Practical Strategies to Overcome Executive Function Weaknesses

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Practical Strategies to Overcome Executive
Function Weaknesses

• Ari Tuckman, PsyD, MBA
• West Chester, PA
• Ari_at_TuckmanPsych.com
• www.TuckmanPsych.com
• [phone]

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We Live in a Complicated World

• The challenge is to do the right thing, at the
  right time, most of the time.
• Need to filter out extraneous stimuli and
  thoughts and figure out what is most important in
  that moment.
• Need to consider the past, present, and future.
• The most important isnt always the stickiest.

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Knowing is Easier than Doing

• ADHD is a disorder of actualizing good
  intentions.
• People with ADHD usually know what the right
  thing to do is, but dont do it consistently.
• Guilt-inducing lectures are rarely helpful.

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Executive Functions

• Highest level cognitive processes that help us
  create a better future.
• Tend to be subconscious, but we can become aware
  of them.
• Young children speak them out loud before
  internalizing them.

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E.F.s Explain it All

• Why people with ADHD have certain strugglesand
  dont have others.
• Why certain strategies workand why others dont.
• Why certain treatments are effectiveand why
  others arent.
• Why your past looked the way that it didand why
  your future can be better.

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Others Fill the Void

• Because people with ADHD have these difficulties,
  others step in to help them out.
• This is more acceptable for kids than adults.
• May also use tools (PDAs, alarms, etc.) to do
  some of the executive functioning.

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Response Inhibition It Starts with Stopping
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Three Places to Inhibit a Response

• Hold back a response to a new stimulus
• Interrupt an ongoing response to re-evaluate next
  steps
• Freedom from distractibility from outside events
• Gives the EFs a space to work.

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Executive Functioning Deficits in ADHD
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Working Memory

• Working memory is the brains RAMin the moment
  storage and processing.
• Blinky working memory creates complex information
  processing problems downstream.
• The immediate is stronger than the distant.

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Working Memory Solutions

• Do it right away.
• Reduce distractions.
• Set reminders.
• Write things down.

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Prospective Memory

• Remembering to remember.
• Becomes increasingly important as we become
  adults.
• Good intentions often falter here.

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Prospective Memory Solutions

• Set reminders and alarms, write notes, etc.
• Get in the habit of using a plannerPDAs beep at
  you.
• Ask for reminders, when appropriate.

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Sense of Time

• Time is very fluid for ADHD folksboring tasks
  take forever, interesting take no time.
• Have difficulty with tracking their position
  through the passage of time and planning
  accordingly, so they often get burned.

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Sense of Time Solutions

• Put up a bunch of clocks to keep you aware of the
  time.
• Wear a watch that beeps regularly to make you
  aware of time passing.
• Set alarms (cheap kitchen timers are great).

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Activation Persistence

• ADHD folks are often poor at self-activating or
  persisting on boring tasks.
• Persisting at enjoyable tasks is like riding a
  bicycle downhilleasy.
• Procrastinationthe pressure of the last minute
  is activating.

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Activation Persistence Solutions

• Create mini-deadlines to get going earlier.
• Keep in mind the rewards for finishing something.
• Bite the bullet. . .

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Hindsight Forethought

• Hindsightusing lessons from the past to guide
  behavior in the present (wisdom).
• Foresightusing projected future consequences to
  guide behavior in the present.
• People with ADHD can do this in theory, but less
  well in the moment.
• Dont stop and think things through.

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Hindsight Forethought Solutions

• Force yourself to plan ahead, consider your
  options, and think about what is required.
• Create a schedule.
• Write out complex plans.
• Talk through your plans with others to fill in
  gaps.
• Look at how youre doing occasionally.
• Afterwards, reflect upon lessons learned.

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Integrative Treatment Model

• Education to reduce blame and increase likelihood
  of success with better strategies.
• Medication to improve response inhibition and
  thereby reduce symptoms.
• Coaching to develop better habits to create
  successes and build feeling of competence.
• Psychotherapy to address effect of ADHD on
  self-image and sense of effectiveness.

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Book for Clinicians

• it is a real pleasure to read Tuckman's
  superbly rendered book on ADHD in adults, for it
  is so well-reasoned, science-based,
  information-rich, to the point, and
  finallyuseful! Apart from wishing I had written
  it, I sincerely wish that you will read it.
• Russell A. Barkley, Ph.D.

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Free Podcast Handouts

• adultADHDbook.com
• Weekly podcast
• PDFs of coping strategies for various challenges

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New Book!

• Written in a clear and easy-to-understand style,
  the book brings together a vast amount of
  information, ideas, suggestions, and research.
  All adults with ADHD can benefit from this book,
  as well as all people who care about them.
   Superb!
• Ned Hallowell, M.D.