Thursday, December 16, 2010

Gift Ideas for the Distracted Person in Your Life

An attendee at a Lansing area workshop a couple of months ago told me about the Smartpen. I tweeted about it without actually having had a chance to look at it myself. So I was psyched to meet someone who was actually using the Smartpen to take notes at a recnet Lend Me Your Brain workshop!

There are a number of time/project management tools for distracted students and adults. One that's caught my eye recently is Skoach. Anybody have experience with this one?

The Pomodoro Technique is a sweet way (it's a plastic timer shaped like a tomato!) to take advantage of "chunking." The idea is to commit to a period of uninterrupted work and then commit to a break.

I was first sold on "chunking" a few years ago after reading Dave Lakhani's The Power of an Hour, and use something a bit simpler - a plain kitchen timer.

photo: i love you

Positive Psychology in Australia

I'll be working with TATRA Training in May 2011 to highlight what we've learned from a decade of Positive Psychology research.

8 workshops are scheduled across Australia!

photo: australia

Tuesday, December 14, 2010

New Journal - Developmental Cognitive Neuroscience

A new scientific journal on brain development launched in November.

Here's a podcast that summarizes that issue.

Monday, December 13, 2010

The Dangers of "Mental Retirement" -- Our Brains Need to Solve Problems!

Freelance writer Sara Rowe recently posed some questions about dementia for an upcoming project. Here are some of my responses on that topic:

Q: What causes memory loss (both in the form of diseases such as dementia and in simple situations such as where you forget where you put your keys)?

A: Some decline in memory functioning is normal over the lifespan. A neuropsychologist can identify "normal age-related changes" beginning in the seventh decade (patients who are over 60). But these should be slight changes and not the sort of forgetfulness that has real functional impact. Frank forgetfulness is not normal in older patients and should not be dismissed. Among older patients, memory complaints may be related to reversible causes or more serious and progressive decline (dementia). Common reversible causes of forgetfulness among older adults include poor B vitamin absorption, sodium imbalance, and sluggish clearing of medications. Progressive memory decline is typically related to two common types of pathology: vascular changes (tiny strokes or insufficient blood and oxygen supply to brain tissue) and abnormal protein plaques and tangles. When the plaque-and-tangle changes are significant, doctors call that Alzheimer's disease.

And even among healthy older (and not so old) adults, transient forgetfulness may be a red flag of stress, depression, or overwork. Some people notice that after a poor night's sleep, or a night of drinking too heavily, they experience memory lapses and word-finding problems.

Just over 70% of the human brain is dedicated to "what is." We take note of the room temperature, what people around us are wearing, the nature of things as they are. The rest of our brain - the prefrontal cortex - is all about "what could be." I could end an unsatisfying relationship. I could move to Phoenix. I could move the piano over there so the door could open more easily into the room. The prefrontal cortex is the home of all that is magic about human cognition. And when our lives fall into a rut of predictability - when we're not solving problems and asking "what could be" questions, we run the risk of declining cognitive efficiency.

Q: What exercises/activities do you recommend to patients to sharpen memory and prevent or delay the onset of dementia etc.?

A: Several lines of research are coming together to suggest that complex mental activity is associated with reduced dementia risk. Cognitive Training refers to prescribed sets of mental activities directed at sharpening memory skills, reasoning, and speed of processing. Informally, many clinicians have encouraged their older patients to “stay active” by keeping their brain busy with crossword puzzles or Sudoku.

But in a recent study, Susann Rohwedder and Robert J. Willis discuss what they call "mental retirement." In the winter 2010 issue of Journal of Economic Perspectives (Abstract here and NY Times article here), Rohwedder and Willis suggest that retirement from vocational activity is associated with measurable decline in cognitive ability. There may be something about work that stimulates and protects the brain against age-related decline. And that may be something that crossword puzzles and Sudoku can't approximate. Vocational activity is an excellent cognitive workout. Work presents the brain - the whole brain - with sensory demand and motor planning challenge and time management and nuanced social problems.

