E125 - The Path to Productivity with ADHD (w/ Ari Tuckman)

Ari Tuckman PsyD, MBA, is a psychologist, presenter, author, With 25 years in private practice, he specializes in diagnosing and treating ADHD and works with individuals, couples, and families. 

Tuckman is the author of four books on adult ADHD and regularly contributes to ADHD-related publications 

As a popular expert and advocate, Tuckman has been widely quoted in major media outlets such as the New York Times, Washington Post, Boston Globe, and Men’s Health. 

His most recent book - The ADHD Productivity Manual  - is out now

https://adultadhdbook.com/the-adhd-productivity-manual/

Interviewed by Dr. Alex Curmi. Dr. Alex is a consultant psychiatrist and a UKCP registered psychotherapist in-training.

If you would like to invite Alex to speak at your organisation please email alexcurmitherapy@gmail.com with "Speaking Enquiry" in the subject line.

Alex is not currently taking on new psychotherapy clients, if you are interested in working with Alex for focused behaviour change coaching , you can email - alexcurmitherapy@gmail.com with "Coaching" in the subject line.

Give feedback here - thinkingmindpodcast@gmail.com - 
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Transcript

Welcome back to The Thinking Mind. Today we're continuing our conversation about A DHD, and with us in conversation is Ari Tuckman. Ari is a psychologist, presenter, author, with 25 years in private practice. He specializes in diagnosing and treating A DHD and works with individuals, couples, and families.

He's the author of four books on Adult A DHD, regularly contributes to a DH ADHD related publications. His most recent book published just nine days ago is all about A DHD and productivity. As a popular expert and advocate, Tuckman has been widely quoted in major media outlets such as The New York Times, Washington Post, Boston Globe, men's Health, and Now The Thinking Mind.

Today we discuss Ari's overall approach to treating A DHD psychologically. Why having a DHD makes productivity harder? Why we should be productive, and what are we even aiming for when we're trying to [00:01:00] be more productive? The difference between playing to win versus playing to not lose how someone can set the foundation for a more productive life.

Some mental frameworks and techniques people can use to improve procrastination. We discussed the ongoing controversy of A DHD in the media, including a couple of recent New York Times articles, some key red flag symptoms that are highly suggestive of A DHD, the potential use of medication for A DHD and much more.

This is The Thinking Mind, a podcast all about psychiatry, psychotherapy, and self development. If you like it, plenty of ways, you can support it. You can share it with a friend. Give us a rating or review wherever you watch or listen. If you'd like to support us further, do check out some of the links in the description.

And now here's today's conversation with Ari Tuckman. Ari, thank you so much for joining me. Well, it is great to be here. I'm always more than happy to talk about this stuff. How did you come to specialize in A [00:02:00] DHD? So the truth of it is, I fell into it by accident that when I came out of grad school in the late nineties, as sort of like one does, right?

Trying to figure out what am I doing out here and at the time. A D in kids was sort of what known. And you know, there are clinicians who were treating it, but a DHD in adults was really pretty underserved. Um, it might be weird to think of this today in 2025, but in the late, you know, late nineties, people were really not thinking that much about aviation in adults.

Somehow you sort of grew out of, it was the thinking. And you know, the reality is if you're hyperactive, you tend to grow out of that, right? You become less obviously, like, you know, you're not running around the schoolyard like a kid does, but you know, the sort of inattentive symptoms still remain. And somehow, I don't know, somehow we were missing that.

It's not, in hindsight it's [00:03:00] kind of not clear how that could be. But, um, so adults with a ADHD in particular were just this underserved population. It was just a really great fit. For how I like to work, and also on a personal level, who I've tended to hang out with in my life. Yeah. What, what fascinates you about A DHD?

I have a saying that A DHD doesn't invent new problems. It just exacerbates the universal ones. So in other words, everybody gets distracted, everybody procrastinates. We all misplace stuff. We all forget to do things right. That's not unique, hardly. Um. But folks with A DHD do it more often and in more sort of visible and problematic ways.

And it's, so in some ways it, it's sort of like, you know, we understand all people by studying certain subsets, if you know what I mean, and that the strategies that work well for folks with A [00:04:00] DHD tend to work well for lots of people. Um, you know, but also it doesn't necessarily go back the other way. So just sort of standard obvious things don't necessarily work as well for folks with A DHD or at least not without some tweaks.

So, so I don't know. It's just sort of interesting to think about how do we, I hope this doesn't sound too pretentious, but like how do we optimize human potential? You know, like how do we do the best that we can do? Yeah. And obviously we're gonna talk about productivity. In a moment. I think your point about understanding all people through these lenses is a really good one.

I felt the same way when I worked at a forensic unit. So I worked at a forensic unit, specifically award for those classed with quote, dangerous and severe personality disorder. So people who had committed quite serious crimes as a result of extreme antisocial, narcissistic, borderline personality. And I felt the same way through these [00:05:00] extreme cases, you can learn a little bit about everyone's personality, even though these are extreme cases, there's something that everyone can learn from.

And obviously if you're gonna work with a DHD, you get to learn all about productivity, I suppose. Yeah, yeah. And that's exactly it. So you know, it's, so some of it, let's say half the work is helping people like genuinely perform better. Um, and you know, let's be honest, we all. At some level would like to perform better, right?

That's why the self-help industry is as big as it is. Um, but the other half of it is, it's sort of the acceptance side in the sense that. We all have things about ourself that we wish were different. You know, I wish I was a little more like this, or I wish I was a little more like that. Um, but, or a little less like that.

So, you know, there's also that side of it of like sort of the self-esteem side of how you feel okay about yourself as you are and sort of recognize the [00:06:00] limits of what you're able to do. Um, but then if we get into relationships, whether it's romantic relationships or you know, parenting, if we get into friendships or relationships at work, there's also that part of it.

You know, how do you sort of balance each person's needs? How do you advocate for what you want? And, you know, sort of balance being assertive with kind of being generous and understanding, you know, and there is a balance there. And I think it's often a dynamic balance. So A DHC really kind of brings all of this together.

