Of all the interventions I have used with my clients with ADHD, the Pomorodo Technique is hands-down the most effective for productivity. You can make all the todo lists in the world, and if you can't ever get started on any of the tasks, you've gotten nowhere. Pomodoro means tomato in Italian. It's a popular shape for kitchen timers. The Pomodoro Technique asks you to pick an important task and to commit to 25 uninterrupted minutes of working on that task. After you've worked for 25 minutes, you get a 5 minute break that you have to take. That's basically it. If you'd like to read more, check out The Pomodoro Technique. 

It doesn't sound very sophisticated, and in a way, it's not, but it's tamed the Getting Started monster better than anything else I've ever encountered. Individuals with ADHD are notoriously bad a self-regulation. This means that we have trouble directing activity toward getting started. We have trouble staying on task, and we forget to take breaks in order to take care of basic needs like drinking water, resting our eyes, going to the bathroom, having a snack, and stretching our legs. We are also bad at estimating the amount of time tasks take. Specifically, we tend to UNDERestimate that time. Pomodoro teacher us about the REAL time tasks take. 

Pick a task, start the timer, and THEN gather all the things you need to begin the task. You may learn that gathering materials actually takes most of the first Pomodoro. If you purchase an app like Focus Time, you can label what you do in each pomodoro time block, and over time, you can look at the history of your focused work. 

If you are wondering which Pomodoro app is best, don't overthink things. All you really need is a timer. Anything that visually shows you the countdown is good. There are many free options in both the Apple and Android markets. 

Essay exam items often contain several related questions. In order to receive full credit for your response, it is generally expected that you respond to all of the smaller questions that were asked. Using a Google search for “essay exams,” I found the following exam question:

What is the role of language and speech in the study of religion by outsiders, and also in the expression of spirituality by members of a religion especially as they try to define God, and their relationship to God? What different types of language, speech and sound have we encountered in  the study of religion and why is each of them both problematic and also indispensable to the Hindu religious community? Are different kinds of speech, language and sound used in different contexts, if so, why?

My approach to this question (or questions) is to break this into as many subquestions as I can. I’m going for maximum points, so I don’t want to miss anything. My first approach is to break this down at every point I see a question mark:

1. What is the role of language and speech in the study of religion by outsiders, and also in the expression of spirituality by members of a religion especially as they try to define God, and their relationship to God?
2. What different types of language, speech and sound have we encountered in  the study of religion and why is each of them both problematic and also indispensable to the Hindu religious community?
3. Are different kinds of speech, language and sound used in different contexts, if so, why?

This gives me three questions to answer. If I answer each of these, I will likely do well on the test, but here’s the thing... individuals diagnosed with ADHD often have weak working memory. That means that all the little subtleties and threads that are included in each question may get lost. For example, for question #1, they may get the “role of language and speech in the study of religion by outsiders part” but write long enough that they forget their role in “the expression of spirituality...” part. So I suggest breaking this down as much as you can. I find that it is helpful to rewrite the stem of the question for each part of the sentence. Like this:

1. What is the role of language and speech in the study of religion by outsiders?
2. What is the role of language and speech in the expression of spirituality by members of a religion as they try to define God, and their relationship to God?
3. What different types of language, speech and sound have we encountered in the study of religion?
4. Why are language, speech and sound problematic for the Hindu religious community?
5. Why are language, speech and sound indispensable to the Hindu religious community?
6. Are different kinds of speech, language and sound used in different contexts, if so, why? (Since there’s an “if so, why,” I can already predict the answer is yes, even though I know nothing about this topic.)
7. Why are different kinds of speech, language and sound used in different contexts?

If you wanted to, you could break this down much further by separating out the language and speech parts of the sentences. For, example, “What is the role of language and speech in the study of religion by outsiders?” could become two sentences. “What is the role of language in the study of religion by outsiders?” and “What is the role of speech in the study of religion by outsiders?” This might be overkill, but again, I’m going for maximum points because I want a good grade, so I want to be SURE I don’t skip anything.

I prefer using a table to make sure that I have answered every single part of the question. 

