Amaha - ADHD Workbook

Table of Contents

What does ADHD mean?

What does one feel or the symptoms of ADHD?

The neuroscience of the ADHD brain

Environmental factors contributing to ADHD

How to manage ADHD?

It’s a bright Sunday morning, you can feel the lazy breeze as you walk towards your favourite coffee shop. You read through the menu which you know perfectly well, but you suddenly feel stressed about what to order. You can’t help but juggle between the usual options of lattes and end up spending over an hour deciding. Yet, you feel dissatisfied with your choice.

Ordering a coffee, deciding what to wear can seem like easy tasks for some, but people with ADHD can see these as severe challenges in their day.

So, what does ADHD mean?

Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

*- ADHD is not a self-diagnosed disorder. It can only be formally diagnosed by a mental health professional.

Have you felt this way?

While choosing your morning coffee, you may constantly feel distracted by other people placing their orders. You hem and haw but are unable to decide which drink should you order. With so many more options, it becomes difficult for you to make up your mind. This is a sign of inattention.

Inattention /ˌɪnəˈtentʃ(ə)n/

A person may have difficulty staying on a task, sustaining focus, and staying organised, which is not attributable to defiance or lack of comprehension.

While deciding, you fidget with your nails and tap your foot constantly. You feel restless about being stuck and are unable to find a way out. This is a sign of hyperactivity.

Hyperactivity /ˌhaɪpərˈæktɪvɪti/

This means a person may seem to move about constantly (excessively fidget, tap, or talk) even in situations when it is not appropriate.

Let’s take another situation. You’ve been waiting in a long queue in a restaurant to place your order for takeaway lunch but you can’t seem to stay calm. While your thoughts are wandering to your next chore, someone 7 spots ahead of you orders a large meal. You sigh and quickly abandon your line, looking for another alternative for lunch .People with ADHD have a need for instant gratification and often find themselves making impulsive decisions.

Impulsivity /ɪmˈpʌlsɪvɪti/

This means a person may act without thinking or might have difficulty with self-control. Impulsivity could also include a desire for immediate rewards or the inability to delay gratification.

Let’s say you’re studying with a group of friends and there’s a sudden, loud noise in the backyard. While others are engrossed, you lose focus and get distracted, only to find yourself scrolling through your phone. This is the inability to stop the inclination and direct attention elsewhere, also called poor inhibition.

Poor

inhibition /pɔː(r) ˌɪnhɪˈbɪʃ(ə)n/

Poor inhibition means the inability to assess, plan, and execute goal-oriented actions that affect future outcomes. The person can have difficulties with the ability to interrupt and disengage from an ongoing behaviour, or pause or delay their responses. This might be observed as easy distractibility as well.

These were the symptoms of ADHD. Now, lets look at how the ADHD brain functions to get a deeper understanding of it.

The

Neuroscience

of the ADHD Brain

Ever wondered what happens in a brain with ADHD? Which area of the brain impacts your daily tasks? Let’s get into the details. Doesn’t it feel good when you have a piece of your favourite treat? Or hang out with your friends after a long time? These are your ‘feel good’ neurotransmittersDopamine and Norepinephrine in action!

Norepinephrine

Norepinephrine and Dopamine are two neurotransmitters responsible for various mechanisms like - attention, arousal, memory, movement, impulse control, goal-directed behaviour, and executive functioning. They help you stay motivated and keep you calm and focussed.

Low eve s of hese neuro ransmi ers in he brain cause High is rac ibi i Hyperac ivi ha enges wi h p anning an organisin Impaire mo iva io ifficu y in sus aining goa - irec e behaviour Poor impu se con ro ifficu y isengaging from s imu a ing ac ivi ies

The A H brain has ow eve s of norepinephrine an opamine. This causes ysfunc iona opamine an norepinephrine ac ivi y in four func iona regions of he brain.

Prefrontal Cortex

Limbic System

Basal Ganglia

Reticular Activating System (RAS)

Prefrontal Cortex

This region orchestrates high-level cognitive functioning like maintaining attention, organisation, and execution of goal-oriented activities.

Basal Ganglia

The neural circuits regulate communication within the brain. All your information from all regions of the brain enters the basal ganglia and is then relayed to the correct sites in the brain.

Limbic System

The almond-shaped structure, located deeply in the brain, regulates your emotions.

Reticular Activating System (RAS)

This is the major relay system of the brain that passes messages from one region to another. A deficiency of dopamine and norepinephrine in the RAS can cause inattention, impulsivity, and/or hyperactivity.

