Accountability, Nagging, and Exercise

Ari Tuckman PsyD, MBA

 Attention Magazine Spring 2017

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Does group therapy work for adult ADHD? I have a sneaky suspicion that I could make a lot of progress if I had a group helping to keep me accountable.

There has been research showing that certain structured, skills-based groups can be helpful for adults with ADHD. Part of the reason for that success is exactly what you suggest–the accountability to your fellow group members can help keep you on track and working on things in between groups. Mary Solanto, PhD, found that one of the best predictors of benefitting from her therapy groups was how much homework members did in between sessions. Members also benefit from the ideas, strategies, and support of their group mates.

It can be challenging, though, to find a group that meets locally and at a convenient time. More and more coaches are offering online groups that make it much easier to attend, however. The challenge with an online group will be less accountability than meeting in person.

Like everything else, what you get out is based on what you put in, but a group can be another great option to help you be more successful, especially if you really benefit from that social aspect.

Ari Tuckman, PsyD, MBA | Psychologist | Author, Understand Your Brain, Get More Done (2012) and More Attention, Less Deficit (2009)

My roommate has ADHD and sometimes drives me crazy with her disorganization and leaving things out. I don’t want to become like her nagging mom, but I also want to feel comfortable in my apartment. How do I work this out?

It sounds like you already understand that these behaviors are manifestations of ADHD and not of bad intent. Nonetheless, they’re frustrating and need to be addressed. Simply requesting that she put things away doesn’t work, however, because ADHD brains don’t process organization as other brains do.

The most successful approach offers concrete solutions, even if they seem obvious. She’ll likely benefit from organizational suggestions like, “Maybe you can store all your cosmetics in a container in the bathroom, in a plastic box or basket that would fit on this shelf.” You can help her create structure by saying, “I know you don’t always have time to put things away, but maybe you can toss your things in this basket [in a living room corner, for example], and then you can put them away whenever you have time, and they’ll all be here if you’re looking for something.”

It’s important that these are dialogues so she can air any frustrations with your behavior as well. And, of course, you have to choose your battles–first address the two most problematic issues, and suggest monthly check-ins to see how it’s working for both of you. Ideally, you’ll both feel heard, respected, and able to admire your progress together.

Ellen Littman PhD | Clinical Psychologist | Coauthor, Understanding Girls and Women with ADHD (2015)

I find that my stimulant medication is helpful, but I worry about taking it when I am going to exercise. Is this something I need to be concerned about?

The answer to your question depends on a number of factors: age, frequency of exercise, duration of exercise, intensity of exercise, smoking, caffeine supplementation, or other medications. Putting those factors aside, the research on stimulant medications and adult ADHD shows a three-to-five-beat increase in heart rate and a 3–5mm change in blood pressure. These changes are clinically insignificant.

For exercise, however, it has been shown that the elevation in blood pressure and pulse decline at a slower rate after exercise while on stimulants versus off stimulants. If you are involved in intensity training (short burst of high intensity exercise followed by brief rest then high intensity again), this causes exercise exhaustion to occur sooner.

As a consultant to the National Football League and athletes in Division I college sports, I have seen this issue. For most people, the stimulant medication is not a risk for an exercise program. I might recommend a pulse monitoring device while exercising, and that you adjust the exercise intensity depending on your heart rate. Also make sure you adequately hydrate before, during, and after exercise. If you experience chest pain, lightheadedness, and/or fainting, please review this with your prescribing physician.

David Goodman, MD, FAPA | Psychiatrist | Director, Adult Attention Deficit Disorder Center of Maryland, Baltimore

Ari Tuckman, PsyD, MBA, is a psychologist, author, and speaker. He serves as a member of CHADD’s board of directors and co-chair of its conference committee