Procrastination and Adult ADHD (Attention Deficit Hyperactivity Disorder)

Procrastination is the number one or two on the issue list when people come see me for either a diagnosis or treatment of Attention Deficit Hyperactivity Disorder (ADD or ADHD). Here are some basic facts about procrastination, along with some suggestions and reading material:

First, about 10% of school children are diagnosed with ADHD. While a lot of people think we over diagnose here in Canada research (Barkley) shows we actually are more likely under diagnosing ADHD. Plus, honestly, there is a bit of misdiagnosis, ADHD being diagnosed as something else, and something else being diagnosed as ADHD.

Of those children Young (2007) says that 40-70% continue to struggle with the symptoms in adulthood. Other reports, such as Ferrari and Sanders (2006) find that about 4-5% of adults report the chronic condition of ADHD. These symptoms often lead to adults being misunderstood and labeled as "lazy" or "malingering."

Recently there has been more and more research on the relationship between procrastination and ADHD. In Joseph Ferrari and Sarah Sander's research it is clear that there is a higher level of in "decisional procrastination and other behavioural procrastination." Well, my patients don't need to be told this, but it is important to know that the research supports what many of us think and feel from our observations and personal experiences.

So, what's causing this procrastination. There can be several causes: First, there is a problem with ADHD itself. The frontal lobes of the brain, the executive area, isn't functioning up to task. Individuals with ADHD have difficulty moving from one task to another, stopping one thing, and starting something new. In neuropsychological terms we call this "switching mental sets." Another issue may be motivation: Individuals with ADHD are simply not motivated by cues and prompts in the environment that might tell them to move on, get going and start a new task. They are often not motivated by the task itself, at least not to the degree others are. If you don't have positive experience engaging in activities, completing them and being reinforced for completing tasks successfully....you will not be motivated like others around you to do that. And, on top of this is often the issue of focus, attention and emotional control. ALL issues of the frontal lobes or executive areas of the brain. Understanding all of this, and understanding your own profile, is critical to getting started on doing something about procrastination. This is usually an issue we look closely at during a neuropsychological exam completed as part of the ADHD diagnosis.

One thing I didn't mention but can't be forgotten: Memory. Short term, long term, active memory. Often people think they "procrastinate" but their real problem is one of focus, attention, memory. These are deficits you can discuss with your medical doctor and perhaps make choices about including medication and treatment. Or you can procrastinate and avoid them.

And that's another critical issue about procrastination. What behaviours do you think we engage in more often than others? Well, behaviours we find reinforcing, behaviours that are reinforced by the environment, ourselves, others. And putting something off, even for a moment, is VERY reinforcing. Procrastination is a behaviour that easily becomes entrenched because it has within it the ability to automatically and immediately reinforce itself. When you procrastinate you feel good, if only for a moment. If you put something off, right at the moment you put it off you reinforce "putting things off." And regretfully, the moment you think about doing it, engage in the task, you are taught not to because it's anything but reinforcing. Usually it's anxiety producing, which is something that reinforces putting it off again.

What can you do about this? Well, behavioural therapy helps. Basically clear prompts and cues, and what we call exposure therapy, along with Cognitive Behaviour Therapy to deal with our deep inner nearly subconscious thoughts about avoiding. CBT has been found very effective in dealing with this troubling aspect of procrastination and ADHD.

One of the tools I often use in my practice is a workbook by Safren, Sprich Perlman and Otto called "Mastering Your Adult ADHD: A Cognitive Behavioral Treatment Program." This workbook addresses procrastination directly. They looks at your strategies for dealing with issues of planning and organization; managing distractability; improving adaptive thinking (that switching mental sets thing); and then directly address the attractiveness of procrastination (and I've pointed out above, it is attractive and self-reinforcing) as well as the consequences of procrastination. They engage you in exercises to work cognitively on changing how you see procrastination, teach you how to use adaptive thinking and problem solving to directly address procrastination; have you keep thought records to understand your "automatic thoughts" and address, in an ongoing manner, the thoughts you might be having that reinforce procrastination and develop a plan for addressing these thoughts when they occur.

In addition to approaching procrastination and ADHD from a Cognitive Behavioural perspective I also include training and coaching in making environmental changes that include external (outside your head) prompts and visual cues to help you get started and switch tasks, and teach you to estimate task length and effort needed. Nothing is more important than setting up tasks you WILL succeed at. Visual prompts and cues help you remember, and finally, keeping a record of your successes and areas of continuing difficulty.

Dealing with procrastination means a multi-faceted approach to the problem.Procrastination, for those with ADHD, does occur as an isolated problem. It occurs as a result of years of negative experiences and reinforcement of poor adaptive choices that may have once worked, but no longer due.

We have tools to help you address procrastination within the spectrum of deficits we find in Attention Deficit Hyperactivity Disorder. The above book by SDafren (Mastering Your Adult ADHD) is a really good place to start. A second recommended reading is Russell Barkley's "Taking Charge of Adult ADHD." This book is full of the latest science based information and interventions for adults with ADHD. You can find these books and others through my own website at www.adhdhelp.ca

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I remind you again that this blog is not meant to provide a diagnosis of ADHD or any other disorder. I advise against on-line "tests" as they often only list symptoms of a specific disorder, and don't take into account the many other causes that may exist for the issues you are concerned with. See you doctor. A medical doctor can usually diagnose ADHD here in Canada, as can a psychologist. A registered Psychologist will usually be able to provide a diagnosis along with other neuropsychological assessment tools to help you fully understand the exact nature of your problems. You can locate a psychologist near you through the web site of the British Columbia Psychological Association. I provide diagnostic services for children, adolescents and adults in both my Burnaby and Vancouver offices. More information about my services can be found at my website at www.relatedminds.com