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ADHD & Habits: You Struggle to Establish Them, You Can't Live Without Them
Author(s): J. Russell Ramsay, Jeff Copper
Topic(s): Adults, Behavior Problems, Habits, Living with ADHD, Routines, Self Management, Self Regulation
Summary: You struggle to establish them, you can’t live without them. Why are they important to adults with ADHD?
Views:Issue: February 2016

 

ADHD & Habits: You Struggle to Establish Them, You Can't Live Without Them

 

by J. Russell Ramsay, PhD, and Jeff Copper, PCAC, PCCC, MBA

 

YOU SIT DOWN AT YOUR COMPUTER on your first day back to work a€fter a restful two-week vacation. As you go to enter the passcode to unlock the computer, your hands stop dead above the keyboard. You’ve drawn a blank as to the combination of letters, numbers, and characters your fingers had flawlessly and mechanically tapped out countless times each day for months at a time only a few days ago. Attempts at logically reconstructing the passcode are unsuccessful. As you start to busy yourself with other tasks around your desk, the passcode suddenly appears and settles in your mind, and you are back in business.

Habits and routines are tricky things. "The example above is imperfect because memory is an essential aspect of the routine involved in remembering a passcode, which was needed to carry out the routine of accessing the computer. Nonetheless, fiddling around the desk likely provided reminders of your typical work routine that triggered your memory of the right code. "Think about what happens if you are forced to change your passcode every few months. "The first week a€er the change you are prone to instinctively enter the old passcode, even as you recognize that it is no longer valid. It has become a habit.

Managing the effects of adult ADHD
"This is an important topic, because habits and routines are a means for managing the effects of adult ADHD in daily life, which requires consistent, active coping. By definition, habits are characterized by a sequence of behaviors, a routine that is reliably carried out. Once established, routines are efficient insofar as they are executed in an instinctive, predictable fashion.

Forming a routine, particularly one that you “want” to do, is the job of cortical regions of the brain, where higher ordered thinking occurs. As a desired behavioral sequence is defined and honed, the cortical regions of the brain hand it over to the basal ganglia, which is located in the deeper recesses of the brain near the brain stem, which is the region overseeing automatic functions, such as breathing. "is automaticity allows the brain to conserve energy for other functions. So, you can perform practices such as showering and dressing in the morning, driving your typical route to and from work, and entering your computer passcode, with minimal effort or thought.

"Throw a monkey wrench into a routine—such as no water in the shower or unexpected construction forcing you to figure out an alternate route to work—will activate the regions of the brain that take charge of the conscious, effortful planning and problem solving, which consume more cognitive energy.

Why is it important for adults with ADHD to pay attention to habits? "The aforementioned processes affect everyone, but are even more pertinent for adults with ADHD and efforts to manage their day-to-day lives more effectively. Here are some important takeaway points to help you recognize and modify habits.

● ADHD makes it more difficult (but not impossible) to establish desired habits and routines.
More and more, ADHD is understood as a problem related to self-regulation or, said differently, getting yourself to do the things that you know you need to do and want to do, but still o€ften do not do. Problems related to executive functioning, such as time management, organization, and impulsivity make it difficult to set up a routine. Even when you have a plan, such as an exercise routine or times for reviewing your daily planner, when it comes time to implement the plan you get distracted, impulsively jump to another task, or face lack of motivation in the moment. It requires an investment of effort to set up a desired routine. It is not just the actual habit itself, but also defining the cues or prompts for starting and then having an adequate reward for completion.

● ADHD makes it more difficult (but not impossible) to replace undesired habits and routines.
“Bad” habits are maintained by the same processes as “good” habits. "There will be cues or factors that prime you to engage in a certain routine. "The routine is rewarding on some level, at least in the short term, if not the long term. To paraphrase a saying in sports when a team faces an opponent with a star player: “You can’t stop bad habits; you can only hope to contain them.” You may not be able to totally extinguish bad habits, but you can replace them with good habits, use stimulus control to reduce temptation (such as, do not have candy in the house), and maybe (in some cases) turn “bad” habits into “good” rewards, such as rewarding exercise with time on social media aft€erwards.

● There are things you can do to establish and/or change habits.
"The self-dysregulation view of ADHD means that it is a performance problem and not a knowledge problem. "That is, you know that it is good to get a little exercise each day and you know that a 30-minute walk around your neighborhood aft€er dinner is reasonable and doable, but every night there is another distraction that thwarts the plan. Implementation strategies that help children with ADHD follow through on homework and other tasks have been adapted for adults with ADHD. It takes an investment of effortful coping to define specific times, specific locations, and specific steps to carry out the desired routine, including scripts for getting ready, such as “If immediately a€fter dinner I put on sneakers and get my iPod, then I will walk around the block at least once.” "The more specific and fitting the implementation plan, the more likely you are to start it. And, as we all know, “Once I get started…”

Behavior change is not easy, particularly for adults with ADHD. Treatment with medication reduces symptoms that interfere with follow through. Many effective behavioral strategies and tactics are outlined in books on psychosocial treatment for adult ADHD. Consider this article your cue for exploring a new routine you can implement and we trust that you will gain a reward on the other side.


J. Russell Ramsay, PhD, is associate professor of clinical psychology in the University of Pennsylvania Perelman School of Medicine. He is codirector and cofounder of PENN’s Adult ADHD Treatment and Research Program. He is coauthor of Cognitive-Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach (2nd Ed.) and The Adult ADHD Tool Kit: Using CBT to Facilitate Coping Inside and Out (both Routledge, 2015).

Jeff Copper, PCAC, PCCC, MBA, is an ADHD coach at DIG Coaching Practice, where he specializes in coaching adult individuals and entrepreneurs who have been diagnosed with ADHD later in life. He is the host of Attention Talk Radio and Attention Talk Video. Learn more at digcoaching.com.


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