These four regions of the brain interact with one another. Dysfunction in one region may cause a problem in one or more of the other regions. Symptoms of ADHD may be the result of problems in one or more of these regions.

Environmental Factors Contributing to

ADHD

While ADHD has a strong genetic predisposition, there are also several environmental factors that have been identified as risk factors for ADHD.

In utero events such as maternal stress during pregnancy, prenatal exposure to tobacco, alcohol and other drugs/environmental toxins, pregnancy/birth complications, as well as intrauterine growth retardation and low birth weight/prematurity have been associated with ADHD

Early postnatal environmental influences related to ADHD include neonatal anoxia/ lack of oxygen and seizures, brain injury, and exposure to lead and polychlorinated biphenyls

Psychosocial adversity and high levels of family conflict are also associated with ADHD. ADHD can be due to more specific familial issues such as inconsistent parenting and children's negative appraisal of family conflict. Children having suffered early nutritional, cognitive, emotional, and social deprivation for a duration of six months or above show high levels of ADHD-like symptoms. Inattention/hyperactivity are also strongly linked to attachment-related issues.

How to Manage ADHD?

Treatment is sometimes used interchangeably with cure, but treatments don't get rid of the condition, they help manage it. Let’s dive into the most essential part. How can ADHD be managed?

You can master skills that help manage your ADHD symptoms. These can enhance your regular habits, and help you identify and utilise your strengths. These activities can also help you acquire strategies to work more productively, stay organized, and work better with others. Additionally, informing others about your situation may also be beneficial in helping them comprehend what you are going through.

However, these self-help skills require practice, patience and a positive attitude. It may take some time to use the strategies but they will improve your productivity, and organisation, and empower you to control your life.

If it is getting too difficult to manage, know that help is available and you can reach out to mental health professionals for more assistance.

Let’s go through some simple, effective strategies that can help you manage symptoms to focus better.

Pomodoro Technique

You are working on a task and a voice in your head murmurs: "Are you sure this is the right thing to do now? Aren’t you forgetting something urgent? Are you sure there isn't a better way to do that?

The Pomodoro technique is a time management strategy designed to boost concentration by dividing tasks into small, manageable 25-minute chunks with breaks in between. With 6 steps, you can block your time and take breaks during a task.

Pick a specific task

STEP 1 Work on it for 25 minutes

STEP 2 STEP 3

Record your progress

STEP 4 STEP 5 STEP 6

Take a 5-minute break. Back to work

Every four Pomodoros take a longer break

How can the Pomodoro Technique be helpful?

The Pomodoro Technique for ADHD may be helpful as it structures tasks into short bursts of focus time. You can easily understand where you’re using your time and avoid being distracted. It also sets a time limit for work, that can help prevent hyperfocus on a specific task for too long.

Manage your time

Remember your responsibilities Stay organised Feel less of an impact of ADHD

How to use the planner?

Tr carr ing our da planner with ou whenever possible. This can remind ou to follow schedules and eep a trac of our time better

Have a planner in the form of a boo /binder, instead of separate sheets. This can avoid it from getting misplaced. Alwa s eep it in the same place when ou re not carr ing it, that wa ou can easil grab it when needed Conduct a dail planning session. Set a scheduled time each da to do our dail planning (put it on our calendar until it becomes a habit!). The goal is to plan the next da ’s activities and appointments. Doing so will give ou a mental map helping ou to complete the tas s on our list

Refer to the planner regularl . Start b chec ing our planner no fewer than three times a da once in the morning as ou are loo ing ahead to our da , around midda , and in the evening to review and plan the next da

Use the da planner as our calendar for ever thing. This could include medical appointments, exercise classes, wor meetings, and dates to mail bills.

Your daily Planner

6:00 AM 7:00 AM 8:00 AM 9:00 AM 10:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM 11:00 PM 12:00 PM

DATE: Top Priorities: To-Do List:

M T W T F

Worry Diary

Individuals diagnosed with ADHD and anxiety disorders tend to have more severe anxiety symptoms than those without ADHD. Even adults with ADHD who do not meet the diagnostic criteria for anxiety may experience occasional and situational anxiety.

Using a journal to jot down your stressors and worries can be an effective tool to help you lean into uncomfortable emotions. It can also help you dissect what you’re feeling and provide you with a path forward.

Writing down the evidence for the worry will help in getting a more realistic perspective about the worry and thereby, help in reducing it.

Grab a pen and paper and write down everything you’re worried about, big and small. Here’s a template for you to write them down.

Worry Diary

STEP 1 About your worries

What am I worried about?

How much do I believe it will happen?

0% 100%

What emotion(s) am I feeling?

What are my worrisome thoughts?

