ADHD : Living Without Brakes – Martin L. Kutscher
I had real trouble forcing myself to sit down and start to write this articlee. I had even greater difficulty forcing myself to stick at it. However, once I had overcome the latter problem I eased my way into things and started to write quite effectively!
One of my real difficulties at work has always been focusing on something. As someone with Asperger syndrome, (AS), I have never been a very good “starter-finisher”: I tend to start something, do it for a while, and then move onto something else before returning. The net effect is that I waste time on switching between tasks, rather than, completing them. My productivity suffers as a result.
Much of the problem revolves concentration; or more pertinently, an inability to concentrate for extended periods. Consequently, I have always been interested in reading anything about ADHD – or Attention Deficit Hyperactivity Disorder.
ADHD: Living Without Brakes by Martin Kutscher is a terrific book. It explains the subject simply and clearly and makes some practical suggestions as to how ADHD can be addressed and improvements made. Most are applicable for a manager with AS and relevant in a work-based context.
The general consensus is that ADHD consists of three key variables: inattention, impulsivity and hyperactivity. However, according to Kutscher, it involves a wider “range of executive dysfunctions” including poor self-control, anxiety and conduct disorders.
From the perspective of having Asperger, this resonates with the view that it [AS] can consist – or not – of a number of different variables. Most commentators I have read seem to believe, however, that ADHD is invariably present.
As the author goes on to state, all humans need to modulate their behaviour by utilising executive functions like inhibition (putting a brake on distracting activities), initiation, (the skill of actually getting started), and procrastination (inhibiting all other activities to get down to work).
Five of the nine criteria for inattention in ADHD are organizational: flexibility – altering plans in mid-stream as circumstances change; shifting between agendas – transitioning between agendas is difficult; separation of emotion from fact which requires time to reflect; the separation of emotional feeling from what may, in fact, be a small or relatively inconsequential problem and; how adding emotion to fact is an important part of “motivation” as it is invariably attached to an activity. All of these are, from my perspective, part f my Asperger.
According to the author, people with ADHD have difficulty in key three areas. Firstly, there are symptoms of executive dysfunction which can create everyday havoc via distraction, impulsivity and hyperactivity. Recognising that these difficulties are innate is an important starting step as attention can be maintained but, usually, only with subjects that are of interest.
Secondly, there is inconsistent work and behaviour: 100% effort is required to do tasks that absorb around 50% of effort by others. Finally, trouble returning to tasks: the major aspects of any job may be completed, but less intriguing details are ignored.
Other problems may include a poor sense of time, reacting on the basis of the moment – not the future, a weaker sense of self-awareness and social cues, trouble with transitions, at times hyper-focusing, frequently feeling overwhelmed and angry and explosive reactions.
The book claims that around 6% of the population are affected by ADHD and that there are many co-occurring disorders which may be mis-diagnosed as part of the condition. They include:
a) Learning Disabilities, in particular, learning the skill of organization which may be indicated by a child “not living up to his/her potential”.
b) Disruptive Behavioural Disorder or blaming others or being easily angered. There are also three related conditions with DBD: “oppositional defiant disorder” or being deliberately negative, belligerent or angry which results from an overwhelmed nervous system; “conduct disorder”, where the person is hostile or lacking in remorse which leads to others’ rights being violated and; “anti-social personality disorder or the severe violation of the rights of others.
c) Anxiety Disorder or daily, painful worries which are not due to any imminent stressor. This means that the person may appear edgy and stressed which may result in panic attacks.
Again, I can resonate with all of these symptoms from my own experience as a manager in the commercial world.
d) Obsessive Compulsive Disorder occurs where there are recurrent, compulsive and obtrusive, obsessive thoughts, which as the author asserts, means an individual “lives in the future”. Again, I can resonate with this. My mind often races ahead when I am doing a task and I have to fight to concentrate on the “here and now” in order to concentrate fully on what I am doing.
c) Sensory Integration (SI) and Dysfunction. SL involves problems with processing information received through the senses which results in over/under sensitivity to stimuli or executing a co-ordinated response.
d) Major/Bipolar Depression: this involves getting depressed briefly or exhibiting a combination of depression, manic moods, extreme irritability or rages that last for hours. Finally, there are Tics and Touretttes and…… Asperger syndrome. So the book believes that ADHD is an integral component of the Asperger personality and so looks at distinguishing between ADHD and Asperger syndrome.
As Kutscher then rightly, I believe, asserts, ADHD can create chaos in a situation or environment which can stress everyone in the process. More bluntly, he states that it can result in unpleasantness for those around someone with the condition which creates new sources of pressure. I have found as a manager a real need to appreciate and address this problem.
As a starting point for improvements, Kutscher states the need to consider all the pre-aforementioned facets in totality. In other words: ADHD is a holistic issue. He also, importantly, emphasises that the issue has to be addressed over a lifetime and that there is no short-term, easy fix.