My advice to anyone concerned about his/her memory is first talk with your doctor. She may ask questions and chart changes over time, or may refer you to specialists for further evaluation. You and your doctor will also try to stay on top of risk factors for memory decline: monitor and regulate blood sugar, maintain normal blood pressure, and keep cholesterol in check.

Meanwhile, the type of "brain exercise" I recommend is activity which is as organic and real-life as possible. If your life is not busy enough to require an alarm clock and a planner, then you are not busy enough to maintain brain functioning. At least 5 days a week, you should have a specific reason to be out of bed, dressed, and out the door. You should have enough going on that you need to keep a calendar to keep it all straight. You should be interacting with people who are a lot like you as well as people who are so different that you have to struggle a bit to figure them out. You should be solving problems every day. We need to avoid drifting into nostalgia and reminiscence; we need to keep imagining "what could be." That's what keeps our prefrontal cortex tap-dancing. Social problems, traffic logistics, travel planning, meal preparation....all of these give your brain the workout it needs to stay healthy.

The emerging concept of neuroplasticity recognizes that experience shapes our brain. Literally, at the level of the cell and synapse and brain structure itself, our daily learnings are shaping our brains. And although our brains don't regenerate as quickly and thoroughly as skin or even bone tissue, we do now recognize that the brain makes effort to heal itself and adapt to ongoing changes. At the risk of sounding trite, "use it or lose it."

Here's a real life story that illustrates the point (with identifying information changed of course!) Marion was surprised to find how dull retirement was. After looking forward to early retirement for several years, she found herself physically healthy but, at age 58, not as busy and engaged as she'd been while working a clerical position at a community college. She began to notice minor aches and pains and checked in with her doctor about these. She'd had checkups but had never had many complaints before, and her doctor questioned clinical depression. Marion complained of some amotivation and malaise but no real sadness. She did confide with her doctor, though, that she'd begun to worry about her memory. She slipped up with words that “I ought to know” and misplaced items in her apartment. She later recalled that she had started to see herself as “old,” and didn’t put much effort into grooming or maintaining her wardrobe. She’d been dedicated to her work at a local college and without that piece of her life, she realized she didn’t have many social outlets.

Marion responded to an ad in a local weekly paper to volunteer as a “baby cuddler” in a neonatal unit. The hospital was about a half hour drive from her home which she didn’t mind if she left early enough in the morning. She loved holding the newborn babies and felt relieved that, because this was volunteer work, there was no pressure to perform. But there were other mental challenges. She now describes her surprise at the cultural diversity and the different personality types among the staff and other volunteers at the hospital. Her coworkers at the college had all been “pretty much like me.” In her volunteer work, Marion found herself navigating social challenges, avoiding “putting my foot in my mouth,” and trying to coordinate her schedule to avoid working with one particularly bossy and overbearing nurse. Most of the staff was younger and Marion loved hearing their take on movies and politics and popular culture. They teased her about dressing “frumpy” and she began to take their advice and tips. To save money, Marion packed a lunch. And this meant planning ahead, prepping the night before, and coordinating grocery shopping around her volunteer work. She began to take delight in the little day by day prizes – finding a secret parking spot near the hospital back entrance, finding the coldest soda machine in the building, and picking up a few words of Portuguese in her conversations with one of the hospital staff members. Within weeks, Marion reported that her memory seemed “back to normal,” and she even felt less focused on physical aches and pains.

For folks who are approaching retirement, then, I'd recommend considering how to keep up the kind of mental workout that vocational activity involves. For example:

Active involvement in caring for grandchildren

We need a specific reason - and deadline - to get out of bed in the morning. We need the challenge of having clean and pressed clothes ready. We need to interact with easy as well as difficult people. Our brains need problems to solve!

Sunday, December 12, 2010

Regional Variability of ADHD Diagnosis

I'm meeting clinicians in North Carolina this week and was interested to learn that is the state with the highest rates of ADHD diagnosis.

An expert in a recent article attributes this statistic suggests that heightened awareness among families, and better diagnosis by professionals.