What am I predicting?

How intense are my emotions on a scale of 0-100%?

0% 100%

STEP 2 Challenging your worries

What is the evidence for my prediction?

What is the evidence against my prediction?

How likely is it that what I’m predicting will happen?

0% 100%

What is the worst that could happen?

What is the best that could happen?

What is the most likely thing that will happen?

How helpful is it for me to worry about this?

If the worst did happen, what would I be able to do to cope?

How else could I view the situation?

STEP 3 Balanced Thinking

A more balanced and helpful thought to replace my worry is

How much do I believe my prediction now

0% 100%

How intense are my emotions now 0% 100%

Jar of Strengths

In the early days of diagnosis and treatment for ADHD, it’s easy to get discouraged. Progress can feel like two steps forward and one step backward—or even three steps backwards. Without an active strategy in place, a setback can sink your mood and self-esteem. This paves the way to pessimistic attitude of, “Why try?”

The antidote? Plan for these times using the Jar of Strengths. Because these things happen. To all of us.

Instructions

Write your daily successes on a piece of paper and drop them in a jar or you can write them down in this virtual jar given here.

For instance, if you managed to finish a report or remembered a co-worker’s birthday, write these things on a piece of paper and put them in your jar. Whenever you feel low, read your successes, and it will surely make you feel better.

Begin writing in the Jar of Strengths given below.

Setting S.M.A.R.T. goals

Setting and achieving goals can be challenging for many people. One reason for this is that goals are often not specific or measurable enough. For example, instead of setting a goal to ‘save money’, it would be more effective to set a goal to "save 1000 rupees per month."

SMART goals can help you define and implement your objectives and intentions. This helps create a structure for execution and eases organisation of resources required for achieving these outcomes.

Let’s take an example of a SMART goal:

Broader goalWhat would be a weak goal? Simply, “I’m going to improve my relationships.”

Improve Relationships

What would a MART goal be

pecific: I will develop my relationships with Jay, Sarah, and Mom

Measurable: I will call each of these people twice per week

Achievable: I get free from work at 7 p.m, so I can make a 10 minute call to these people after I reach home, say at 8 p.m on Tuesday and riday

Relevant: I want to deepen my social ties, feel more loved and supported in my life, and support those I love

Time-bound: I will stick to this plan for 3 months, then reevaluate and plan my next steps.

To summarise, your MART goal will be:

I will call Jay, Sarah, and Mum twice a week for 3 months to develop my relationship with them.

How do MART goals help with ADHD

Often with ADHD, the best system of goal setting is one that takes into account the executive functioning struggles. The aim is to work with your strengths and create appropriate accommodations for your limitations When setting goals, we aren't just focusing on the what’, we also want to understand how’ to achieve it, especially because planning and execution are significant challenges. This is where the SMART goals strategy works as it defines both the 'what' and 'how' of goal achievement.

SMART goal setting for people with ADHD.

STEP 1 Define the chosen task

Define your priorities based on the urgency, relevance and importance of the tasks.

STEP 2 Set goals and timelines

Define the broader goal and task - write one task at a time, and the time within which it needs to be done. For example, "Clean the house for guests by Sunday, 7 p.m."

STEP 3 Divide each task into smaller chunks

Break a large goal/task into smaller parts to make it more manageable. ‘Clean the house’ might sound exhausting, but ‘wash dishes’ and ‘do laundry’ seem easier to handle. Set time limits for each part, based on the best estimate you can make of the time required and accounting for buffers.

STEP 4 Create a schedule

Schedule the tasks for a specific time (e.g. between 3-4 p.m.), or link it to daily activity (e.g. ‘do the laundry when I get home’). Also, plan how you will remember to work on the task (e.g. set a phone reminder).

STEP 5 Prepare for the task

List how you will g t r ady to work on th task, b for th sch dul d ti

Eli inat distractions: List distractions you can li inat b for starting ( g sil ncing your phon , working fro a roo without a TV Gath r at rials, suppli s and oth r r sourc s: List it s you will n d to co pl t th task Who will you r ach out to for h lp if you g t stuck? Hav a conting ncy plan

Plan for unavoidabl distractions: Cr at , ‘If, th n’ plans for lik ly distractions ( g If y fri nd calls, th n I will say, "L t call you back in 15 inut s "

Physical pr paration: List actions you will tak to b r ady for th task ( g dr ssing appropriat ly, g tting ho on ti , having a snack

STEP 6 Imagine the outcome

Many p opl und r sti at th positiv f lings that co fro co pl ting a task D scrib th b n fits of co pl ting th task, and how you will f l as a r sult

Distractibility Delay

A simple yet effective way to minimise distractions is to use the Distractibility Delay technique. This technique allows us to move distractions out of our head and ‘park them’ somewhere else so they’re not forgotten. Then, we can return focus to the task at hand.