If this is a take home test, I would literally make this table and answer every question first. In graduate school, I actually turned in tables like this and was told by professors how easy it was to grade my exam, since the answers were all so clear. On the other hand, you might want to put this back into a long narrative paragraph. This is your decision based on your preferences and your predictions about the professor/instructor who is teaching the class. 

If you are taking this test in class, I use your pen or pencil to draw a dark line after each question mark, then underline any lists that are there. For example:

What is the role of language and speech in the study of religion by outsiders, and also in the expression of spirituality by members of a religion especially as they try to define God, and their relationship to God?

Even scribbling down very short answers to each part of the question ensures you won’t miss a single detail when you go back to write your long essay. 

Good luck!

An Individualized Education Plan (IEP) is a document created by a team for a child as part of Special Education Services. With an IEP, it is assumed that the child requires specialized instruction in order to function at grade level. This often means time outside of the regular classroom with support staff who have special training. 

The decision to use a 504 Plan implies that the child is able to function in a regular classroom setting, but they may need accommodations in order to succeed. A 504 Plan is not part of Special Education. In public schools, there is something called a Least Restrictive Environment (LRE), which means we want kids to remain in the general education classroom unless they really can't function there, so in the public schools, teachers and administrators work hard to find ways to help children succeed in those regular classrooms so they have access to the same curricular content as everyone else. Lots of things can get in the way of academic success. 504 plans remove some of those barriers. 

If a child has been on a 504 plan (as many children diagnosed with ADHD are), and the accommodations are not helping a child reach their academic goals, teachers or parents may revisit the question of Special Education, but in most cases, the 504 Plan is sufficient. This 504 plan is a document that will follow the student from year to year, classroom to classroom. It formalizes the use of accommodations and interventions that tend to work with this child. This is a good thing. It means it's not necessary to reinvent the wheel every year, and it will save your child from experiencing frustration with new teachers who may not pick up on what your child needs quickly at the beginning of the school year. 

If you would like more details, I recommend this article on LD Online: Understanding the Differences Between IDEA and Section 504

I never thought I'd say this, but I'm playing a game with some of my clients, and it's one of the most effective treatments I've ever encountered! I love TED Talks. If you don't know what these are, I highly recommend checking them out. TED stands for Technology, Entertainment, and Design. The TED conference invites individuals at the top of their fields to discuss whatever ideas are most exciting to them. Topics range from Neuroscience to Play to Fitness to anything you can dream up. Basically, it's smart people talking about new ideas. Watching TED Talks gives you extra IQ points. Promise!

Recently, I noticed many friends posting this TED Talk by game designed Jane McGonigal. In short, she got a concussion, it didn't heal well, and she was told that she was to spend a month without all the things she loved: reading, running, gaming, driving, using the computer, etc. When you watch the talk, you'll see that she is a very colorful, vivacious, and ALIVE person. This prescription - to basically do nothing for a month - had Jane down in the dumps, so far that she felt suicidal.

She came up with the idea to make getting better into a game. She created a secret identity for herself: "Jane the Concussion Slayer." She enlisted allies to support her. She identified bad guys (bright lights, crowded spaces). She came up with power ups to feel a little better (call a friend, pet her dog), and she created quests: things that were difficult but made her feel better when she actually did them. Her "epic win" was feeling emotionally better even if her pain was still there. The result? It worked! Her head hurt. She couldn't do what she wanted to do (go online, go running), but she could feel better during this difficult time.

There's a lot more to the talk than that. She talks about regrets of the dying, post-traumatic growth, and the four areas of resilience. There's so much in the talk. I HIGHLY recommend watching it. 

Here's the fun part. She turned her game into a game everyone can play. She calls it SuperBetter, and I'm playing it. It's mostly an online thing, but it's also an iPhone app. I have identified some personal and professional goals to work on. The big picture goals are called my "Epic Wins." And I make up quests, power ups, bad guys, etc. I have found allies, both people I knew before and people I've met on the SuperBetter forum. In short, I'm turning my big goals into something I'm really working on, but since it's in a game, it's FUN! I get points and my phone makes little dingy noises. I love it! One of my Epic Wins is writing my psych reports faster, and this game has actually made reaching that goal a fun thing. This is HUGE!

