Attention deficit disorder, with or without hyperactivity, is still all too often associated with someone who ‘can’t sit still’ or who is unable to concentrate. In adults, the reality can be much more subtle. Difficulties with organisation, time management, sustaining attention or getting started on tasks can play a significant role.
Let’s take a seemingly trivial decision. First, we need to understand what is expected of us. Then we need to find the necessary information. We compare the possibilities. We rule out certain options. We make a choice. Finally, we carry out what we have just decided.
On paper, there is nothing extraordinary about it.
But each of these steps draws, to varying degrees, on what neuroscience and cognitive psychology refer to as executive functions: planning, working memory, inhibition, organisation and the ability to maintain goal-directed behaviour. Research shows that, on average, some of these processes are more challenging for adults with ADHD, although this is neither systematic nor the same for everyone.
This helps to explain a situation which, viewed from the outside, can sometimes seem absurd: someone may have intellectually completed a task before they have even actually started it.
They know what needs to be done. They have understood why. They may even have prepared everything they need. And yet, they do not get started.
This disconnect between intention and action can lead to procrastination, a backlog of unfinished projects, or that particularly frustrating feeling of having put in a great deal of mental effort without producing the corresponding result. Difficulty in getting started on tasks is indeed described as one of the symptoms frequently observed in some adults with ADHD.
The process of decision-making itself also warrants a more nuanced understanding. ADHD does not simply mean ‘taking more risks’. In particular, a meta-analysis concluded that the differences observed were more closely associated with sub-optimal choices than with a general inclination towards risk. Working memory, inhibition, immediate reward and anticipation may all play a part in these situations.
This is why reducing these behaviours to a lack of willpower is often a misinterpretation.
One can be intelligent, creative and perfectly aware of one’s obligations, yet still find it extremely difficult to turn an intention into consistent action. Conversely, one can be extremely effective when an activity sparks sufficient interest or stimulation.
The real issue, therefore, is not simply: ‘Do I know what I need to do?’
It is sometimes much simpler – and much crueller:
‘Now that I know, how do I get started?’
And it is precisely in this tiny gap between knowing and doing that some of the least obvious difficulties of adult ADHD can lie hidden.