And that's almost certainly part of the story here. But when we consider the state-by-state variability of ADHD diagnosis, or of stimulant therapy, there are likely other factors at play here. We notice, for example, an Eastern bias towards making the diagnosis.

This regional variability is an issue we touch on briefly in the workshop but I'm interested to hear the thoughts of my colleagues in North Carolina next week.

photo: psychiatric news

Friday, December 10, 2010

The Best Part of My Morning

My favorite moment of the day is my morning journaling practice. Three or four days out of the week I'm able to get to it. I have coffee, read a couple of newspapers, then open my journal. My practice is based on themes in the Positive Psychology literature.

I clarify some specific gratefulness, I remind myself of what I like most, and I commit to some specific way of being kind to myself and another person that day.

And my favorite moment is usually five or ten minutes into the practice when I feel a shift, like I'm settling down a bit more deeply into myself. Kind of a "oh yeh, that's why I'm here!"

This practice is, I think, part of my ongoing challenge to maintain a spiritual life. I got an early start, growing up in a minister's family. But the "pull" or the gravity of my life is to the dry and dusty details of daily commitments and tasks. I want to keep it juicy and alive. To feel the pulse of it all running just under the surface of the visible and quotidian.

Here's a link to my journaling template if you'd like to try it.

photo: january first

Thursday, December 9, 2010

Intrinsic Motivation! Magical Unicorns! Serial killers!

Elizabeth Báthory was a Hungarian countess who tortured and killed over 600 girls and women in the early 17th century. Clearly this was an individual with some disordered motivations. Ideally we'd like to see her develop empathy and other pro-social intrinsic reasons for not serially brutalizing others, but if the best we could do were keeping her behavior in check with extrinsic reward, well I'd settle for that. I really wish her parents had offered her music downloads or candy corns or 20 minutes past-bedtime play for every day she could go without hurting someone. more at my Psychology Today blog

Wednesday, December 8, 2010

The Body Double

ADHD Coach Linda Anderson discusses the role of the Body Double here.

And there's a very helpful discussion of the Body Double concept in a BlogTalkRadio show from earlier this year right here

I've got a theory about how this's the same way stimulant meds work. They "increase the saliency" of difficult or dull tasks. That is, at the brain level, one is more "in touch" with the medium- or long-term payoff of the activity.

Which is exactly what a good teacher or ADHD coach does! You know how organized and efficient you are the day before vacation? That deadline "increases the saliency" of work activities - even those which are dull or hard.

And you know how students tend to "tighten up" their behavior as the teacher moves physically closer to the student? As entertaining and rewarding it is to misbehave, there are rewards that I want even more than that....and the proximity of the teacher puts me in touch with those rewards (avoiding detention hall, or being seen as a "good kid"). That proximity "increases the saliency" of sticking-to-the-ground-rules in the classroom.

So my theory here is that the presence of the body double functions like that looming deadline or that nearby teacher...the Body Double increases the saliency of at-hand tasks.

I'm going to be kicking this around with clinicians who work with ADHD clients. And I'd love to hear from ADHD coaches out there!

photo: astronaut twins

Q & A: Homework Challenges

Here's a question from a recent participant in the ADHD and Processing Disorders workshop.

Q: Any suggestions for parents who struggle with homework issues with their ADHD children?

A: Our first piece of work is to determine where the student is breaking down. To ask "what's the kid's deal"? And to encourage parents to direct support to those points of performance.

In order for homework to get "done," a number of things have to happen. So when homework is not done reliably and painlessly, there are a number of common points where the project goes awry. The student might, for example:

Fail to write down assignments

Forget the assignment book

Forget necessary materials

Have trouble with the "getting started"

Take hours to do minutes of homework

Hassle parents about when and where to do homework

Lie about having done homework

Need constant supervision with homework

Forget to bring homework back to school

Our intervention will depend upon the student's specific way of not getting the homework done. The student with problems "getting started" might need strong incentives up front. And once he's actually dived into the task he might be more independent.

The student who gets the homework done (usually with good parental supervision) but who fails to get the material turned in the next day needs support with that piece. Faxing the homework to the school office in advance might help, or attaching the work to an email which can be opened, and printed at the school computer lab might be a fun way of getting the material to the teacher.

