“What to do when you don’t feel like doing it.” Task initiation in ADHD.

In my role working with individuals with ADHD, I commonly hear from patients who are perplexed by a repeating pattern.  They understand that there is an important task at hand.  They may need to write a report for work, schedule a medical appointment, or plan a family reunion.  Though these tasks may seem very important, they may also feel it is very difficult to get started.

The folks I work with have described problems with task initiation in many different ways.  They describe how they are “trying to run in quicksand,” or “feel weighed down,” or that they feel “too tired to do anything.”  They all point to the phenomenon of wanting to do something important but also feeling the pull of avoidance.  While this is a common experience that many of us have from time to time, those with ADHD may have this experience more often and intensely than most people.

The benefit of ADHD skills training is that it helps implement the tools that can help address some of these kinds of problems.  Many who receive medications for ADHD do report an increased ability to focus when they want to and more energy to devote to tasks.  However, medication alone will not address unhelpful strategies for managing one’s responsibilities.  Skills training helps a person identify what their organizational strengths are and what areas they might need to develop.  Trying to address the problem of task initiation is one of those areas that effective skills can begin to address.

Visualizing Time

Many of the tools I commonly recommend in skills training aren’t revolutionary.  Most people have tried some kind of organizational system including a calendar, agenda or to do list.  How these tools are implemented makes a substantial difference in how useful a person finds them and whether they can develop consistency with them.

For instance, a calendar system can help visualize time, which can help individuals make better decisions about time management.  A common response many have when faced with an undesirable task is assuming that this task “could be done later.”  This is usually a quick judgment made in the absence of concrete information, such as “when do I want to commit to doing this,” “what other commitments do I have,” or “how long do I believe this will take?”  Maintaining an effective use of a calendar and reviewing it regularly helps counter this tendency by keeping one’s commitments more front-of-mind and thus being less likely to make errors in scheduling.

Make Starting Easier

Another strategy includes breaking down tasks into more manageable parts.  This is, again, not a ground-breaking approach to organization, but one that can easily be overlooked, nonetheless.  Many of us engage in some measure of avoidance for tasks that we believe are complex, time-consuming, or dull.  We also may underestimate how complex tasks are because we haven’t thought through the little details.  Understanding the small steps that consist of the larger task help guard against both of these errors.

I often use the example of baking a cake to illustrate this idea.  It’s possible that you could add the item “bake a cake” to a to do list.  Some may look at this task and experience a reflexive sense of dread, wondering how or whether they will be able to produce something edible.  In this way, we’re experiencing a form of task avoidance.

You can break the task down by asking yourself “how would you instruct a child to begin completing this task?” or “What would be the very first things you would do to begin?”  This usually results in an action that seems a bit more reasonable (e.g. “Identify what ingredients the recipe calls for,” or “Get eggs and milk from the supermarket.”).  A good rule of thumb I usually recommend to my patients is that when they look at a to do list item and think “oh, that seems easy enough,” it is usually broken down into a small enough task.  By doing this, we’ve moved from that sense of dread at doing the big, scary, and ambiguous thing (bake a cake) to task initiation when faced with a manageable one (get eggs and milk).

How we use and think about time can also help make starting easier.  For some, setting a discrete block of manageable time can help in getting started.  For instance, planning to start a task for 5 or 10 minutes may seem reasonable enough to allow someone to begin working.  For others, blocks of time like this can feel arbitrary, and they may benefit from thinking in terms of a common activity that they usually find easy and not time consuming.  This could be “the time it takes to fry an egg” or “the time it takes to get to the supermarket” or “the time it takes to walk two blocks,” or “the time it takes to listen to 2 songs.”  Any of these strategies can help break time down into more managable parts and help promote task initiation

Changing How You Think

Now you may be thinking to yourself “none of these tools seem all that difficult,” and when taken at face value, they do seem relatively simple and intuitive.  However, many still struggle with the use of these tools.  One of the major reasons why people struggle with implementing these tools or using them consistently is related to our thoughts, predictions, and expectations.

The role thoughts play in organization are a significant point of emphasis in my approach to skills training.  It is a core feature of Cognitive Behavioral Therapy (CBT) for ADHD which posits that while learning certain organizational skills are necessary important, equally as important is understanding how we think about organization and the circumstances around it.

A CBT-based approach assumes that we are constantly trying to make sense of the world around us, and we use automatic thoughts to help us interpret our world.  Often these quick judgments, predictions or expectations are helpful and accurate.  Other times we might be engaging in some errors or biases in thinking that are worth evaluation and correction.

Take for instance someone who would like to use a to do list more often but believes that “they’ll just give up anyway” so it is “pointless to spend all that time” forming one.  It’s possible that this person is jumping to conclusions about the prediction that they will “give up” on the task quickly.  It’s also possible that a person assuming a to do list is “pointless,” is engaging in some all-or-nothing thinking about the activity.  This person seems to be dismissing the possibility that they 1) will use that list in some form and 2) that even inconsistent use of such a tool could prove useful to them.

This is just one example of how our thoughts, predictions and expectations play a role on how or whether we use organizational skills well.  There are many other ways in which the way we think about these skills could help or hinder our ability to navigate our responsibilities.  Individual skill training can help identify the way you approach these problems and help make modifications to improve your ability to be as effective as you’d like to be.

Conclusion

In total, many of us can recall times when we had a terrible time getting started on something important.  Skills training can help with situations like this by focusing on not only implementing skills that can help make initiating tasks easier but also by focusing on how we think about organization to ensure these thought processes are accurate and helpful.  CBT-based skills training aims to target both of these areas to improve your ability to get and stay organized.