Yeah, I'm glad you mentioned self-esteem. 'cause when I assess people for A DHD, self-esteem issues are so, so common. Like I see people will tell me I see people doing things in a way that I just can't do with an efficiency that I just don't seem to manage. And that just makes me feel bad about myself.

And I spoke to Russ Ramsey recently who connected me to you [00:07:00] and he, he talked about this that, similar to what you said, A DHD, treating it as this de delicate balance of acceptance and change. And I think that's true for everyone to some degree. It's where, where do you accept? Yeah. Where do you change?

Yeah. And that's exactly it. I mean, it's absolutely, you know, if you're too accepting, then nothing gets better, you know? And that is a problem, right? But also if you push for change that somebody can't do. Then that's a different problem because it becomes another failure, another falling short. And you know, the, the issue with self-esteem and A DHD is that, you know, unfortunately that self-doubt, there's too much reality behind it, right?

It's sort of like, so we'll say like, anxiety and depression will lie to you, right? They tell you things are worse than they are. But when you have a DHD, you've had a million [00:08:00] examples of times of, you know, where you didn't do the thing that you should do. And you've had a million times where somebody else has been very happy to point out to you what you didn't do right?

So this thing of, you know, what are the odds that I'm gonna do the next thing, right? Like, we all would like to think we would, but. I don't know. I mean, if your track record suggests otherwise, you would be frankly a little bit foolish to say. Sure. I think I got this. Um, and you know, it sort of brings up Russ Ramsey coined the term self mistrust, you know, which is sort of the idea of like, can I trust myself that I will do the things that I should do?

Yeah. Along those lines, I spoke to the author Ian Robertson last year. He wrote a book called The Winner Effect, which is a great book. And he also wrote a book about confidence. And he has an excellent definition of confidence, which is you're confident when you know you can do something and you will do [00:09:00] something.

So like you're confident that you can lose weight, for example, when you know, you know, what's the diet strategy, what's the exercise strategy, and also that you can execute on that. So that being the case. If you have a DHD, of course you, you're gonna have, like you said, this, this list of evidence of things that, you know, you've, you've had trouble with.

So of course that's gonna knock your confidence in a very real way. And it exactly, and I think, you know, what's important about confidence is it's, it's sort of domain specific in the sense of, you know, I mean here, it's like a silly example, but like, I'm really not good at matching colors and like, does this tie go with that shirt and whatever.

So like, I'm not confident about that. But then other things like, I don't know, coming on a podcast that I'm pretty confident about, like I've done it a lot. I know I do. Well, I have zero anxiety about it. It's great. Um, you know, if my wife was outta town and I suddenly had a [00:10:00] presentation where I had to wear a suit, right, I would be worried about that.

So, um, but. The thing with a DHD is, it's not specific, right? It's not like, I don't know, like someone who's colorblind, right? And like they just, they're bad at seeing colors. Right? Specifically, um, with a DHD, this shows up across lots of things, including things that somebody is very good at, you know? So even if we take, like, I dunno, I don't have a DH adhd, but like if I did, um, you know, showing up at this podcast, there would be the worry of, okay, so we're recording at 10.

I hope I get everything set up on time. I hope I don't get distracted and, you know, wind up showing up late or worse, God forbid, put it at the wrong time. Like screwed up the time cal the time difference calculation and have it at 11 when it should be at 10. And then you're wondering where I am or, you know, I.

Interrupting too [00:11:00] much or forgetting or rambling answers or, right. So it's sort of like a DHD undermines one's confidence even in things that one has good skills at. Yeah. And it's, it's gonna, it's gonna impact your performance in the long term, if not the short term. Like if you have a DHD and you love playing guitar and you have loads of talent at playing guitar, that's great.

That's gonna set you up really well. But the best guitar players are gonna be the ones that can practice and do the scales. Mm-hmm. And do all the boring things you have to do to really achieve Yes. Masteries, as you say, in the long term, that's, that's gonna wear, that's gonna, it's gonna put you behind the competition.

Yeah, I mean, it absolutely does. And unfortunately there are many things in life that are like that in the sense that there's these sort of. I don't know, let's just say related aspects or, or I don't know the mundane aspects of it. Like I think, you know, playing scales is a good example. [00:12:00] Um, that it, you know, if you mess up some of the sort of basics or this stuff surrounding it, so, you know, forgetting you have a meeting or forgetting, you know, your boss said, oh, by the way, for this, you know, this, um, you know, proposal, it has to, you know, something, you leave that part out or you forget it.

And then, you know, you might be great at putting any other sales proposals, but without that specific piece, you know, it doesn't hit the mark or, um, you know, other sort of things of that sort or, you know, not planning the right amount of time or procrastinating on it or, you know, lots of other things like that.

Right. So it, it kind of hamstrings your other strengths and abilities. Yeah, and people often don't realize this when they're thinking of pursuing stuff. You know, they'll look at the shiny object of it all. Like people will say, oh, I'd love to start a podcast. 'cause having the conversation sounds so great, or putting together [00:13:00] an episode sounds so great.

And it is, it is really great. But what you're not seeing is all the tedium that lies underneath the, the researching, which, which is the best microphone to buy, or the editing, or to make sure the post-production is just right or the hundreds of emails to set up interviews and scheduling them. So like, you know, every successful endeavor.

Increasingly so in a modern context, I think is this, this little sort of shiny object on top of really like a hill of tedium that you, or the people you delegate to are like responsible for producing really. And, and that is exactly it. I think it's a really good example because, you know, the one hour of the fascinating hopefully discussion, right?

Like that's the visible part, you know, but there's all the less visible part, but the visible part doesn't happen or it doesn't happen well, um, without, you know, all the work behind it. It's sort of like, [00:14:00] I don't know, I'm one of the co-chairs of the annual conference here in the States and you know, we spend an entire year planning three days.

Like we don't show up and say, okay, so what rooms are we using? You know? So I don't know. I sort of came up with a line like, the only things that just happen at a conference are the things you don't want to happen, you know? Um, does that, are there No. Are there, is there no space for magic moments for improvisational moments though, at the conference?

I mean, there are, there absolutely are, but I think. You gotta hit the fundamentals right? And, and maybe sort of set up some of those, you know, sort of create the context in which those magical moments can happen, which I think is, you know, very true for situations at work or social situations, you know, those sort of chance encounters or those random conversations that, you know, are great and like really interesting things come [00:15:00] of it.