I decided to show this talk to a few choice clients, and one has REALLY taken to it. This client has installed some PowerPacks that are available on the site (related to battling Anxiety), and I am this client's ally. This client is a techie and does very well with structure, so it's PERFECT! It's not for everyone though. One younger client had NO interest at all, but it did lead to an interesting discussion about other issues.

This blog is often dormant, but when something this cool comes along, I feel I must share. Happy getting SuperBetter, whether your goals are big (recovering after heart surgery) or small (lose 5 lbs)!

Nikki Kinzer interviews Pete Wright about the powerful features of Evernote. If you aren't using it, you should. One bit of advice I give to all my clients with ADHD is, "Never trust your memory. Instead, have a failsafe plan for remembering things, because if you don't have a plan to remember, you can assume you'll forget." Evernote's tagline is "Remember everything," and its ability to help users do just that is why I see Evernote as an indispensable tool for individuals diagnosed with ADHD. Please take a listen to enthusiastic Pete Wright describe all of Evernote's "magical" qualities.


Take Control Podcast, Episode 71: The Wonders of Evernote

While many psychologists write blog posts about feelings or internal challenges, I find that I am mostly motivated to blog about the common practical issues that many of my clients face. Since I am a Blue Cross Blue Shield of North Carolina provider, a large percentage of my clients use this insurance. BCBC-NC uses Medco to manage their members’ prescription drug benefits. Getting prescriptions filled regularly can be quite a hassle and difficult to stay on top of.

For clients taking prescriptions to treat AD/HD, Depression, or Anxiety, skipping doses or taking medication sporadically can have negative effects on treatment outcomes – in other words, it means that you’re not going to progress in the ways that you’d like. Usually there are a lot of ups and downs and trials that happen BEFORE the decision to start medication has begun. Once the prescription has been given to you by your doc, my short message to you is TAKE IT!

It’s not always easy, and I’ve found out some ways that getting that sucker filled can be much less of a hassle. Medco has a website (www.medcohealth.com) that is available to most holders of BCBS-NC where they can conduct a variety of pharmacy benefit transactions including online access to their mail order pharmacy. You just have to check your insurance cards. Look for "PAID BNCDRUG."

What is VERY cool about this site is that once you are logged in for the first time, you will see all of the prescriptions that you have been filling at your local (real world) pharmacy, and with a few clicks, you can transfer ALL of those prescriptions to the Medco pharmacy.

Yes, there is some initial paperwork involved. For certain medications (like the stimulants prescribed for AD/HD), it will be necessary for you to fax a driver’s license, and it will be necessary for your doctor to mail in a paper prescription. You’ll also have to mail in a form. Yes, it’s a pain, but it’s a necessary evil. But here’s the beautiful part: Once you’ve gone through this hassle, they will ship you three months of your prescription at a time! One hassle for THREE months, not the usual one.

For those of you diagnosed with AD/HD holding BCBS-NC insurance, this will be a HUGE relief, because that monthly obstacle course of calling the doctor, getting the call back that the script it ready, driving to the doctor’s office, picking up the script, driving to the pharmacy, waiting for it to be filled… that’s fraught with potential derailment. And it’s often the case that people with AD/HD don’t make it all the way through. For those of you taking other less protected psychoactive medications (SSRIs, antidepressants), the hurdles aren’t as tricky.

A few tips:

• Start by going to http://medcohealth.com
• Under the login fields, you’ll see First time user, then after that click on “Click here to register.”
• Fill out the info in the light yellow boxes called: (1) Tell us about yourself, (2) Tell us about your Medco member information (your Member number / subscriber ID is your BCBS “Subscriber ID”), and (3) Provide your e-mail address and create a password.
• Click “Register Now.”
• If you get stuck, there is a number on the back of your insurance card called Pharmicist Help Desk. They should be able to help you.

THIS IS WORTH YOUR TIME!

