Eran Grayson, MA, ACC


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May-June 2021

March Membership Meeting Write-Up — Douglas Green, LMFT

Time Management for Individuals with ADHD
and Other Executive Functioning Disorders

Presented by Eran Grayson, MA, ACC

Fans of Monty Python’s Flying Circus might remember a skit in which Beethoven is trying to compose his 5th Symphony, but can’t concentrate because of the noise from his yammering mynah bird, neighboring construction, and his screaming (and vacuuming) wife. Eventually, however, he goes deaf, and is able to compose in peace, even with all the noise around him.

My mind kept going to this when attending the SFV-CAMFT presentation “Time Management for Individuals with ADHD and Other Executive Functioning Disorders” by Eran Grayson, MA, ACC. Grayson’s client-centered, action-oriented approach detailed an organized, focused, method for helping our “Beethoven” clients, whose focusing difficulties make their lives endlessly frustrating.

Grayson began his presentation with some basic information on this population. People with ADHD statistically earn $600,000 less in their lifespan than their neurotypical counterparts, due to their problems with Time Management and Productivity. Common challenges include poor follow-through, missing deadlines, procrastination (which often is due to hyperfocus on a single task), lack of systems and processes for getting work completed, inattention, poor concentration, lack of organization, poor planning, impulsive decision-making, and ineffective prioritization. (If much of this sounds like your teenager at home, while most grow out of this phase, Grayson begins seeing highly-impaired clients at age thirteen!).

The costs of all this of course can be terribly painful: low self-esteem and feelings of inadequacy (beginning early in life, certainly by school age), negative impact on learning, poor grades in school, missed opportunities for occupational growth, poor interpersonal relationships, and inadequate self-care (from poor follow-through on medicine to problems with exercise and health routines).

With all this against them, Grayson insists these people can be helped. “But change is hard. Especially for people with poor follow-through!” He supports medication for improving focus, but emphasized, “Pills don’t teach skills!”

From here, Grayson delineated his method. First, “Get Buy-In and Offer Choice.” These people, he argued, have been told what to do all their lives. So clients would be more likely to accept ideas from a therapist than their teachers, parents, or bosses, whom they’ve likely always seen as “bossy.” And instead of ordering them what to do, he recommends offering them “suggestions,” in the form of an experiment, with unpredictable outcomes. Then if they “underperform,” it will be the experiment’s fault, not theirs!

Importantly, he argues that therapists should “start small” and suggest ideas that you’re confident the client can successfully complete. This will help build their sense of self-efficacy, which is likely low. And then keep suggestions in “small bites,” making task completion a concrete and step-by-step process.

Then the therapist should introduce accountability measures. Writing goals and objectives down, along with a deadline, gives a sense of mild urgency. An accountability partner (besides the therapist) can also help in many cases.

The big goal at this stage is to help the client develop Metacognitive Awareness (people with ADHD tend not to focus on the consequences of actions as much as those from inaction). So when they struggle with an assignment, ask questions like “What do you think came in between you and completing that task?”

A great tool to help this is creating an environment conducive to task completion. This is one of the more difficult of the strategies, but has great payoffs. Reducing distractions is of course paramount. But, again, Grayson aims us toward the detailed and specific: instead of telling a student not to watch TV, when other people in their home might have theirs on, better to make a no-TV policy for everyone there for a few hours a day). Barriers to distracting technology are great — there’s software that can cut off access to YouTube, Facebook, etc. — but the client ought to be able to control the software, so they get used to the empowerment of creating ownership over their situation. Putting a cell phone in a container with a timer is often successful, for example.

And setting work in a novel environment helps as well (for example, everyone knows not to talk loudly in a library). Choosing to not do homework in a household, or naming a table in the house exclusively for schoolwork, can help.

Then, once the client begins to achieve success with these specified tasks, the process then moves to sustainability: Building structure, habits, routines, and processes around task completion. One great way to do this is to help the client create expectations that indicate when it’s time to perform a specific task or behavior (like a home version of the bells at schools). Then make habits in the work (avoiding “I’ll do it later”), such as always putting homework in one’s backpack when they’ve finished it, which leads to routines (series of tasks instead of single ones), and, in the end, processes (overall methods that that individual has found lead to successful outcomes). The overall message Grayson gave us was simple and difficult: that improving the productivity of people with ADHD is possible, but requires giving attention to all the details they tend to miss. A therapist or coach who achieves this will grant those clients improvement in nearly all aspects of their lives, from work to relationships to general happiness.

And they won’t even have to lose their hearing to achieve it!

 



Douglas Green, MA, MFT, has a private practice in Woodland Hills and West Los Angeles, where he specializes in helping children and teens live lives they can be proud of. To find out more, you can contact Doug at 818.624.3637, or DouglasGreenMFT@gmail.com. He's also often at our chapter meetings, serving as the volunteer coordinator. His website is www.DouglasGreenMFT.com.






San Fernando Valley Chapter – California Marriage and Family Therapists