Attention Deficit Hyperactivity Disorder, commonly called ADHD, is a neurodevelopmental disorder which effects your ability to maintain attention on the appropriate stimulus or task. There are considered 3 subtypes, inattentive, hyperactive and a combination type.

 

It is theorized that a person with ADHD creating absorbing or managing dopamine in the brain and so they rely on stimulus from their environment to jumpstart that process.

 

ADHD is a disorder that often has comorbidities, including but not limited to: depression, anxiety, autism, oppositional defiant disorder, obsessive-compulsive disorder, learning disabilities, and tic disorders. The symptoms of these disorders and ADHD work in feedback loops that affect each other greatly. It can be challenging to determine the chicken and the egg when thinking of goal areas and appropriate interventions.

 

ADHD greatly effects a person’s ability to manage their emotions, which has real life implications beyond just emotional outbursts. Below are some examples what may be happening under the surface of an emotional outburst:

 

  • Difficulty with identifying how one’s behavior effects themselves or others.
  • Poor processing of their internal sensations.
  • Challenges controlling impulse to react to adverse physical, mental or emotional stimulus.
  • Difficulty initiating non-preferred or challenging tasks negative associations.

 

Continued negative experience surrounding a task, place, routine, or person creates a learned behavior to avoid the negative stimulus. This is a common experience for all people but is amplified for those with ADHD. Sometimes in order to overcome these negative emotions a person will have emotional outbursts, sometimes they will a continuous stream negative thought, sometimes they will become frozen and avoid the thing entirely. ADHD specialist, Brendan Mahan describes this phenomenon as the “Wall of Awful.” Each brick in the wall is made up of failure, disappointment, worry, fear; all negative emotions.

 

It is essential to manage emotions prior to attempting to do this thing that has such a negative connotation. Eliminate the negative emotions by providing a jumpstart of dopamine to the brain. This may look like playing a pump-up song prior to doing the dishes (my favorite is Pump Up the Jam by Technotronic). Below are some strategies to help climb the Wall of Awful:

 

  • Urgency: Create a sense of urgency through time limits, timing how long a task truly takes. This works especially well with tasks that are repetitive.
  • Prep stimulus: Engage in a positive stimulating experience to get primed to complete a lesser preferred task e.g. exercise, listen to music, tactile play, (even more brownie points if you can include the stimulus amongst the challenging task).
  • Novelty: Make an unpreferred task into a game e.g. fold the basket of clothes faster than a sibling. Try completing the task in a new place, type with a new font, write with new gel pen, etc.
  • Rewards: create a plan and a goal for completing a certain amount or duration of a task then provide a reward e.g. candy, extra play time, a new art supply, etc.

 

This strategy can be effective for many diagnoses or someone without a diagnosis. A key factor to making this strategy work, or any strategy work, is checking in regularly to determine what is serving you, what is having no affect and what is a detriment. Good luck climbing your walls and please reach out to your occupational therapy provider for more information on the Wall of Awful and other strategies for emotional regulation.

By: Sydnie Waschbisch, COTA/L