You can fully relax, focus, or be free, until the moment the timer goes off.

You might also consider non-auditory timers. For example, my husband and I wanted get to sleep at a more regular time. (By the way, that is also one of the most often named changes my clients want to make). So he programmed one of our lights to switch off at the same time every night. It is is not a disruptive „light’s out“, just a decorative light clicking out. But it works, since it’s a reminder of something we want to do anyway. The difference between wanting to do something and consistently doing it is sometimes just an programmed light switch.

What other tools and tricks help with executive functioning if you have ADHD?

In this post, I focused on the practice of externalizing memory, since it is such an essential part of managing ADHD. However, deficits in working memory are not the only challenge for many people with ADHD. Another hallmark of ADHD is a difficult relationship to time, especially the future [15, 30a]. This includes poor time estimation [6, 30a, 40]. But also includes a tendency towards impulsive choices, and with that, difficulties to get motivated when consequences are delayed [6, 21, 29, 37, 38].

In my next post, I will discuss these problems in more detail. I’ll provide practical examples of tools that help with delaying gratification and managing time. Whether or not you have ADHD, these practices will help you take better care of your future self.

Stay tuned!

by Ursina Teuscher (PhD), at Teuscher Decision Coaching, Portland OR

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