What’s Phil Boissiere’s book Thriving With Adult ADHD about? What does ADHD look like in adults?
In Thriving With Adult ADHD, therapist Phil Boissiere explains why ADHD makes it harder to navigate tasks such as organizing a schedule, maintaining focus, switching between tasks, and controlling emotional responses. He then offers strategies that can help.
Read below for a brief overview of Thriving With Adult ADHD.
Overview of Thriving With Adult ADHD
For people with ADHD, managing daily life at work and at home may feel like a constant struggle. In Thriving With Adult ADHD, therapist Phil Boissiere offers a collection of strategies meant to support people with ADHD as they learn to navigate these challenges, which all stem from the same thing: problems with executive functions. Executive functions are skills that help with complex cognitive tasks such as organizing a schedule, maintaining focus, switching between tasks, and controlling emotional responses.
Boissiere is a marriage and family therapist who has over 10 years of experience treating adults with ADHD. In addition to his clinical training, he received training for ADHD assessment and treatment from Harvard University and Massachusetts General Hospital. He created Beyond Focused, an online course for adults with ADHD, and co-founded an ADHD clinic in Silicon Valley.
How ADHD Works
Boissiere explains that struggling with executive functions can make many aspects of daily life more challenging for people with ADHD, including relationships, jobs, and finances.
For example, if you frequently feel overwhelmed and you’re unable to regulate your emotions, you might lash out and harm your relationships with friends and family. If you can’t keep your schedule organized, you may miss important deadlines and appointments, hampering your success at work.
ADHD in the Brain
According to Boissiere, executive functions are carried out primarily in a part of the brain called the prefrontal cortex (PFC), which is responsible for complex decision-making, logical thinking, impulse control, and emotion regulation. When you’re a child, your prefrontal cortex isn’t fully developed, so you act based on impulse without understanding the consequences of your actions. For example, babies often try to put dangerous items and substances in their mouths because they don’t understand why they shouldn’t.
As you grow older, your PFC develops, and you gain greater control over your executive functions. For instance, you improve your abilities to make plans, think before acting, and use logical reasoning. However, people with ADHD continue to struggle with these skills as they grow older because their PFCs develop differently than the average adult’s.
Norepinephrine and Dopamine
ADHD is also linked to a deficit of two important neurotransmitters: norepinephrine and dopamine. Boissiere states that together, these neurotransmitters help you prioritize and focus your attention on the right things. Specifically, norepinephrine helps you filter external stimuli (such as sounds and smells) and internal stimuli (such as thoughts and feelings). Dopamine makes you feel like you’re being rewarded when you finish a goal or task. Without enough of each neurotransmitter, your brain gets easily distracted and has trouble sticking with a single task.
Debunking Common Misconceptions About ADHD
Boissiere debunks several common misconceptions about ADHD. Before you can begin managing ADHD symptoms, it’s important to understand that the following beliefs are myths:
Misconception #1: People with ADHD are less intelligent than neurotypical people (people who think and behave in ways that are considered “normal”). This isn’t true—having ADHD doesn’t mean you’re less intelligent. It just means that your brain works differently than other people’s, and some aspects of daily life may be more challenging.
Misconception #2: Every person’s experience with ADHD is the same. In actuality, every person with ADHD has a different experience. Some people may be severely affected by their ADHD, while others may hardly feel its impact. Instead of comparing yourself to others, figure out the advantages and struggles that represent your individual experience with it.
Misconception #3: ADHD will always control your life. ADHD can make you feel out of control, but with the right tools and skills, you can vastly reduce the negative effects ADHD has on your home and work life. As with any skill, you get better at ADHD management the more you practice.
Strategies for Managing ADHD Challenges
Now that we’ve explored how ADHD works, let’s dive into the specific challenges that people with ADHD face and the strategies they can use to prevent these struggles from ruling their lives.
Challenge #1: Maintaining Emotional Equilibrium
As we’ve touched upon, people with ADHD often struggle to regulate their emotions. This means that if you have ADHD, you might find it harder than the average person to recognize the feelings you’re experiencing and moderate their strength.
Strategy #1: Mindfully Acknowledge Your Emotions
Boissiere asserts that one way to improve your emotion regulation is by acknowledging and spending time with your feelings without trying to change them. When you fight or ignore a troubling emotion, you usually make yourself feel worse. Your anguish about experiencing the emotion compounds your negative feelings.