Um, but for that to happen, other things have had to happen first, you know what I mean? Like, um, if you're scrambling to catch up and, and hit a deadline, you know, get something in before two o'clock, you don't have time to have that conversation. Or if you miss some things from the meeting. Then the discussion that happens doesn't, you know, like something doesn't come together or there's something missing.

Um, so, um, so yeah, I think it, it again, right, it's not having every moment scheduled because that's too much, but you also can't be flying by the seat of your pants either. So it's finding something in between. Yeah, absolutely. Um, before we talk about productivity, do you take the view that A DHD comes with natural strengths as well?

And, and if so, what are those strengths? So there is debate in the field on this, and you know, there are, there are some people [00:16:00] who will sort of take the position that, you know, a DH is a gift or the more, you know, updated term is a DH is a superpower, and you know. The position that I take is if you really look at the research, I think it's hard to say that, that it is.

Um, but having said that, people with A DHD have tons of gifts and strengths and superpowers right Now, did that come from your A DHD or is it just who you are or do you inherit it from your grandmother? Like, I, I don't know, but truthfully, I don't care. Like, whatever. If you're good at a thing, then you're good at it.

I don't care where it came from. Um, I think the idea of sort of the strengths of A-D-H-D-I think is well intentioned in the sense that if, you know, you struggle in lots of ways, like for God's sake, it would be nice to have some things you can feel good about, you know? So like from a self-esteem perspective, I think it's, uh, I agree with the end result.

[00:17:00] Like I do want people with a DH to feel good about themselves. Um, I. The risk in overplaying this, A DH, ADHD is a superpower card is, on the one hand, it's a pretty good reason not to do anything about it. You know, like it either as an individual of saying, well, I don't want to take medication, or I don't need to talk to someone because, you know, I'm have this amazing superpower.

You know, it potentially also runs the risk of sort of undermining like, you know, accommodations at work or school or other sort of legal protections, which, uh, you know, until this past year, this past six months, at least in America, was not a thing we had tons to worry about. But given the current administration and the, you know, attempts to close the Department of Education, this is legitimately a risk.

Like when the Department of Education gets closed, the, all those IEPs and 5 0 4 plans, the school accommodations that students get, all get [00:18:00] thrown away. Every single state needs to enact new laws to offer protections. And let me just say, good luck, right? All of these students on IEPs and five oh fours, A DHD, or hearing loss or any other thing, every single one of those students is out in the wild and we need to start over.

So like, this is a big, big deal. And I think when you say a DH is a superpower, there are those who will use that in a problematic way. Yeah. And we're, there's this, this debate of course is happening within, uh, the autism community as well. And in the UK we tend to use more understated language. We might not use the word superpower, but we'll, we'll ask a question like, is autism a disability or a difference?

Or is A-D-H-D-A disability or a difference? And I, I think I would take the view that it does come with some natural strengths, probably like what I hear over and over again. [00:19:00] From people with a DHD is they tend to excel at physical tasks that require like immediate dynamic attention. Things like playing sports, other more hands-on tasks.

But I do agree with your point that if we, in an effort to help people feel okay about themselves, uh, use words like superpower, we, we can really, uh, obscure some of the things, some of the very real problems that need deserve attention. You know, it's hard to, it's hard to deal with a problem at any level, societal or cultural or individual if we don't name it as a problem.

Of course. Yeah. And I mean, the thing about it is, I totally get it. This idea they. You know that things are over pathologized or, you know, there's problems with the medical model. It's not perfect. So, you know, I understand the idea of sort of pushing back and, and talking about difference and talking about a range [00:20:00] of abilities and ways of being, and I'm all behind that.

Like, that is totally fine by me. Um, I think by definition, A DHD and autism are a difference. You know, like there's a range on these abilities and some people are on one end and some people are on the other and most people are kind of somewhere in the middle. So like absolutely it is a difference. I think where potentially it becomes a disability is how do your abilities intersect with the demands placed upon you.

What are the outcomes? Now, on the one hand, obviously I would like to see, you know, society be more flexible about how things are done and, you know, some accommodations and just people not being jerks, right? Let's just call it that. Great. Also, you live in the real world and everybody around you will not accommodate everything about you.

Right? And I'm not saying that that's okay. I'm just saying that that is what it's like if it [00:21:00] rains and you're gonna get wet. Like I don't approve or disapprove of the rain, but I'm just telling you it's raining. I don't think, I think you might want an umbrella. So, um, the question then is for you as a person in the world, what is your best path to happiness?

And if you continue to sort of say the world needs to bend around me sometimes, but also sometimes not, and you're gonna be less happy with the outcome. Um. I think there's also a concern, you know, it sort of, this a DH is a superpower that it, that positions tends to be taken by folks with privilege, right?

If you are a white guy with a kind of high, high level job and you have a, I'm gonna be completely like traditional here, and you have a wife at home who's pretty on top of things, you get to do all the awesome, I'm creative and spontaneous part of A DHD, it's my superpower. But then everyone behind you is picking up the pieces and, and if it happens to be on the [00:22:00] milder side.

Yeah, exactly. Exactly. And you're smart and you're hardworking, and generally people like you. So you have other strengths as well, right? Like you can lean into the whole superpower part because other people will make up the difference. But if you have less of that privilege. Um, it's not a superpower, right?

Because there are, there aren't other people behind you to pick up the pieces. You don't have the financial resources to kind of make up the difference, you know what I mean? So then it is not a superpower. And I think that really the big, big point that this highlights is it's always about context. How do your strengths and weaknesses match up to the demands being placed upon you in this moment?

And I'm glad you brought that point up and, and made it so vivid actually, because A DHD remains controversial a lot when it's discussed in public. Lots of big, big newspaper articles, which we'll talk about coming out, lots of books being written, [00:23:00] and they always tend to emphasize those kinds of cases, which you just mentioned.