The student who lies to parents about assignments (I actually hear this complaint fairly frequently) is in a tough situation. She's doing something fun, or at least benign. And Dad asks whether she has homework. Now if she says yes to that question she will have to stop doing something fun and do something less fun, possibly even something hard. It's almost a set-up to tell a fib. I'd rather encourage teacher-parent communication. Some schools have websites for just this type of daily communication about assignments. So parents can maintain an overview of schoolwork there rather than using the student as the primary source of pure truth about necessary assignments which might be dull or hard.

Practical Tips

Ongoing school / parent communication regarding assignments and due dates.

Regular predictable routine regarding where and when homework takes place.

Limit distractions. If your student claims she performs homework better with simultaneous chat/IM or texting, you can definitely inform that in fact multitaskers perform worse on tasks than individuals who perform one task at a time.

Chunk cognitive activities. Commit to working on one single thing for a specified period (length of focused activity will depend on the age of the student). If you like cute, the Pomodoro Technique is a cute way to think about chunking.

Support the “getting started.” If your student has difficulty engaging with even moderate cognitive challenge - they drag their feet, use stall tactics, and so forth, you might consider rewards and incentives which are front-loaded. "I'll give you 4 iTunes downloads if you finish your math homework. And I'll give you 3 downloads just for opening your math text and taking out a pencil." For some students, this strong push to get started might be all it takes. Then, they're moving.

Each of has a specific recipe for success. Likewise we have a specific recipe for not getting things done. Mess with my recipe and you change the outcome. The goal here is find where exactly the homework isn't happening and direct support to that point of performance.

Tuesday, December 7, 2010

Brain: The Inside Story

I can say this to you because you're,'re reading a blog called The Neuropsychology of Happiness. But some of my friends think my excitement about the brain exhibit at the American Museum of Natural History is overexuberant. I cannot wait to see this.

In NYC through August 15, and the perfect excuse to plan a trip there.

Monday, December 6, 2010

Deep Happiness by Design - at Kripalu Center

One of my great pleasures is facilitating a workshop called "Deep Happiness by Design."

The core experience of the workshop is identifying our preferred states - what we need to feel in our body to be motivated and engaged. Each of us has a brain/body blueprint that is our unique recipe for feeling on-task.

And my approach to time management flows from that. In the workshop, we journal to recall great moments and memories. We then identify the "Kodak moment" in these memories and then drill down to the feeling: how it felt in our body to be in the middle of all that. With that self-knowledge we take an honest look at our schedule. Our commitments, obligations, and relationships need to flow directly from our unique motivational blueprint.

During the holidays there are more opportunities than there is time. And we say yes to the right experiences based on this self knowledge of what our bodies most want to feel.

I'll be offering the workshop in 2011 at Infinity Foundation in Chicago, and through the Alternatives program at St James Church in London.

And in just a week or so the program will be offered at Kripalu Center in the Berkshires of Western Massachusetts. There's still time to sign up right here!

Also,the journaling exercises that we use in the workshop are available (and 25% off right now) right here.

Thursday, December 2, 2010

What Kind of Holiday Experience Do You Want this Year?

Think about your overall holiday experience last year. Give it a rating on a 10-point scale, with 1 being miserable and 10 being the best possible holiday experience. Got a number in mind? Now, a challenge for you: What would it take to make this year's holiday experience just one point better?

There may be a part of this that's actually within your control. You might be able to make some changes this year. The commitments and relationships and obligations you pursue over the next several weeks will in part determine whether the holidays will a better experience for you this time around.

Here's a journaling exercise to help you take control of Holidays 2010:
Find a quiet place before you're already in the "thick" of holiday activities. In the morning is good, while the house is still quiet and before the day has started. Take out a journal or other blank paper and make a list of great holiday memories. These could be from last year or 20 years ago. We're talking here about the big memories as well as the tiny little things that made the holidays great for you. See how many memories you can come up with in 15 minutes or so.