Getting started is one of the most difficult things in the world. Of course, I could add “for individuals diagnosed with ADHD,” but let’s face it: getting started on projects isn’t really easy for anyone. There are so many reasons it can be hard

1.       The task ahead is unclear. You may have this vague idea that you need to “get yourself organized” or “clean the house,” but these aren’t very specific tasks. They are too broad for you to have much of an idea of how to get started. In these instances, you need to scale things back and come up with something much more specific like: put away all the shoes sitting around the house or put a small spiral notebook and a pen in the kitchen to use for making a grocery list as needed items come up.

2.       The motivation for the task is low. Do you actually care about this task? Have you set yourself a goal to do something that you THINK you should be doing, but you don’t really want to do it? Is this something your parents or your partner think is important, but you really don’t care about? If you have no internal motivation, everything else will seem like more fun than getting started on this task.

3.       Unidentified Fear and Anxiety. Maybe you’re telling yourself you have no fears about getting started, but if you’ve been avoiding doing something for weeks and weeks, perhaps there really is something about the task that you are afraid of. Maybe you’ve been putting off scheduling that appointment at the dermatologist because skin cancer runs in your family, and thinking about picking up the phone call makes you start to feel fearful about bad news you might hear. I don’t have to tell you that you might be wrong about your fear and that you might be right, and that there’s no way you’ll know until you make the appointment and go. One thing I have noticed, though, is that once clients recognize that maybe it is their fear getting in their way, they are oftentimes willing to pick up the phone and make the call.

4.       The task or goal isn’t really that important right now. Sure starting a diet or an exercise program is important, but if it’s the middle of tax season or you have a close relative who needs your support, or things are busy at work, it might be a reasonable decision to delay “doing it all” until such time that things in your life are a bit less hectic. That doesn’t make you a loser. That makes you human. Forgive yourself, and pare down your list to essentials until a better time.

5.       Perfectionism. You think you have to do things perfectly in order to check them off the list. NOT SO! You can delegate, ask for help, delay until a better time, do a “good enough” job. Sometimes getting something done adequately is all that is needed. In real life, many things are pass/fail. A+’s aren’t all that important after high school. Remember that perfectionism creates stress and worry, it inhibits creativity and risk-taking, it usually leads to procrastination, and it is generally no fun to be around (since perfectionists are generally stressed-out and demanding).

When you are having trouble getting started on a task, review your tasks and your personal barriers to getting started. I do this all the time with my clients as well as for myself, and I so often find that the goals I have set or my expectations of myself are unrealistic and need to be tweaked.

There's a nice little freebie in the iTunes app store this month. Flashcard Touch is designed for students. There are a number of pre-existing flashcard sets, but you can add your own as well. If you happen upon this post after the month of March (2010) has past, do not fear, the app is still an affordable one. Having your flashcards at the ready is crucial to actually studying them. This seems obvious, but if you increase the chances of having your study materials with you, you increase your chances of success.

Open in iTunes

Some children are born with the ability to wait patiently. Others (me included) aren't as lucky. The good news is that researchers say that waiting is a skill that can be taught. The further good news is that teaching the skill of waiting is one that has far-reaching positive effects. For more details about the Stanford study that began in the 1960s, take a look at Don't: The Secret of Self-Control by Jonah Lehrer (New Yorker, 5/09).

In short, according to Eat Me, Daily: the ones who passed the marshmallow test enjoyed greater success as adults. Said Walter Mischel, the Stanford professor of psychology in charge of the experiment, "What we’re really measuring with the marshmallows isn’t will power or self-control... It’s much more important than that. This task forces kids to find a way to make the situation work for them. They want the second marshmallow, but how can they get it? We can’t control the world, but we can control how we think about it.”

Helping to put things into perspective (how we think about the world) and accepting the brain's and levels of control we are born with is the kind of work I find myself doing the most. Learning about the marshmallow experiment got me thinking a lot about my clients, their struggles, and the kinds of things we work on together. The waiting isn't easy. Many things aren't, but they can be learned. To that end, I present to you some Tom Petty to get you going.