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Dr. DavenportLast Words

by Betsy Davenport, PhD

Now, what the heck are those? What does "Transition" mean, exactly? "Transit —" now there's an interesting word that conjures the notion of travel, or motion. Innocuous-sounding enough, until one considers that setting oneself in motion is what motivation is all about (not desire — go look up the root for "motivation" in a good dictionary — it's "movere").

That's ironic: hyperactivity combined with poor ability to get moving, at least in an organized way, in a directed activity, when one wants to.

There are more such ironies about AD/HD. The same people known to have a poor sense of time can, if notified of a deadline extension of, say, 3 hours, immediately shift speed (requiring the same gears which usually freeze in Neutral when the pressure mounts, or in Overdrive when Time To Leave was 5 minutes ago) and change direction and destinations (interruption? what interruption?).

That 'extra' 3 hours are added with such precision that after the 3 hours elapse, the work will be at exactly the same point as when the reprieve was given -- it's really nothing short of miraculous, considering this occurs in the same person who hasn't a clue how long it takes to get across town, who is always surprised by the clock. So it would seem everything should turn out okay with the deadline, right? Nope. There's one little problem: there was no accounting for "Transition."

Transition — that black hole one forgets is even there in the lives of people who can dawdle so effectively that if they were any more effective, they'd be going backwards; and who can also turn on a dime, and do so frequently, as long as the dime is their own.

What is it about being between things that is so onerous, so aversive, so downright impossible-sounding to the person with AD/HD; so much so that before she will get up to go to the bathroom she will often sit in a chair well beyond bodily discomfort and on into what any urologist would say is "bad for you?" Transitions are so undesirable to some of us that no matter how pleasant the next activity, it is as though we hated it, for all the power it has to move us away from the current one.

Couples have great difficulty sometimes, when the one with AD/HD doesn't go to bed at a reasonable hour; the one in bed would like, perhaps, to read together, or chat, or something more intimate. That one is prone to feeling uncared for, rejected — when it may be that the AD/HD spouse is just glued to a kitchen chair, nodding off with a stiff neck but stuck at the edge of that precipice between the chair and the bed.

It's the between, isn't it? Between here, and there. Between breakfast, and getting in the car for work. Between being done at the office, and packing up the briefcase to go home. It's the niches, the unaccounted-for spaces in time and location, that are unnerving, like the places in a stream where the rocks don't quite touch, so when you go across the stream, even with rocks to step on, with no rope to hold onto, and maybe not knowing quite where the path picks up on the far side, the water can splash you, and you might even slip a little...

When you're In-between, where is the map?
People with AD/HD are notoriously dependent upon their external surroundings for getting, and keeping, their bearings. New situations have unknown markers and cues for the getting and keeping of bearings (meaning, stability).

But what of the Transitions we make repeatedly? How can they continue to be unknowns, to be destabilizing? Well, if you're a person without Routines — or without Reliable Routines you can Count On — then the In-betweens are not the same each time, are they? If every day when you leave work for home you have a different way of readying yourself, and no plan of how you go about it, daily, the same, then each day you're on unfamiliar ground.

Once, early on, I made a sequential list of every task, no matter how small, that needed doing on my arrival at the office. This included Setting briefcase down on right-hand side of desk; Put purse on left-hand side; Keys in outer pocket; Turn on lights (2); Straighten rug; Hang coat; Take out appointment book; Open to today; Lay upon desk; Pen on the right; Call for messages, write down in book when to call back; Set timers for meds; etc. Then I did the same for leaving the office at the end of the day. I posted these lists where I could see them, and I forced myself to adhere to them for ages. I no longer use them, have thrown them away.

In the beginning, though, as I surveyed these daily lists, the maps to get me through the Transitions and saw how I had for years (mis)handled them, and as I contemplated how I could begin to handle them capably, this deliberate, conscious system sounded to my mind's ear like an Overhaul more than a Tune-Up. What I needed were more Routines, for which I clearly had no time and never had (now I saw what it meant to have routines for Leaving Home, Arriving Work, Leaving Work, Arriving Home).

It sounded like a lot of work. And I now know, it's not more work, it's just the work, which up until then (and sometimes still I decry it) I had thought this "work" was something that just (invisibly, one supposes) Got Done, without my actually Doing it, which is why, I soon saw, it wasn't Done.