I see, you know, I assess NHS patients here in the UK for A DHD, and it's not uncommon to see, you know, single mom of two children. Part-time jobs struggling with financial issues with, you know, moderate to severe A DHD on top of that. And then when you see cases like that, you, you realize, wow, this is the A DHD part is a really important piece of this puzzle, for example, in that it causes a lot of impulsive overspending, leading to debt problems with personal organization, personal organization problems taking care of the kids.

It's a really, like when it, when A DHD is a big deal, it's a really big deal. I'm sure you agree and it absolutely is. And I mean, the thing of it is like that single mom has no margin for error. You know, the demands are very, very high and she has to function at a [00:24:00] high level to just keep her head above water.

You know, so A DHD or anything that knocks her down is gonna pay, she will pay a heavy price for it. Um, mm-hmm. So, but you know, the thing of it is, is that when you look at the research that has been done on sort of long-term outcomes in A DHD, you know, now this is obviously gonna be much more true of those who aren't managing it well in some variety of ways.

But, um, you know, a DH ADHD is associated at the level of group averages, at least with lots of outcomes that, that people don't want, right? So things like unplanned pregnancies, less educational attainment so they don't get through college or whatever. Um, you know, more divorces, lower lifetime earnings.

There's even research that, you know, shows the negative health effects. So things like higher [00:25:00] blood pressure, higher blood cholesterol scores, um, ultimately a decrease in estimated life expectancy that people with A DHD do not live as long. As a result of the way their A DHD impacts various health maintenance habits.

So if we care about things like obesity and diabetes and substance abuse and accidents, then we should care about A DHD because if you don't treat the A DHD first, you're really not gonna make a lot of progress on the others. Yeah, and that's what I see. You know, as a psychiatrist, you'll often see people being attempted on various different kinds of treatments before they come for an A DHD assessment, people will try and treat their depression, say with various means, psychological medication or, or anxiety.

And, and, and you really realize actually the A DHD is. Often the most fundamental layer, which needs to be addressed before anything else can move. And that is absolutely true. [00:26:00] And you know, it's not uncommon that folks, you know, particularly adults, particularly women, um, tend to be more likely to di to be diagnosed and treated for things like anxiety or depression before finally maybe eventually being diagnosed with A DHD.

And I mean, on the one hand, like there probably is some anxiety and depression there, you know, um, but the analogy I use is it's sort of like painting the water stains on the ceiling, but not fixing the roof first. You know, like you have more things to be anxious and depressed about. Um, you know, it's like that single mom that you mentioned, right?

Is just so, I don't know if she shows up late to work and then, you know, loses shifts as a result. Right. They sort of dock her, or if she impulsively spends too much on, you know, something then, you know, money is tight for the month. Or God forbid she like leaves [00:27:00] her cell phone, you know, on the train or the bus or who knows where, right.

And doesn't have another, I don't know, whatever the hell a new cell phone costs these days, you know, a thousand bucks or a thousand pounds or something. Um, you know, like. That's easy to beat yourself up about, right? Nobody's gonna feel good about that, but especially when it's not like that one, you know, one time it happened, but it's more like, ugh, here we go again.

Or I didn't read the email from the teacher, or I don't have time to sit down and help my kids with homework because I got home late and I'm just barely trying to get food into them. So, you know, beating herself up about how she's sort of failing her kids as a result. So like she should be anxious and depressed.

She's reading her world accurately, you know? But you know, let's get to the root of it. Let's help her genuinely feel more effective in her life. And then I think she's gonna have a lot less to be anxious and depressed about. [00:28:00] And on that point, and I'm curious to get your thoughts on this, it's striking how often when people get a diagnosis of A DHD, often they're very relieved.

And I'm not sure what to make of this. I've been a clinician for 10 years. You know, I've diagnosed things like depression, anxiety, psychosis, bipolar disorder, various personality difficulties. Sometimes the diagnoses are more like psychological or informal. Like, you know, I think you might have people pleasing tendencies.

And with, with none of these, do I experience the kind of, generally the kind of relief that you see often when when someone gets a diagnosis of a DH, adhd? Yeah. Or sometimes autism. What do you make of that? Is that something that concerns you? Because I've seen that as a source of consent for other people in the media.

What do you make of it? Sure. And it's odd to me that some people feel concerned about it. I think it, to me, what [00:29:00] it reflects is finally, finally, I. Answer that really makes sense, right? You know, people like logic, they like it when the pieces fit together. I think it's that for folks with a DH adhd, they have been told, because a DH ADHD is a, is a rather visible kind of a thing, right?

People may not know, oh, that person is A DHD, but they know something, right? Why she always late? Why does he keep losing stuff? You know? He says he is gonna get, get it to me by three o'clock. He never gets it to me by three. Right? So like, people see things and they sometimes say things and not always in the nicest way.

So like, this is something that if you have a DHD, you know, you have something, even if you don't know what it is that's causing the way things happen. Um, but I think now it finally, it becomes a, i, I kind of use the analogy, it's like when you're watching, you know, a mystery movie. Then in the last [00:30:00] five minutes they reveal and you're like, oh, right.

You know, and all these weird random things sort of fall together and you're like, oh, that's why the boyfriend, I don't know, his hands were wet when he came out of the kitchen or whatever, you know? Um, so I think it, there's a sense of relief of how it all comes together, and I would, as so, I think partially it's sort of in retrospect, looking back, this all fits together, but I think maybe there's also a, um, some hope looking forward of, now that I understand this now, it, now I think I've, I've got now there's some hope that I'm gonna be able to do something about it.

Yes. And, and adding to that, I think there's a sense of relief because the, the, the group of problems that A DHD comprises, it's not obvious if you didn't know about the existence of A DHD, so not obvious that those problems would be connected. It's not obvious that problems tracking your time would be connected [00:31:00] to problems with concentration would also be connected to say, fidgeting, impulsive spending at first glance, they seem like separate sporadic issues and only through kind of an A DHD type understanding can we realize, oh, actually these have common origins.

Like they all relate to, you know, sustained attention or delayed gratification, et cetera, et cetera. So I think that's helpful for them as well. Yeah, and and that's exactly it, right? It's sort of that if, if when you think about A DHD is either hyperactive boys or I just can't pay attention right then, then these other things don't really fit together.