How does Distractibility Delay help someone with ADHD?

For people with ADHD, inattention is a major challenge, increasing distractibility due to both external and internal factors. At times, you may just lose awareness and almost get ‘lost’. This interferes with task completion, causing unnecessary delays and mistakes in the task at hand. This is where Distractibility Delay becomes a useful technique.

4. Jot down distracting thoughts, but DO NOT act

Whenever any distracting thought pops into your head while the timer is running, quickly write down a few keywords, but don’t take action on the thought.

Instead, return your focus to the original task and remind yourself, "I'll focus on the task in hand till the timer beeps, I'll take care of everything else later."

Repeat this process until the task is completed, or until you’ve done as much work on it as you set out to do.

Urgent-Important Matrix

For people with ADHD, time mana ement is crucial for boostin productivity, personal rowth, career and social success. A useful technique to prioritise tasks is the Ur ent-Important Matrix. This can help you focus your attention on the tasks that matter the most

Think of the matrix as a box divided into four areas, or quadrants’. Each representin how your work time can be divided accordin to importance and ur ency of tasks

This model uses a four-quadrant system to help you cate orise each task based on Urgency: Tasks and responsibilities requirin immediate action or attention Importance: Tasks with hi h si nificance or value to oals.

The matrix represents the total amount of time you have so the overall size can't be altered, but each quadrant can change size depending on how much time you spend on it.

The idea is to try and shift as much of your time into quadrant two, whilst reducing the time spent in other quadrants.

The Quadrants:

Urgent Important Not Important

Not Urgent

Q1 Q3

The Quadrant of Urgency

The Quadrant of Distraction

The Quadrant of Quality

Q2 Q4

The Quadrant of Waste

How does it help someone with ADHD

or people with ADHD, doing urgent tasks seems more stimulating and rewarding This hampers the ability to plan and put consistent efforts for long-term benefits Many adults with ADHD struggle with prioritising their goals and managing time The Urgent-Important matrix allows you to do just that It helps you organise your time and plan for what’s important

How an you use the Urgent-Important Matrix

List the tasks you need to complet

Include deadline Identify the most urgent task Organise by importanc Place tasks in the correct quadrant Assess your productivity

Timers and Time Estimation

The Timer is a visual representation of time that can either show a visual cue or beep when time is up. Timers and stopwatches can be your best friends. They will cue you to realise how much time is passing and will help you determine how effectively you utilised your time.

How do they help someone with ADHD?

They will keep you on track and facilitate planning of tasks. To be able to work efficiently and effectively, it’s important to first know how much time is required for a task. This estimation needs to be specific to you, depending on a realistic measurement of time recorded across previous attempts of the task.

The Timer allows you to SEE time passing as an external cue, so you won’t have to rely as much on intuition. You're more likely to start and then persist when you have a very obvious sense of time and its limit.

How does this work

Define the task

Make an estimation for time taken to do the task. time you think is require to complete this task) omplete the task and note the actual time taken Analyse the difference. Was it more or less than the estimate

Note down reasons for the time difference and ways you can improve your estimation next time.

Here are some tips that can help you

Get isibility on your tim

To gain control of your time and use it effectively, use visual tools like calendars, clocks, and timers. Keep clocks in every room to help you remain mindful of the time as you go about your day

Using timers is another way to help you stay on track and ensure you don’t spend more time on a task than you intended.

Set an ala

Strat gically s t tim rs to ring or vibrat as a conv ni nt xt rnal cu of laps d tim Wh n th alarm go s off, us that as a cu to ori nt yours lf in tim . Ask yours lf if you ar doing what you n d to b doing and if you hav mad th int nd d progr ss.

Account fo uffe

Consciously ov r stimat th tim you think you will n d by a factor of 3, m aning, if you ar not sur how much tim to allot for a c rtain task, tripl th amount of tim you think you will n d

This will giv you suffici nt tim , without hurrying.

At Amaha, we use a comprehensive, compassionate and evidence-based approach needed to help people with ADHD. Our mental health experts will take the time to understand your concerns in-depth and create a care plan personalised to your needs. This can help you manage symptoms, improve functioning, and reach your full potential.

You can also join our community to share your experience with others who are going through similar struggles.

Address: Amaha Centre, 501, 2nd Floor, Chinmaya Mission Hospital Road, 1st Stage, Indiranagar, Bengaluru

Call: +91 20711 71501