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Some people equate ‘treatment for ADHD’ with ‘medication’, yet research clearly shows that even though medication can help many with their ADHD symptoms (not all), medication alone is not as good as it gets. As treatment for ADHD is somewhat personal – i.e. the same things don’t work for everyone – it’s helpful to use the conceptual framework below to understand whether you can further improve your treatment. And, before I begin, let me say that I view treatment broadly as anything you do intentionally that improves your symptoms and your life with symptoms.
What’s the Big Idea?
Managing ADHD is about both the symptoms themselves, such as distractibility or impulsivity, and about how those symptoms impact your life and the lives of those around you. This means there are multiple approaches to managing ADHD – and understanding how you are doing against each of those approaches will help you. I like to describe treatment as having three legs, like a stool. You need strength in all three legs in order to function well. (You can imagine that two-legged stool, right?!) Compare what you are currently doing to the treatment options in each leg below and you’ll know whether or not you’re optimizing your treatment.
Pick Your Target Symptoms
First, you need to know which symptoms are the most intrusive in your life – i.e. which you wish to ‘target’ for improvement. Family members can often help you figure this out – their outside perspective can get you thinking about issues of which you might not be so aware. Choose between 1-3 of the most important issues and identify the corresponding ADHD symptom. Try to be as specific as possible. So, for example, if one issue is that you are always late, then this might be due to a variety of symptoms or reasons - ‘distractibility’ or ‘having trouble staying on task’ or ‘getting hyper-focused and becoming unable to disconnect’ or simply ‘losing track of time.’ Which seems most appropriate to you? The more specific you can be, the better you and your doctor(s) are able to choose tactics to address the issue. As you assess your symptoms and treatment you will measure your progress against how well your target symptoms are being managed.
The Three Legs of Treatment
Treatment for ADHD is most effective when multiple approaches are used simultaneously. As the saying goes - 'pills don't teach skills' - and yet 'skills' are what you are seeking to improve when it comes to performing better at work and at home. The three-legged stool model of optimizing ADHD treatment can help you broaden your approaches and improve your outcomes:
Leg 1 – Changing the Physiology of Your Brain
ADHD starts with neurochemistry – so treatment does, too. The current thinking is that when you have ADHD you don’t have enough dopamine (as well as some other chemicals) in your brain. In addition, the chemistry and structure of your brain impacts anxiety, depression and your ability to plan and remember. So things that improve the chemistry ‘upstairs’ make a very real impact on the severity of your symptoms. Here are some of the things shown to help ADHD symptoms physiologically:
- ADHD medications
- Aerobic and multi-modal exercise (the latter are exercises that call on coordination, skill and aerobic capacity simultaneously)
- Adequate sleep (7.5 hours or more. Many with ADHD have sleep disorders – check with your doctor or a sleep specialist if you’re not sure)
- Fish oil (Omega 3s)
- Mindfulness training
- Perhaps estrogen replacement therapy for post-menopausal women
I want you look at this list – it turns out that you can do almost ALL of these things simultaneously. How many are you doing? If not many of them, then you have just discovered ways you might be able to improve your treatment.
Leg 2 – Improving Your Behaviors
With good treatment in Leg 1, most people with ADHD find symptom improvement – they might be more focused, able to think before acting (i.e. less impulsive), and feel less overwhelmed because they are getting adequate sleep. But being able to focus better is not the same thing as applying that focus in a way that helps them. So Leg 2 is all about taking symptom improvements and translating them in meaningful ways to improve your life. In other words, it’s about changing your behaviors and habits.
For many with ADHD, this means putting external structures in place that help them stay more organized, remember more easily, manage their time, and plan better. Some examples might include:
- Using your cell phone to record ideas as you think of them, then scheduling them into a reminder system such as a calendar each evening so you don’t forget
- Putting your alarm clock on the other side of the bedroom so you don’t hit “snooze” for an hour and get to work late
- Creating an organizational and filing system for your office so you don’t lose your bills (and putting a reminder in your calendar so you don’t forget to pay them!)