Um, so. You know, there, there often is a great sense of relief about how this all sort of comes together. Um, my, my fourth book I called a DHD After Dark, and then the subtitle is Better Sex Life, better Relationship and the sort of title A DHD After Dark, [00:32:00] it had kind of two meanings, right? The one meaning is, um, here in the States, when I was a kid, there used to be this thing Cinemax After Dark.

It was one of those paid TV things and they had all these kind of like, you know, s muddy movies and whatever. So it was kind of a callback to that, but it was also kind of the second meaning is when you're sort of living in the dark, right? Where you're like, I don't understand what's going on. Why do I keep doing this?

I try all this stuff, or we try all this stuff, whether that we is your parent, your romantic partner, your therapist, your prescriber, whoever the we is like, we keep trying and something somehow it never quite gets the job done. Um. Once you get that diagnosis of A DHD and you sort of come into the light, so to speak, um, you can see much more clearly, right?

And you understand what's getting in the way, and from there you understand that, what to do about it. Uh, on the note of diagnosing, I, I think a lot about, you know, do we need to update our diagnostic criteria in any [00:33:00] way? I, it doesn't seem to me like they've been significant, significantly changed for a long time.

And on that point, when you're assessing people for A DHD, are there any red flag symptoms or phrases or problems that you look out for that aren't in the diagnostic criteria, but which in your view Wow, that's really typical of A DHD? I think the thing that I look at the most is a little more broadly, but like I.

How does, you know the times where this person kind of shoots themself in the foot, right? So in other words, if a kid forgets to bring home his math homework and can't do it, and I guess has to play video games tonight, right? We might wonder about that. You know? Or if you forget to take out the trash often, and then your partner is angry and has to do it themself, or might be like, well, maybe this person just doesn't care about the trash.

Or maybe they're passive aggressive, or maybe they're just kind of a selfish jerk. I don't know. Right? Like, we could come up with other reasons, but when you, I don't [00:34:00] know, lose your cell phone that you really love or your new sunglasses, right? Like what? What do you get from that? Nothing. Um. When you run late to your own things, and it's really stressful when you feel frustrated with yourself about how these things work out.

Despite really trying, despite these promises of like, this time is gonna be different, you know, like, not different, not much, you know, not three days later it ain't. So, you know, like that's the stuff that I look at is like, despite knowing better, despite knowing how, despite putting in the effort, just like not hitting the mark.

Yeah, I think I, I think that's a good, good way of going about it. 'cause a, a lot of people might say, how can you tell the difference between A DHD and certain personality traits and differences? And I think it's important in an assessment to really get a sense of what that person cares about. 'cause [00:35:00] then by definition, you're kind of pricing in what their personality is like.

Like, okay, do you really care about the guitar? Yes. How do you find practicing? Well, actually, even though I have a lot of talent, I just can't get those scales done because, you know, and then a, a huge red flag would be like, for me, frequent boredom, even in things that you typically enjoy and having to, having to take in multiple forms of stimulation At the same time, I need to be on my phone with the radio on while watching tv, needing stimulation for me, needing stimulation when I'm going to sleep.

Like I need something to occupy my mind, to allow my mind to shut down, because otherwise my mind is too loud, obviously, excluding any crazy, you know, pres sleep practices. Um, but those, those really stand out for me as very typical. Yeah. Yeah. No, I agree. I mean, these are, these are the sorts of things that we're looking for, right?

[00:36:00] It's that sort of across time, across situations. That there's, you know, continued struggles, but also sort of an inconsistent performance, right? So when you're interested, when it's exciting, you do great. Um, when the pressure of the deadline is on, maybe then you do great. But when it's not very interesting and when there's no immediate deadline, it's like, you know, trying to, you know, drive through mud.

You just can't get the wheels turning. And, and now going deeper into the topic of productivity, of course, you've just released the book, is it nine days ago? Yeah, nine days ago. The A DHD productivity manual, which I'll definitely be having a look at. First question, why does A DHD make productivity harder?

Some of it is the stuff we've just been talking about, right? That like the, it's just all the ways that A DHD affects procrastination. Forgetfulness kinda [00:37:00] losing details or being disorganized. So like I, you know, I have this thing but I, I can't find it and I need it for this project. Um, you know, tuning out in conversations or like in a meeting or you read an email and there's a couple things in the middle there, but you don't really, you know, those sort of slide by.

So in lots and lots and lots of different ways, A DHD impacts your ability to kind of do the right thing at the right time and hopefully in the right way. So, um, so yeah, I mean in lots of ways, and folks a DHD and the people around them know this well and how certain are we from a scientific standpoint about what's going on in the brain that's contributing to these problems?

Um, I mean there is absolutely research out there, right? That, now I should put a little caveat here that. When you compare group averages in research, we can [00:38:00] absolutely show differences in brain scans and brain volume and things like that. Um, that does not mean that you can do brain scans to diagnose individuals, right?

Like it, it's good for research, but it's not good for individual diagno diagnosis or treatment. But, but yeah, like we do, we see differences in activity levels in different parts of the brain, primarily related to things like attention, you know, also, um, emotional regulation and just in general, sort of where the executive functions kind of do their thing to help us navigate a complex world and, you know, do the right thing at the right time.

And when we start working on productivity, obviously you work with patients with A DHD to help improve their productivity. Uh, I think we need to inject some optimism into the situation. How optimistic. Should people be if they have a DHD and they want to improve their performance and their productivity, I say that A [00:39:00] DHD is at its worst before you know what it is.

But if you like anything, right? If you understand what's getting in your way, you're in a much better position to figure out what to do to make it better. So, you know, a lot, a lot of managing attention begins with managing your environment, right? It's kind of obvious to say, but we don't know who just do it.

So, you know, if you know you have things you need to do to, you know, reduce the competing distractions and temptations, you're more likely to stay on track. Um, you know, other stuff like, you know, using your calendar and your to-do list. Well, you know, which is another obvious thing, but like there is an art to it, you know?

So even things like, you know, putting something on your to-do list, right? There's a question of like, well, I. Should it even get put on there in the first place? Like, do I want to do this thing? Do I have the ability, and do I, you know, do I have the ability, not just in theory, but [00:40:00] also in reality, like, do I actually have time to do this?