This is what I have also personally found with addressing the difficulties I have identified in a work context with Asperger syndrome. Many managerial issues have necessitated real persistence and perseverance on my behalf in order to bring about required change. Not over-reacting when attacked personally is one behaviour that immediately comes to mind.
The book then goes onto list some key actions or requirements that can assist a person with ADHD to manage their condition more effectively.
1. Keep it Positive
Central to this is avoiding criticism and sarcasm and for any third-party (manager) to believe in the person . These messages I have found are so pertinent to my performance as a manager with Asperger syndrome.
As one chapter of my book Managing with Asperger Syndrome alludes to, I simply cannot work for overtly negative, critical or aggressive management. As Kutscher goes on to say, there should be positive reinforcement which should be immediate, frequent and consistent. It is no coincidence for me that the three organisations I have worked most effectively within are those where I have had a superior manager who exudes these facets.
However, other managers have not exercised the next suggestion sufficiently: if things start to go wrong, redirect in a positive direction rather than criticise. All have failed to even try to empathise by understanding the reasons why I may be acting in the way I am and so have treated me in a way that have helped me to control my impulses or negative responses.
Achieving the latter according to the author necessitates recognising that there is a disability present (though this can only occur, of curse, if one has disclosed). Doing so can help minimise any anger and frustration by practising actions such as “reflective listening” and accepting the person for who they are. Avoiding arguments based on blame so as to avoid the “resentment treadmill” is also essential for both parties. Interestingly, the text states that the dysfunctional person is unlikely to stop first!
2. Keep it Calm
When the nervous system is overwhelmed people overreact. There is a need, therefore, to keep it calm. However, many ADHD-ers are “brakeless” so the objective from both parties’ perspective is to defuse not deflame. As Kutscher rightly I believe asserts, serious discussion can only proceed when there is composure.
The advice here is sound: try to anticipate problems and head them off beforehand. Being criticised or shouted at makes it harder for the individual to regain self-control. Looking back these factors have been integral and instrumental in many of the extreme cases of difficulty that I have encountered as a manager with Asperger syndrome.
According to Greene, there are five skills or “pathways” that lead to explosive behaviours or learning disabilities: i) executive function skills: trouble shifting agendas, self-talk, organization and hindsight/foresight or using past lessons to keep the big picture in mind; ii) language processing skills: word manipulation to form complex thoughts and communicating them; iii) emotional regulations skills: difficulty modulating the magnitude of response to frustration – little frustrations feel like major disasters; iv)inflexible thinking skills or “seeing the world as all or nothing”; v) social skills: misinterpreting the subtext of a situation which can be a recipe for blow-up. Difficulties result from specific events that a person with ADHD’S inadequate skills or pathways cannot cope with. For example, switching activities or to someone else’s agenda.
The book then makes some most useful suggestions on starting points for any ameliorative action. Key to this is identifying ones’ own “triggers” and adopting “collaborative problem solving”. For example, if one is stressed , postpone facing the problem. Next, establish empathy and either ask for assistance, compromise or seek an “out-of –the-box” solution. Importantly, t is emphasised that any solution must meet the needs of both parties or it simply will not work. If the solution doesn’t work it needs to be worked on. This is especially useful advice in my opinion for any manager with AS dealing with inter-personal conflict.
3. Keep it Organized
As previously mentioned, five of the nine diagnostic criteria for ADHD are organizational: difficulty organizing tasks, inability/failure to follow through, avoidance of tasks requiring sustained organization, losing things needed for tasks and forgetting things in daily activities, (the others are: not appearing to listen when spoken to, being easily distracted by extraneous stimuli, failing to pay close attention which results in the making of mistake and difficulty sustaining attention). There are associated issues with this. The person with ADHD may not appear to care when, in reality, they do for example.
The book therefore goes on to list some components of an effective organizational system: an assignment pad that things can be written down on; a monthly planner that projects can be recorded in which should be referred to regularly. Accepting what is recorded may not correlate with that which is needed on a particular day however, is vital.
A teacher (manager) must also stay in close contact to assist in effective communication. It will also help if they understand what ADHD involves which can help mitigate the perception of a lack of interest/motivation. Help should be provided in the form of support such as a quiet environment or a “this is important” message. Usefully the book states that support should not be withdrawn as soon as success appears’ which leads on to the next point.
To this I would personally add the importance of taking self-responsibility: informing your superior about AS, what you personal requirements are and explaining why you may, at times, appear disinterested for example.
4. Keep it Going
As Kutscher rightly says, this is simple to state but hard to accomplish. Although people with ADHD usually know what to do, carrying out the plan is difficult because the disability itself is causing the delay. A child [manager] may continue to use unsuccessful strategies in this area. A manager should emphasise therefore that, if something is not working, a different method should be switched to. This is a requirement that I have personally have not exercised particularly well.