Challenge #2: Making Plans and Prioritizing
According to Boissiere, another hallmark challenge of ADHD is difficulty keeping your life organized and making plans. When you’re unable to properly plan out the tasks you must complete—work projects, household chores, and so on—they feel more overwhelming, provoking anxiety. Feeling anxious makes it more likely that you’ll procrastinate on the task, which can lead to missed deadlines, work backlogs, and a continuous cycle of overwhelm.
Strategy #2: Prioritize Your To-Dos
To help you plan and prioritize, Boissiere suggests writing down a list of tasks you want to accomplish each day. Place each task in one of the following categories:
Category #1: I must complete this task. You must do these things because their deadline is today or because another person is depending on you to complete them today. There will likely be unfortunate consequences if you don’t complete tasks in this category.
Category #2: I should complete this task. These are things you should do today because their deadlines are coming up soon or because they’ll significantly benefit you in your personal or work life if you complete them.
Category #3: It would be nice if I complete this task. These are things that don’t necessarily need to be done today, but it could be helpful or enjoyable if they were. They’re the lowest-priority tasks.
Challenge #3: Forming Memories Through Focused Attention
Boissiere conveys that ADHD affects memory formation as well. ADHD makes it difficult for people to focus their attention consistently on the right things, and memories can only be formed when you’re paying attention. Memory begins with awareness of your subject, and then the information moves from working memory to short-term memory and finally to long-term memory.
Strategy #3: Tell Yourself the Story of Your Task
According to Boissiere, one way to prevent distraction and keep track of the steps of a task is to tell yourself a story detailing what you’re about to do before you begin. Practicing this technique can improve your working memory in general.
Choose a relatively simple task or chore, such as cleaning off your desk. Then, narrate the task using a beginning, middle, and end. This narrative should include every step it takes to finish the task. You can write it down if you find that helpful. Once you’ve created the complete story of the task, actually do the task.
For example, before cleaning your desk, you might say to yourself, “First, I’m going to gather all the papers that can be thrown away and put them in the trash. Then, I’m going to file the papers that I need to keep. After that, I’ll remove the other items from my desk and dust them. Finally, I’ll wipe the surface of my desk with a cleaning solution and put everything back in its proper place.”
Challenge #4: Pausing Before Acting
Boissiere names poor impulse control as another common ADHD challenge. Impulse control involves stopping, considering your options, and choosing the best action in a given situation. Executive functions are necessary for this process to work, which is why people with compromised executive functioning (as in people with ADHD) struggle to manage their impulses. This can become problematic, as impulsive behaviors aren’t the best responses in most circumstances.
Impulsive behavior typically looks like this: Something happens that provokes an emotional response. You react immediately without considering the possible consequences of your actions. Then, you must face those consequences, no matter how unpleasant they are.
For example, say you get a notification that your favorite clothing brand is releasing a limited-edition jacket. Without considering the cost, you immediately order the jacket using your credit card. A couple of days later, you see the charge on your credit card statement and feel overwhelmed by how much money you’ve spent. Now your budget for everything else this month needs to be overhauled, and you have several hundred dollars more debt than you did before.
Strategy #4: Examine the Consequences of Your Actions
Boissiere states that this strategy prompts you to examine your role in recent situations that resulted in a negative outcome. In doing this, you practice creating a mental connection between your actions and their consequences, which helps to reduce impulsivity.
Think of three recent scenarios when your behavior led to an unpleasant outcome. In a notebook, write down each scenario’s outcome. Then write down how the results of your actions made you feel.
For example, “My partner interrupted me while I was trying to focus on work and I snapped at her without thinking. This hurt her feelings and we got into a fight. Afterward, I felt ashamed that I upset her, and I could no longer focus on anything.”
Challenge #5: Being Cognitively Flexible
Finally, Boissiere names low cognitive flexibility as a common challenge for people with ADHD. Cognitive flexibility is what enables you to move between different tasks, jump from old to new ideas, and engage with multiple concepts at the same time.
Shifting your attention from one complex task to another requires a lot of cognitive flexibility. People with ADHD commonly struggle with this, especially if they’re emotionally invested in the original task.
Strategy #5: Solve a Problem From Multiple Perspectives
According to Boissiere, one way to improve cognitive flexibility is by frequently considering ideas and problems from different points of view. To practice this, start by asking yourself a question that poses a simple problem. For example, “How can I crack an egg?” Then, come up with an answer. You might say, “Tap the egg on the side of a bowl.”
After you come up with your first answer, consider how another person would approach the same problem. Make the other points of view as specific and interesting as you like. For instance, how would a world-class chef crack an egg? How would an engineer? How would a magician? By considering alternatives to your first thought, you expand your brain’s ability to come up with multiple solutions in any situation.
