Organizational Techniques

    Frequently, adults with ADHD complain of chronic disorganization at home and in the workplace. The home is often cluttered with unsorted piles and unfinished projects. Bills are often paid late. Appointments are often forgotten. At work, the desk is often invisible under piles of unfinished paperwork. Meetings and appointments are missed and productivity standards are unmet.

    Teaching organizational skills is one of the most important components of psychotherapy with ADHD patients. There are several important keys to becoming more organized, all of which are emphasized in psychotherapy. First, we recommend to our patients that they use a structural system to help them organize their time. Helpful items include day planner books, family calendars and electronic organizers.  

    There are two ways to use a scheduler:

    1.  Write in appointments.  This methods serves as a reminder of where you need to be and when. This is the most common way people use their day planners..........a list of reminders.  It's a very poor ad inefficient way to manage time.  Time management is critical to optimal productivity and stress reduction.

    2. Write in your tasks according to time slot.   You entry all the tasks of the day into the time slot it will be done.   For example, morning bathroom routine gets assigned to 7 to 7:20am, breakfast 7:20 to 7:45am, drive to work 7:50am to 8:30am, meeting with supervisor 8:30am to 9:30am, etc.   You'll find that there are free time slots  during the day.  These slots don't need to be filled.  A little down time is needed and prevents you from feeling overbooked and a prisoner of your schedule.  However, we all have unexpected requested and tasks that can be put in free time slots.  If you find that a large   number of tasks are being requested, you need to defer to the schedule to see " if it will allow me to say yes" to a request.  This method will help you avoid say yes out of guilt or sense of responsibility.  Because is there is no time in the schedule to do the task, your response is "I'm sorry.  I'd like to do it but my schedule will not permit it." ( You've heard other people say this.  Now you know why.)   Thus, you can prevent being overcommitted and overwhelmed. 

    This method addresses and achieves a more efficient time management goal.  When you enter the tasks into a time slot, you eliminate the decision process of "what will I do now?".  Instead, no decision need be made because the schedule to tasks tells you what you will be doing next.  When you eliminate the decision of what to do, you diminish the chance that you"ll make that decision based on what you feel like doing at that moment.  Decision making that rests on how you feel at the moment is the cornerstone of impulsivity.

We encourage our patients to allow time at the end of their day to plan the next day. We encourage prioritizing and breaking tasks into small, manageable steps.

    There are several steps to establishing the prioritization of tasks.   With a long TO DO list, it's necessary to decide which tasks get done first.   Tasks are assigned to several categories:

1. Work vs  home: Be careful to assume that work always comes first
2. Level of difficulty/time necessary/resources needed: Can be done in a short or long period of time
3. Time deadline: By the end of the day, within 3 days, within 1 week, within 1 month( these time frames are arbitrary, you can set them the way you need them)
4. Want to do vs need to do: You can decide to do what you want but it may come at the cost of not doing what needs to be done.  With this system, you make this a very conscious decision and can't fool yourself when saying "How did this happen?"

With your task list in hand, grade each task in each of the four above categories.   It becomes quickly evident which tasks need to be assigned the highest priority( tasks that need to be completed by the end of the day).  Then tasks are assigned to be done within 24 hours or within the week.  As with an overbooked time schedule, you will clearly see that you're overextended which you have more "priority one" tasks then there is time to complete them within the day. A compassionate attitude towards self is encouraged in the setting of realistic goals.

Routinization is the behavioral equivalent of doing several small tasks in the small sequences every time they're performed.  The benefit is that you don't have to think your way though the tasks.  Think about your morning routine.  Generally people do this in the same sequence each morning.  If you didn't, you'd have to consciously remind yourself to shower, brush teeth, brush hair, use deodorant, put on make-up, take medicine, put towels back, etc.  It may be a lot to remember and you haven't even left the bathroom. 

Breaking behavioral tasks into routines is very efficient.  Such routines occur in the morning (bathroom, dressing, breakfast, leaving the house), after work( dinner preparation, dinner and clean-up) or bedtime( bathroom, reviewing tomorrow's schedule).   these are examples of common routine times.  Your schedule may have additional routines.  The secret is to do the routine in the same order each time.  Make a list of the small tasks for each routine and put the tasks in an efficient order.   It's best to retain some of the sequence already done.  Put the list of tasks ( in their sequence) in the room the routine occurs.  Now, when you perform the routine, do it in the listed sequence.  If you forget, refer to the list.  In thirty days, it will be a routine and less thought will go into performing it. 

    Other helpful hints include assigning specific places for important items, such as keys and bills.  It can be hard to remember this so post signs to remind you.  Visual cues (signs) are very important to changing behavior and thereby establishing the routine.   Visual cues can be post-it notes on the bathroom mirror, refrigerator, car dashboard, or 3x5 index cards in your breast pocket to refer to during the day. However, don't over "post-it" yourself.  The visual cues are only effective if they draw your attention.  Be careful, too many notes creates visual clutter which gets ignored.

    As the visitor to this website, you can go to our recommended booklist for several excellent books on adult ADD which highlight good organizational skills. Many patients, however, find that they are more receptive to problem-solving psychotherapy sessions than they are to books.  The interactional style of therapy offers specific information on your personal difficulties.  Although helpful, people with ADD may found it difficult to stay focused when reading books.  In therapy, "the tricks" can be tailored and modified to your specific situations and learning style. Of course it should be emphasized that with optimal medication treatment, the patient’s ability to focus on problem-solving organizational skills will improve considerably.

    It is vitally important for the therapist to offer hope to the patient. It also important to adjust the expectations of the patient and his or her spouse or partner so that the patient gains a sense of accomplishment and mastery. In behavioral terms, positive reinforcement contributes to improved self-esteem.  In this case, postive reinforcement falls into two catagories: positive feedback from others and a personal sense of mastery over a task or situation.  It is very important for the therapist to stay one step ahead and anticipate the next organizational problems to be tackled. Another resource available to our patients is an organizational consultant. . This individual will visit the patient at home and/or at work in order to help devise a customized organizational system. Our center has such a consultant available for our patients.