The book then looks at medical treatments – these are largely outside the remit of management issues – and related biological factors. The latter investigates some useful difficulties associated with the condition: how a child’s mind is pulled off the main topic towards something more “interesting”, but how their condition means that they may have trouble seeing something “coming up”.
There is then some most useful insight provided as to how these problems can be overcome. Firstly, just stop. I cannot emphasise enough from my own experience just how beneficial this advice is. By being able to recognise when tension is building up inside me and putting a mental block on any reaction means that I can prevent any escalation occurring.
Secondly, make decisions when you are calm. As the preceding text states, you cannot make appropriate decisions correctly when “hyped-up” and this is especially true in the case of having Asperger. It certainly applies in the area of management and, I believe, specifically when there is the need to exercise judgement.
Thirdly, resolve any problems before they arise. This is, perhaps, the best advice of all for someone with Asperger. Doing so means that anxiety and stress do not appear in the first place. Another piece of advice that the book gives is also, I believe, incredibly beneficial – ask others for advice.
Finally, realise that other people are usually good at preparing for the future and so listen to others. As I have come to appreciate that I have shortcomings as a result of my AS in this area, I have found I have a necessity to respect this observation.
The book then advocates that the ADHD dysfunction stems from an inability to inhibit current behaviours so that the demands (requirement s) for the future can be met. Successful change involves putting a stop on distracting activities and enjoying some time to consider options before reacting.
Key to this is the skill of initiation or getting started: stop the trips to the bathroom and actually start a task. As procrastination comes easily for someone with ADHD, (and with Asperger) getting down to work involves inhibiting all other possibilities. This, again, is something that I have sought to practice in a business context. If I have a priority I need to clear, I focus hard on mentally asserting that I need to address it, and address it, only.
Foresight can also help to keep the future in mind and so avoid distractions by being mindful of what is coming and building it into any personal schedules. Keeping in mind the past may also be necessary to ensure that past mistakes are learnt from. Exercising effective working memory is important here, as is developing and exercising organizational skills to readjust actions to demonstrate flexibility when circumstances change and impact upon immediate priorities as they inevitably will in business.
The next point is also, I feel, incredibly useful and invaluable: adding emotion to fact to realise motivation. ADHD’s may have difficulty here and this is certainly true for someone with Asperger also. I have found that unless I feel strongly (or emotionally) about something, I struggle to motivate myself about it. I think, in part, this has something to do with the high levels of honesty and inherent sense of fairness that is part of the Asperger personality profile and associated propensity to view things literally.
This has had enormous career implications and, partly, stem from some of the different types of problems associated with ADHD that the book next goes on to cite.
1. Symptoms of Executive Dysfunction
A key issue here is concentrating on what is of interest not of what is of importance. Attention span is high on the former but, sometimes, low on the latter. This is simply not possible in business. To use my above-cited example: a manager may be making demands on others for egotistical reasons, not because there is a strict business need to do so.
The solution advocated is to repair things earlier. Look to stay calm, be busy and occupied, return mutual favours and complete projects. All sound advice!
2. Co-occurring disorders
Address learning disabilities and disruptive behavioural disorders. Be less hostile to people and less anti-social. Good advice I feel also.
3. Anxiety Disorder
Worry less about what “may” happen. If necessary, change your environment, undertake exercise and meditate. It is also advocated that Cognitive Behavioural Therapy (CBT) is utilised.
I personally have tried to adopt an “if it happens it happens” approach. The reason I do this is that my [negative] mindset has been partly responsible I feel for bringing about things that was what I didn’t want!
4. Obsessive Compulsive Disorder
Fight intrusive and recurrent [negative] thoughts. Live in the now and not – totally – in the future. In other focus on what you are doing now and concentrate – don’t let the mind drift and complete what you are doing at the first attempt and do not allow a wandering mind to mean that th work you do is of a sub-standard quality.
These are not the only issues (there are others like bipolar depression, sensory dysfunction and auditory processing disorder) but they can all be addressed by the four key actions; keep it positive, keep it calm, keep it organized and keep it going.
To conclude, Kutscher emphasises that addressing only the triad of inattention, impulsivity and hyper-activity alone is not enough. There are associated symptoms that also need to be acknowledged. A long-term plan is required, but success can only be achieved if is patience is exercised!
I really enjoyed ADHS: Living With Brakes. There was so much in there that related to Asperger syndrome and many of the issues that I have encountered on a personal level in the world of work.
I would recommend this book. In fact, it is now on my list of essential reading.
ADHD: Living Without Brakes, Martin L. Kutscher
Jessica Kingsley Publishers, ISBN: 978-1-84905-816-2