ADHD and Procrastination (again)

Again this week 3 or 4 patients coming to see me are visiting my office because of problems with procrastination relating to ADHD. Attention Deficit Hyperactivity Disorder (ADHD or sometimes called ADD) is a neurological disorder, and executive disfunction, that effects not only our ability to focus, stay on-task, concentrate, plan and follow through, but also effects our ability to get started - we procrastinate and out things off. And this is one of the most disturbing aspects of ADHD. 

Dr. Russell Barkley, a leader in the field of ADHD says this about executive dysfunction and ADHD: ""In ADHD, if the information that is suppose to be generated by executive functions is being generated at all, it appears to be extraordinarily weak in controlling and sustaining behaviour towards the further..." We seem to get stuck in the here and now and can't ...well move forward.

What Dr. Barkley says about treating this aspect of ADHD is that, "clinicians treating those with ADHD must beat the environment at it's own game. They must put into the immediate context the sorts of cues, prompts, physical reminders, and other captivating information that will guide behaviour towards the intended goal."

That's a very fancy way to say that you need to develop prompts and cues that help you move from one state of mind (maybe watching TV or lying in bed) and move to the next (getting up and taking a shower, or getting out the door to get in the car and get to work.).  That means alarms, signs, signal and prompts. But it isn't as easy as it sounds.

Two things inter fear with just setting up a system of prompts and cues and moving forward. They include  anxiety and ...the lack of reinforcers for engaging in the behaviours you want to be doing.

One of the dangerous things about procrastination is that it is "self reinforcing." If I have to work on a task, go do something I don't particular want to do, to avoid it wait a few minutes before I do it, is rewarding - reinforcing. For that few moments the anxiety associated with the task is gone. I need to get to the office ....but I wait. When I first thought about going to the office I had some anxiety -about what I'm going to do there, getting there on time, maybe about my ability to get there ...since I procrastinate and avoid so much. Just the thought of going to work is a negative experience. And avoiding it makes me feel good, immediately ....if only a little bit. For those of use who understand behaviourism we know an IMMEDIATE reformer is VERY powerful, even if small and short lived. So, avoiding and procrastinating in itself reinforces the behaviour of procrastinating. You may have had one or two things you were avoiding and this reinforcement was very strong. Then avoiding itself started being reinforcing and spread through everything. Now avoiding is your preferred way of dealing with things.

The second issue is reinforcement. A simple rule of behaviour is this: Anything we do that is reinforcing we will do more often, for longer periods and with more intensity. Things that are not reinforcing, we do less often. As adults, the plain and hard truth in life is this: When you stop procrastinating and actually get things done...your more likely going to be rewarded with more hard work. More things to do. Not very reinforcing, is it?

Both of these issues need to be addressed through understanding them, applying your understanding to the situation, and changing the environment so getting things done IS reinforcing rather than the opposite. Through coaching and planning we can usually find ways to do this. Setting up a variable schedule where work completed (non-preferred tasks) are followed by preferred tasks (and remember, the reinforcement or reward can be small...but needs to be immediate). We can use check lists, visual schedules, there are all sorts of things we can do to help with this depending upon the situation.

Now one step back: While all this is going on with procrastination we also have the issue of needing to increase the environmental prompts and cues to help you "switch mental sets" and move from one task to another. SIMPLE visual, auditory and other types of prompts help. and setting things up so that small initial changes are rewarded and reinforced, two, three...before we get to bigger changes.

So, ADHD and procrastination may be difficult to deal with, but there are things we can do.  Understanding the nature of the disorder is critical, and a good deal of the time I spend with clients is spent explaining how the brain works ...and how ADHD effects the brain. Knowledge is the first step towards health.  Often CBT is also recommended for clients with ADHD, this is because we have been worn down by failed attempts to control these behaviours caused by ADHD. And friends, relatives and work mates often turn ADHD symptoms into what they think are signs of your personality. Often they turn this into a moral or ethical issue. "If you would just put more effort in to this!" Well, ADHD is a complicated disorder, and more effort doesn't necessarily lead to success. Understand and ADHD specific interventions are what help. CBT (Cognitive Behavioural Therapy) helps individuals with the issues of inappropriate and negative thinking that comes from repeated exposure to failure. CBT is a critical part of dealing with ADHD.

For more information on ADHD (ADD) and procrastination, along with help in making an ADHD diagnosis, ADHD (ADD) coaching in Vancouver or Burnaby, please visit my website at or call me directly to set up an appointment. There are also a number of science based self help books on ADHD listed on my web page.

This blog is not meant as treatment or diagnosis. For treatment and diagnosis please see a registered or licensed professional in your community. Both medical doctors and registered psychologists can diagnosis and treat ADHD (ADD or Attention Deficit Hyperactivity Disorder).
KEYWORDS:  ADD, ADHD, Attention Deficit Hyperactivity Disorder, ADHD coaching Vancouver, ADHD coaching, Burnaby, ADHD coaching Coquitlam, ADHD coaching New Westminster, psychologist, diagnosis, treatment, procrastination, executive disorder, psychoeducational assessment, psychological testing