Now, identify the one single moment that captures that holiday memory for you. The "click," the sound of a camera shutter catching what was the best about that experience. Try to drill down to the one moment in each of your holiday memories on that list.

Next, identify what you were feeling in that single moment - really try to identify where you were feeling that in your body. If you try to recreate that feeling now, can you "find it" in your belly or chest or around your eyes? What exactly does it feel like?

If you've done this with a list of 15-20 holiday memories then you've identified a number of really great feelings that you have associated with the holidays over the years. And you want more of those feelings, and less of the stress or obligation or whatever might be the negatives that have become attached to the holidays for you. As you consider activities and invitations and commitments over the next month or so you might ask yourself "with which of my core preferred feelings does this connect?"

You might need to be firm and decisive to manage the universe of holiday possibilities and carve out just those experiences that make the holidays great for you.

Hope you feel great this holiday season!

Monday, November 29, 2010

The Best Thing I Had Not Noticed Until Now

Running through the various elements of Positive Psychology is the theme of non-pathologizing. Of looking for the health-promoting quality of behavior. In some older models of human behavior there is a persistent looking-for-the-hidden-negative. A craving for ice cream could be understood as trying to fill some emotional void, or as sabotaging weight loss goals, or as a subconscious response to inadequate breast feeding.

Another way of looking at the same behavior - craving ice cream - avoids pathological understandings and, instead, looks for the health-promoting core of the behavior. I seek out ice cream because it's a treat and serves to remind me that I'm not poor anymore. Or I'm an adult now and can make my own decisions about snacks. Or because eating ice cream feels soothing and good and when I want to celebrate something or if I need to comfort myself or if I need to calm down or if I need to perk myself up, I eat ice cream. I am an agent of change in my own life.

Now at this point someone will likely point out the (painfully obvious) concerns about over-doing it with the ice cream. Identifying the problems of too much ice cream is easy enough. But identifying the positive, health-promoting core of many problem behaviors takes work.

Our brains are specifically wired for quickly taking note of problems and finding dangers. That is a remarkable feature of human neurology and helps protect us. So the work of finding the positive is, in some ways, going a bit against the grain of our brains' typical way of functioning. And it's the modus operandi of Positive Psychology. Thinking like a "positive psychologist" allows that even unhelpful and difficult behaviors may have, at their core, an essentially okay function. Let's try it:

In an adolescent residential program, counselors observe that Vicky is "splitting" the staff. And this behavior makes her less popular among peers and treatment team. But can you find the best thing about this that we haven't noticed yet? To "split" the staff Vicky needs to have been observing and taking notes and figuring out who's the weak link. Noticing what "buttons" she can push to get her counselors all worked up. That takes remarkable emotional intelligence and memory and observational skills! Rather than sitting around a table at treatment team and telling stories of pathology about Vicky wouldn't we rather help her use these skills in a pro-social way that helps Vicky earn friends and income and self-esteem? That will not be easy. It will be easier to simply write her off as a problem resident. But asking questions about "the best thing we had not noticed yet" might actually create its own energy for the work we need to do with Vicky.

Another illustration: Your colleague Steve provides good administrative support and his coworkers like him. He shows up for work and doesn't complain, and is usually available for a bit extra effort during big projects. It's fairly common knowledge that he drinks heavily. He tends to leave work and spend several hours at a bar near his house before driving himself home and going to bed. This pattern is a problem in several different and obvious ways. Is he alcoholic? Is this pattern suggestive of alcohol abuse, or even dependence? Yes, or probably. And he almost certainly needs treatment. But what's the core positive about Steve's behavior here? What has he learned about his own body that might lead to problem drinking? You and I might have 5-10 quick "state change" tricks that are healthy and risk-free. We take a hot shower. Or a cold one. Or you pop in that Bon Jovi CD in you car after a stressful day and play the music really really loud. Or you ask your partner for an extra long hug. We want the same thing for Steve - we want him to have a big bag of self-soothing and state-changing tricks. So if he's feeling bored or lonely or itchy or scared, Steve has a number of behavioral strategies at the ready.