There are a large number of books that suggest specific tactics for improving how people with ADHD function in their daily lives. Two of my favorites include:
- ADD-Friendly Ways to Organize your Life by Judith Kolberg and Kathleen Nadeau
- More Attention, Less Deficit by Ari Tuckman
If you find you are still struggling with feeling overwhelmed by the everyday activities of life, chances are good that there are ADHD-friendly tactics out there that can help you, thus providing another way to improve your treatment. Most likely you’ll have the best luck with the tactics in Leg 2 if you are already including a wide variety of Leg 1 treatments in your regimen, because Leg 1 treatments allow you to focus more consistently on implementing Leg 2 treatments.
Leg 3 – Improving Your Interactions with Others
I work to help couples improve their relationships, so I have a bias, but to me you don’t improve your symptoms just to be more organized, even though that’s nice! You manage ADHD symptoms so that you can choose to spend happy time with those people (and projects) you care most about. So the third leg of the stool is about learning ADHD-friendly ways to interact with those around you that are healthy and productive. That way you (and those you love) can be happier. In this leg, treatment includes you and the others with whom you interact.
This is the leg that many with ADHD miss completely because traditional treatment plans typically focus just on the person with ADHD. However, learning how you and those you care about can interact better can make a huge difference in your life! There is so much upside for optimizing your treatment here…but understand, too, that your ability to do so depends heavily upon your success with legs 1 and 2 because some of the problems you are having interacting are directly related to how much focus you have, and your ability to be consistent and follow through on what you promise.
Treatments in Leg 3 include:
- Ways to communicate more clearly with partners of all types
- Balancing out the power and status in your primary partner relationship (i.e. making sure you are an equal to your partner and not in a parent/child dynamic)
- Ways to stop conversations that are escalating into an argument
- Coordinating better around everyday tasks in ways that relieve anxiety and stress and improve reliability
- Learning how to validate and support others, and be validated by your partner
- And, ultimately, clarifying your dreams and priorities and bringing your life into line with them
Let me give you some examples so you can see that though this leg might sound ‘heady’ or nebulous, it’s actually pretty practical. Here are some tactics in Leg 3:
- Setting a verbal cue that either you or your partner use when you start to feel yourselves moving into an argument. The cue gives you permission to take a time out, and to come back to the topic when you can constructively discuss the issue.
- Learning how to give a really good apology and acknowledge your partner’s point of view
- Using Leg 2 improvements to create a ‘new norm’ in the relationship – one in which a non-ADHD partner knows he/she can depend upon the ADHD partner to complete what they promise – then celebrating that norm
- Instituting a once-a-week coordination meeting in which both partners talk about what they are doing that week, which helps you stay coordinated and helps couples move away from patterns in which one spouse dictates to another what they must do, and when
- Creating specific times of the day to review homework with children when you aren’t too tired, lessening the chances you’ll lose your patience with them (or they with you!)
There are many more of these tactics, and a good place to find them is in my books or my couples seminar, which you can find at my website, ADHDmarriage. If you haven’t been thinking about your interactions as part of your treatment, then Leg 3 is another place where you can optimize your results.
Make a List
You can make a simple 3-column chart to help you understand how to improve your treatment. Put one leg per column, then write in each column what you are doing in each leg. If you aren’t aware of many tactics in Legs 2 and 3, do some research in the books I’ve recommended. Over time, the more activities you do that are ADHD-friendly and targeted to allaying your symptoms, the better you will succeed. Start in Leg 1, take one item at a time, make a plan for how to improve your skills against that item, then implement your plan.
Measure!
Your partner can help you assess the effectiveness of your treatment, as it’s not always easy to see the full effect. One man I know, for example, couldn’t feel the medication working, so assumed it wasn’t working, while his wife noticed very significant improvements in his ability to control his impulsivity.
Treatment Really Helps
Research suggests that treatment that includes medication can make a huge, huge difference in how ADHD adults perform – significantly improving their symptomatic behaviors 65-95% of the time. This makes ADHD one of the singly most treatable issues in the field of mental health.
If you’re not taking your treatment seriously, or not seeing the results you would like to see, perhaps it’s time to try this three-legged approach.