Right? And this is a place where folks of a DH should get themselves into trouble. Or you, someone will say like, Hey, can you work on this thing and get it to me by Wednesday? And you know, like in the moment they're like, well, let me think. Sure, I can do that. But if they really thought about like, well wait a second, lemme look at my schedule.

Also, let's assume I put most of the things into my schedule. Let me think about what else I, I need to do. What's between now and Wednesday? Is this really a thing that I can actually pull off? And in that moment they might say like, you know what, I can't on like maybe Friday, but like definitely not Wednesday, right?

So if you say, sure, and then it's like end of Tuesday and you go, oh crap, I was supposed to get him that. It's sort of too late. Right. So, um, so part of being productive on some things also means being able to assess whether you can do it and want to do it, and sometimes saying no. Right. Saying no to other things.

Yeah, absolutely. I think [00:41:00] that sense of, that ability to be strategic and and realistic is so important. 'cause, you know, even people without a DHD of course, have this problem. And then we have to interact with those other parts of our psychology, like our people pleasing tendencies, which might mean, you know, we really want to get everything done for everyone, or we, god forbid, attach our self-esteem to our ability to perform and get things done.

So I guess I, I'm sure every patient with A DHD treating the A DHD, but also whatever other personality traits they have and what have other sorts of, uh, weaknesses they might have pre predictions as well. Yeah, I mean, that's the thing, right? A DHD is a part of someone. I mean, it's not all of who they are, right?

So what are their other strengths and supports and resources? What are their other sort of weaknesses and challenges and struggles? So yeah, I mean, we always treat the person, not just the one [00:42:00] thing. And that's true for obviously everything. What do you think, I mean, you mentioned some of them, what, but what do you think are the most crucial, like first steps someone with a diagnosis needs to make to set up a more productive life?

You know, the first thing I always recommend is. Really like spend a bit of time to really understand what a DHD actually is, right? What is it? What is it not? And I think usually, I mean if it's the right diagnosis is there's gonna be a lot that will sort of resonate. Now obviously people are different, so not everything, but, but I think there's a lot that will resonate.

And on the one hand it may just help you feel better of like understanding yourself. And also it may, um, hopefully give you some kind of good strategies or as I say, like don't reinvent the wheel, right? Other smart people have figured out good ideas, don't figure everything out the hard way, right? So there's that part of it Also, um, [00:43:00] I think it's also worth having, you know, some serious thinking about, you know, is now the time for medication because.

You know, in general, the medication for A DHD, specifically the stimulants, right? Like we know from decades upon decades of research that like these medications are generally quite effective, right? They do a good job at what they're supposed to do, and also quite safe and tolerable, right? And if you don't like how you feel on one, you, you know, change a dose, change the medication, talk to your prescriber, right?

Most people can figure out something that works pretty well. And the reason, and I say this as a psychologist, like I do not prescribe medication, so I got nothing to gain on this. But, um, but it helps sort of close the gap between intentions and actions. So things like, you should put everything into your schedule and then you should check it when someone asks you if you can do something.

[00:44:00] Sounds great. Also here, let me give you some other advice. You should wake up at five in the morning. You should floss your teeth and then you should go for a four mile run, ta-da. Now you're in shape, right? Like lots of things sound great, but can you actually do it? And by the way, not like three times, but like every goddamn day for all of the days, right?

And that is where medication can be really helpful in just helping someone with A DHD be more consistent and better able to apply the rest of their skills and abilities. Yeah, and we see this debate with antidepressants as well, and I think actually the evidence for antidepressants overall is actually weaker than for A DHD medication.

We've spoken to a number of experts on this and participated quite actively in this debate in the uk, and one of the really strongest arguments for medication for treating a mental health condition is. The fast relief. You know, we're [00:45:00] often dealing with people who have been burdened by a problem for 2, 5, 10 years.

A DHD tends to be longer term than depression, but even for antidepressants, you know? Mm-hmm. It is very, very understandable why someone with depression would need some kind of fast acting relief or would at least want it. And it's not an i, it's, it's not a, it doesn't have to be mutually exclusive. Of course, medication can be a super useful tool to help catalyze those more psychological strategies.

Yeah. And, and I mean, that's the thing. Whether you take medication or not, you still gotta do the work. Like we all have to do the work. That's just life. Sorry. Um, but what it does is it makes it a bit easier to do the work and makes it easier to be more consistent about doing the work. How do you have much, do you have a strong view on the long-term effectiveness of medications?

'cause one of the concerns is perhaps the medication. Might wear off after two, three years. Of course, it's quite hard to do [00:46:00] long-term medication research, so there isn't a ton of it. Do you have much experience of that with your patients that you could speak to? I mean, I think it, it's hard to say and I think, you know, as you said, right, long-term research is hard to do because there's so many other variables of like, what else is going on in this person's life over three to five to 10 years.

Um. Are they being consistent about taking the medication? Has the dose changed or has other stuff in their life changed? You know, so I've certainly had conversations with clients where they're like, oh, my medication is not working as well. And then we start talking about it and you know, they're getting like five hours of sleep a night, right?

I'm like, well I don't think it's a medication in that case, you know, or let's say, I don't know, they have a, a newborn who's keeping them awake or their job they got promoted or their cutbacks or whatever and they're working twice as hard or you know, so like we need to take things like that into account as well because, you know, [00:47:00] medication can take neither credit nor blame when other circumstances in your life change.

G, getting back to productivity, of course, one of the most common problems people with a DHD report is procrastination. What, what is procrastination? Mm-hmm. It affects us all. We are all affected by, it's like the most, that's the real pandemic, of course. Uh, what is procrastination? How, how can we start to deal with it?

So procrastination is basically, and as you said, we all do this, so we all know this, but it's, it's not doing something now that would be better for us to do now. Um, and you know what's interesting about procrastination is most of the research on procrastination is more about the sort of anxiety-based procrastination, right?

I should really do this thing, but I feel kind of nervous about it. I'm not sure how to do it, or I'm worried I'm gonna mess it up, so I'm just gonna avoid dealing with it. Right? And it's anxiety that holds a person back. The [00:48:00] A DHD brand of procrastination is a little bit different in that it, it is more, it's not about I feel anxious, I can't do it.