Now try it yourself. Start with a client or a student. Or someone you love. What is their biggest problem behavior? Things would go so much more smoothly if they'd just do more of what? And less of what?

And what's the best thing you'd not noticed until right now? When I ask about the "best thing," I mean just that: the best thing. So let yourself generate 4-5 good things about this problem behavior and then select the one best thing. And then say "good for her/him." And then ask how you might be a part of facilitating their movement towards health and independence and success.

Now let's do this with ourselves. Scan your private experience and identify the one really big problem behavior. The one which, if corrected, could make the biggest difference for you right now. Got it? You can probably generate several pathological labels for it, and you probably would be able to generate a few explanations for why this problem showed up in your life. But sidestep all that for just a minute and notice what's positive about this behavior that bugs you so much. See whether you can keep drilling down until you find a core purpose of the behavior that is praiseworthy, even if misdirected.

This approach starts with a commitment. To the central assumptions that 1)everybody is doing the best that she can, and 2) every behavior serves a function. Are these assumptions that we believe?

Thursday, November 4, 2010

Ask Two Questions

I'm enjoying emails from folks who attended the Lend Me Your Brain workshop yesterday. Many thanks to UMass Med School Disability Evaluation Service for setting that up!

One of the topics we address in the workshop is the business of Asking Two Questions. And that kind of ongoing personal inquiry is possible to the extent that our executive functions are well-developed and trained.

The prefrontal cortex is that part of the brain we believe supports the "executive" functions. The capacities to choose, inhibit, weigh consequences, and delay gratification are executive skills that improve with neurological maturity and are fully on-line in our early to mid-20s.

The executive functions distinguish an 18-year old from a 10-year old. Good executive functioning may also distinguish excellent college freshmen from more average students, and high-functioning middle management staff from their more average coworkers.

Less than 10% of a dog's brain consists of prefrontal cortex. Over a quarter of the human brain, on the other hand, is dedicated to managing these cognitive skills. Essentially, the "older" part of the brain - the part we have in common with most other animals - is responsible for determining "what is." The room is cool, that guy's wearing a red sweater, the cup of coffee is steaming, etc. Mice and turkeys and cats can do the "what is" part pretty well. But humans are uniquely skilled at determining "what might be." And that's the purview of the prefrontal cortex.

That's 25% of your brain dedicated to imagining (creating a mental picture) or self-talk, or otherwise thinking of a reality that has not yet happened. Essentially, the prefrontal cortex works magic. Creates experiences out of pure idea!

So we're walking around with, basically, these two brains. The "what is" part and the "what could be" part. And at our best we're asking ourselves Two Questions.

Those Two Questions are "Am I having fun right now?" and "Is this what I've set out to do"? I'm convinced that each of us is here to do and be and have something pretty specific. And if I'm doing what I'm here to do, experiencing what is mine to experience, I'll be motivated and focused and engaged. And everybody around me will benefit from that, too, just like I benefit from being the people I've known who are truly living On Purpose.

I love it when I'm able to say yes to both those questions. I'm engaged, happy, and aware that I'm doing the very best thing right now.

Often I'm doing something fun or interesting but it's that second question, "Is this what I'm here to do and be and have?" that gets me. There's an episode of "The Office" followed by another episode. And another episode after that. And it's fun to watch that. But at a deeper level I'm fairly sure that watching a lot of TV is not what I'm on the planet to do.

But the toughest answer to the Two Questions is when I'm honestly not having fun (filling out tax forms, waiting in line at the cleaners) but I'd have to say "yes" to the second question ("Is this what I've set out to do?). Because it's important to me to wear clean clothes, and to avoid tax penalties (and avoid jail, and generally be a good citizen!).

If you know anyone with executive deficits (maybe someone with ADD/ADHD or a survivor of brain injury), you might have noticed that this is someone who's much more likely to just ask the first question. "Am I having fun?" is only half the conversation we need to be conducting with ourselves, on an ongoing basis.

Hope you're having fun right now. And hope you're living the life - right now - you're here to live!

Saturday, October 23, 2010

Cutural Competency and Lifelong Learning

After every workshop I teach, I leave with something. A book title, a website, a human story that really illustrates an important point.

And sometimes I leave with a correction, or a dressing down. Or an entirely new way of seeing something that I thought I had nailed down.

A few weeks ago, a workshop participant spoke with me during the morning break. She spoke positively of the way I was addressing some material that was particularly important for her clients, and she affirmed that she was glad she'd decided to attend the training. And then she shared a perspective with me that she thought would complement my own perspective. Something I might be missing. During the workshop I had said something I've frequently pointed out, something along the lines of "we tend to forget how toxic racism is, and the impact that prejudice has on our clients' mental health, because it's so ever-present and constant that we stop noticing it and considering it as a factor in clinical evaluation and treatment." Something like that.

And what this participant shared with me was that as I was making this comment, she was looking around and making contact with a few other attendees. And thinking to herself that she, and other people of color, do not in fact "forget" about the impact of bias and racism. Thinking in fact that "forgetting" this is a privilege that some of us cannot lay claim to. Wondering - to whom might the "we" in my comment refer?

I've shared this story with a few friends and colleagues and hope that this "ongoing cultural competency education" - this gift from a workshop participant to me - makes me an even better clinician and educator with people who are different from me in all the 57 ways that people can differ from each other.

What am I going to learn next?

Tuesday, October 19, 2010

5 Tips for Adults with ADD/ADHD

1. Marry well - pair up with someone who has great "executive skills." And find someone who "gets you" - someone who understands what a partner with ADHD brings to the table. To remind yourself, you might google "positive qualities of people with ADHD" and watch it blow up. You are probably creative, energetic, spontaneous, and fun to be around. If your partner loves that about you, and is better able to do some of the planning ahead, catching details, and goal-oriented targeted worrying, you guys might make a great pair.

2. Get a crackerjack assistant - or see what you can outsource, or see how web-based personal assistant services might work for you, or talk with your supervisor about moving some administrative support your way. What could you do (Carry the pager one extra weekend per month? Clean the break room fridge?) in exchange for two hours per week of clerical services by someone already in the organization?

3. Find a great personal planner or smartphone app, and use it for every commitment, every relationship, and every obligation. A calendar is not a scolding reminder of doctors' appointments. It's your number one tool for making sure that you are living the life you are here to live. With any luck you've got 85 years or so here on the planet. Minus your current age. Multiplied times 365. That's how many days you've got to play with (or work with). Now how do you want to use them, what do you want to do most? Write it down, break it down, and then schedule it.

4. Use a "single in-box." See David Allen's "Getting Things Done" for a great discussion of this. In your work or home office, the single in-box is an actual physical "box." In your planner or calendar app, this "in box" is your To Do list. Yep, the To Do list is a virtual "in box." It's the one place where you write down all the things you need to do, want to do, hope to you. All the phone calls you need to make, websites you want to check out, songs you want to download. One list. In fact, let's go ahead and do it; you know those 4 or 5 things that are banging around inside your head right now? The thing with the snow tires, the email from your sister, the umbrella insurance policy you wanted to check out? Write it down now. And then tomorrow when you're doing your regularly scheduled deep-checking-in with yourself (see #5), you'll review that list and move the most important ones to your calendar.

5. Set your alarm a few minutes earlier every day. Get up. Pull out your planner or your calendar app (both you and your phone are fully recharged at this point), and look at your schedule with an eye towards "what do I want to do with the time I've got today." If you're working two jobs or raising children by yourself you probably don't have too much unstructured time. And so you, of all people, have got to take this question seriously. What am I going to do with the one or two unstructured hours I have on my calendar today? What about that to-do list of everything you need to do, want to do, or dream of doing? (See #4 regarding the To Do list as an "in box"). Which one of those pops out at you right now as the most important? Alternatively, answer this question: What's the one thing that I've been putting off that would make the biggest positive difference in my life right now? So in the morning, before the day has quite started to come at you, sitting there quietly with your cup of coffee, you'll ask yourself: "What am I here to do? To Be? To have?" And you'll determine how your calendar reflects that right now.

Good luck!