It's more the opposite. It's that like, oh. Yeah, I got this thing due next week. I don't know, I guess, I don't know. I, I, I'm working on this other stuff, but you know, I should really figure it out. Right? And then as the deadline gets much closer, now they begin to feel it, right? It sort of hits their mental radar and they get that kind of fire in the belly, so to speak, of, I should work on this.

But the difference is when folks, with folks who don't have a DHD is that they're thinking a little further ahead, right? So it's not just today and tomorrow, but it's also like next week, maybe even next month. And I should really, you know, it would be good right now if I did some work on this, even though I'm not gonna pay a price for it until later.

You know, so it's, it's sacrificing in the present in order to make a [00:49:00] situation better in the future. Mm-hmm. How do we learn to, how do we learn to improve this? I mean, when it comes to a DHD medication is quite helpful, right? So that's part of it. Um, but I think otherwise there's a whole bunch of strategies and some of it is to try to, I kind of say kill the competition, right?

That if more interesting things are, are available, it's too tempting to choose them instead of the thing you should be doing, whether that's, you know, doing the reading and the second week of a college semester, even though the test isn't for two months or. I don't know, saving receipts now because I'm gonna need them for taxes in eight months.

Or, um, you know, I should plan my summer vacation before it's actually summer, or, I don't know. We're having people over this weekend on Saturday, but now it's only Monday. Do I really need to start thinking about this? Right. All that stuff. So, so it's getting rid of some other competition. Some of [00:50:00] it is about maybe even being intentional about putting it into your schedule, kind of like an appointment with yourself.

Right. So I. Every Tuesday is the time that I read my history stuff in my college semester or you know, at the end of the month I gather up all my receipts so that I have them. Because when it's time to do my taxes, I'm not gonna remember and I'm gonna basically be donating money for things I can't deduct.

Um, you know, so it's, some of it is that, but there's also kind of mental strategies of like, I kind of call it feeling the future. So thinking about if, you know, how am I gonna feel then if I don't do anything about this now, how am I going to feel in that moment? Let's really like put myself into that situation.

What is it like? I hate that stress, the scrambling and I'm yelling at everyone and I can't do the things I really want to do, and I wind up staying up late and it all really sucks. Like, I don't, I don't wanna do that. [00:51:00] I was just gonna ask you about that. I was going to ask you if you ever use.

Visualization techniques and it's kind of sounds like that's what you mean when you say feeling the future. Because often people have problems with long term goals or maybe uncharted territory psychologically because they don't have that emotional experience yet. So someone with a DHD might not have, feel the emotional urgency about a college assignment due in three months, but they can visualize it and then if they visualize it in a couple of minutes, they can give themselves two emotional experiences, the emotional experience of what it'll feel like to hand it in properly and get a really good grade.

And then the opposite, the experience of having to do a last minute. And, uh, so is that, is that kind of the format to take something like a visualization? That's exactly it. And I think it's also a thing of like, if we use this example of like gonna the library to study, I mean it could be any example but is, you know, is to sort of build it onto an existing [00:52:00] transition.

So when I leave class and then I go and get lunch. After lunch, I then go to the library versus I'm gonna go back to my room, I'm gonna do some stuff and then I'm gonna study much less likely. You know, so kind of building in some of those habits and systems. So just it, it takes less force of will to do the things you need to do.

I, I can see looking at the outline of your, your productivity book, you also make room for kind of what is it all for? Yeah. Productivity is the engine that gets us places. But it sounds like in the book you also discuss overarching goals and meaning and why are we doing all this? Um, and along these lines I've been thinking about the dichotomy of playing to win versus playing to not lose.

And I think this is applicable to everyone. I think a lot of people, a lot of the time are playing to not lose, they're doing something 'cause they feel they have to, it's an obligation. I'm just trying to not fail out of school as opposed to, [00:53:00] I'm really trying to excel at this course. I wonder if there's room for helping people with a DHD to really play to win.

Because if A DHD has motivational problems, winning just seems so much more motivating than not losing. Yes, I, you know, I, I haven't used this language, but it's exactly what I talk about in the book and it's exactly what I sort of preach, is that if you're not managing your A DHD well, or whatever in your life, you know, then too much of it is, too much of your energy is just about kind of surviving the day or dodging the bullet.

Right? I don't want my boss to ask me about this in the meeting 'cause I, I'm not really where I need to be. Um. That kind of sucks, right? It's not inspiring, it's not motivating versus working towards something that really matters to you, right? Like, I want to feel effective at work. I wanna walk into a meeting head held high and to know if my boss says anything, I got it.

[00:54:00] Um, or if my boss is being a jerk, I, I'm not gonna take it personally because like, I know I'm where I need to be. You know, this is about them being a jerk, not about me, right? So, um, so like that really, really is the goal. And even in terms of a book in on productivity, as much as one might think I would be all rah rah, productivity all about it, it's all, you know, be more productive at all costs.

It's not, it's really about productivity in service of living a good life. What is a good life? What's good enough? What do you work hard at and try to change? What do you sort of accept and you're just like, look, this is who I am. This is okay. Exactly if you want to play to win, you have to ask yourself the question, what is winning for you, which is gonna be very different from winning to, you know, for your partner, for your friend.

And, and the what bothers me again, kind of about the culture. So we just don't ask this question about ourselves enough, like what is actually a win for me as opposed to what I'm [00:55:00] told the win is through TikTok or a movie or what my parents tell me. A win is. It's also what a win is, is gonna evolve with your life stages, right?

So before you have kids, it looks like one way, or in this job it looks in one way, but in the next job it looks like something else. Or you know, as your circumstances change, your priorities probably are gonna shift a bit as well. And that's how it should be, right? So sometimes we say this is a goal for me, but not right now.

'cause these other things are a goal. But maybe if things change then that is gonna go up the list before we run out of time. I wanted a couple, I wanted to discuss a couple of New York Times articles that I've, I've read about A DHD, seemingly it's a bit strange, both written by the same person Paul T released on the same day.

I'm not sure if this is correct, but that's what I found. Uh, one of them have we been thinking about A DHD all wrong. And the second one, five key takeaways from new research [00:56:00] about A DHD. They're both, you know, suggesting perhaps new ways, modifications. To the ways we have been thinking about A DHD. Have you read these articles?

Do you have strong thoughts on them? I have read them and I do, as many of my colleagues do, I do have strong thoughts. Um, I mean, the thing that's, it's, it is, I have to admit, like New York Times, I've the alt utmost respect for, I don't know what happened on this article. I don't understand how this got by because all of this like quote new stuff, this new thinking, it's all old thinking like this is decades old.

He's just, he's parroting the old Scientology antip psychiatry anti-medication nonsense from like 30 years ago. And the thing about it is. The, the first article is a big article. It was in New York Times magazine. It takes like 12 minutes to read. So here's the thing, this guy [00:57:00] absolutely did his research, right?

It wasn't a 200 word blog post that he just whipped something up, right? He absolutely did his research and yet he said many things wrong. And he said some things in a very suggestive way and intentionally omitted other context information that would change the interpretation of what he said. So all of this to me says, I think indisputably, he had an agenda.

And he very much wrote to that agenda. He did not come in in a neutral way of like, let's see if there's something here. Right? So there was very, very clearly an agenda to undermine the validity of the diagnosis to say that it's being over-diagnosed to say that medication's being over-prescribed. And also by the way, we don't really understand whether medication is safe or effective.

And all of that is completely untrue, right? Like there's a lot of things sort [00:58:00] of that he said that are just either patently false or just clearly misleading. Like there was an intention to mislead in the way that things are said. And, uh, you may not really have an answer to this, but do you have any intuition as to what the, the agenda is or the motivation is to sort of undermine the.

The, the validity of any of A DHD in this way. Yeah. And that is exactly it. It is exactly, it is undermining the diagnosis, the treatment, and I don't know what to offer instead, but it's, you know, not helpful. Yeah, I feel similarly, there's a book just that just came out by Susan O'Sullivan, who we've actually had on the podcast and we invited her back and we're awaiting a response and it's called the Age of Diagnosis.

And it's covers many things including a DHD. I think there are important points to take into consideration in that book. [00:59:00] And also, uh, in the article. I think the things that I think are important is sometimes it's very difficult to, to, to make the call. Is the diagnosis, is the diagnosis appropriate or not?

There, there are cases where it's very clear to not make it sometimes ca a lot of cases where it's very clear to make it. There is a gray zone of people with traits and it's, there is a subjectivity to the diagnosis in those situations. Uh, and I think that being the case, we should start, this is my personal opinion, start to think of a DHD as more of a spectrum, more along the lines of autism.

Then as a Yeah, categorical you. 'cause right now, officially it's, you either have a d, h, D or not. And I just don't think that reflects the, the reality. And it's abso, I mean it is 100% a spectrum, but so is anxiety and so is depression and so is blood pressure and so is lots of things. So like in the real world, that occurs on [01:00:00] a spectrum.

But in terms of how we make a diagnosis and how we treat it, we kind of need to say, yes you have it, or no you don't. If we're gonna do things like, it seems like medication is warranted, but like, you know. Again, it's the same thing as high blood pressure, right? What we know from the research is above a certain level, blood pressure becomes dangerous to one's health.

And that's the point where we say, okay, diet and health changes are not enough. Maybe we need to consider a medication. So like blood pressure is 100% on a spectrum and yet we still diagnose it and treat it and research it and you know, so I don't have a problem with that. The second point that I do like to mention to patients, I do like to tell them that, you know, right now we don't have a biomarker, like a brain scan or a genetics test or a blood test that we can do to confirm or dis-confirm uh, A DHD.

Just because I think like often the way [01:01:00] patients describe it, they say, you know, I'm getting tested. Whereas actually it's not a test. Exactly. I mean, they do some, some standardized scales and it's a clinical interview. I think patients should, we should be transparent with patients about. The lack of biomarkers.

So they're aware. I think it's an important thing to be aware of in mental health in general. Yeah. Um, and then maybe the last thing that I took away is I also think we should be transparent about the uncertainty of the effectiveness of medication over like a, over the long term, like beyond two years, three years, plenty of evidence to show medication is effective within a two, three year timeframe, but beyond there is more uncertainty.

So those, those are things that I think those are PO points worth making. Mm. Yeah. But the uncertainty, it's, it's not that research shows that it is not effective is very different from saying we don't really have good research that shows either way. Right. But here's the thing, whatever [01:02:00] the research on group averages shows as an individual, we always treat the individual.

I. Right. So for you in this moment in your life, how are you doing? What's going on? Do we need to make changes? Do we stay the course? So, and there's also plenty of things an individual can do. Like, for example, take breaks from medication. Like they might take medication for a couple of years, take a couple of years off and then come back to it.

And that could help. Um, they might, mm-hmm. They might take a break when things are actually going more easily in their, in, in their life. And then use medication perhaps for periods which are more stressful. So there's all sorts of things which can be applied to the individual situation that can help.

It's very strange how when diagnoses and medications come into picture, come into the picture, there's all sorts of like, it inspires a lot of moral conviction and a lot of moral Yeah. Reactions. And I don't know why it happens to be happening with A DHD now more than with other things. Perhaps that's just because.[01:03:00] 

You know, A DHD is being talked about more. I'm not sure if you have any strong opinions on this. Yeah. But it is true people, people have strong opinions, but strong opinions doesn't make it true. I could look out my window and say, I 100% believe the earth is flat, because when I look out it's flat. Doesn't make it flat.

No matter how strongly I feel that, and no matter how much my eyes tell me that, right? So like having an opinion is nice, but the world is what it is. Facts are what they are and science tells us what science tells us. So, you know, let's not confuse this. And I think that's a good analogy. 'cause the people talking about these opinions usually aren't clinicians who have worked with A DHD much generally.

If you've worked with a DHD much, you're like, yeah, I see the same picture clinically over and over and over again. Wow. Do these problems. Need some focus and some treatment. You know, pro, you know, other problems priced in. [01:04:00] It's a really important population of people to treat. We're out of time. Ari, thank you so much.

It's been wonderful to speak to you. Thank you for coming on. My pleasure. This was great. Always happy to talk about this stuff.