Once that map of tasks became a clear set of steps, and I knew it by heart, and then my body knew them (it felt "off" to miss a step, after awhile, so I'd catch myself in an error), it was no longer a troublesome Transition.

For those among us who have slower processing speeds, a new environment can handicap us more than usual, because we're taking in new information, having to make an adaptation to newness, while our Brain's Osterizer is moving slowly — just when we'd like it to move faster than usual. Only in certain emergencies, when all else is shut out, can many of us zzzzzip into a higher gear and handle newness and novelty with greater-than-average ability.

What we can learn from the child literature:
Child development professionals always counsel that a sense of security is instilled in a child whose home life is well regulated, predictable (if flexible), when she knows what to expect ahead of time and in what order; the order or sequence is more important by far than the precise time.

Extrapolating to adults with AD/HD, if as Russell Barkley asserts, this disorder is a developmental deficit in certain brain functions, the same setup recommended for the immature brains of children should be salutary for adults with brains that are often running around like those of children. The singular difficulty in this, of course, is that adults are not expected to require another person to set up and maintain the structure and consistent routines needed. People with AD/HD typically rebel against being managed, even as they crave and need the management. Like children who have run around too long without a meal or adequate rest, it's a relief to be reined in, held down firmly and kindly, and fed, bathed and sent to bed for a good night's sleep.

Maybe you need a guide; a companion who will help shepherd you from one place to another at the appointed time. Left alone, will you "obey" the timer you have set for yourself? Will you place it across the room in order to set your body in motion to turn it off? Or will you kid yourself you don't need that much of an assist, and set it next to you; and when its alarm signals you, lean over, turn it off, and keep going on your task? This is, after awhile, not "kidding" yourself; it's lying.

Coaches can help, but sometimes a shepherd is called for. It helps to live with someone who is naturally well regulated; you can copy that person, or be swept along by the momentum, as children so often are at school, of the other person's activity. Oh, he's brushing his teeth, I guess it's bedtime! How come you're going to bed now? What?? Because you have to get up early? (Since when did that govern your bedtime?)

Out in the world without a shepherd, or a coach, either:
Imagine the cognitive demands placed upon you when arriving at a meeting: finding the address, parking; then you must find the room, survey the layout of seating, determine where to sit and be most comfortable (experience has taught us that just plunking down "anywhere" isn't a good choice, as that doesn't take into account the trouble one has in adapting [to an uncomfortable chair, poor acoustics, others' whispering, not enough room to squirm, etc.] or accommodating to the conditions that preceded one's arrival — and in fact, early arrival can be used to create a mini-environment more suitable to one's own needs, when feasible); handling the social aspects of greeting others, remembering names and/or roles; and one of my personal favorites, the cognitive-motoric demands of managing one's own body in cramped quarters, often with something to carry, perhaps a coffee cup or handouts pertaining to the meeting, the keys you're still clutching in your hand from remembering not to lock them in the car; finally, settling in with pad and pencil, or knitting if one must keep one's hands busy, and taking care of a host of other details which most other people may do automatically but which the person with AD/HD may not do routinely, or is, if diagnosed and being treated and duly working at it, now beginning to do, but still in a deliberate, front-burner (not automatic) way; and, finally, being set and breathing inaudibly in that silent moment just before the meeting begins.

Now I made that whole scenario into one long sentence for a reason. Everything in that paragraph-long sentence is potentially being crammed into five minutes — or fewer, if you're late, and if it's too much for one sentence, it's too much for a five-minute slice of time. Get it? Maybe you could keep track of it on the page; but if you could, it was likely because you could backtrack when you got lost, and/or because I labored sufficiently over its construction that while lengthy, its grammar and syntax remained logical and intact. Not so one's entry into a meeting, particularly on unfamiliar ground.

Never forget that. There are no do-overs, and no one is preparing the way ahead of time. Those of you with children know how difficult it is to receive thoughtful, coherent accommodations for them at school and in extra curriculars; the world is just not flexible enough to do that even when the law requires it and when people are taught how to do it. To think it's going to happen on any but a random basis in the regular, walking-around, adult world is fantasy. Those of us with Quirky Brains may not be very good at making the accommodations, but we are still the owners of the Quirky Brains, so the responsibility lies with us to make life work, or not. It's a good reason to show up early.

What to do?
We must never cease being aware of the struggles people with ADHD have in non-structured environments. The more structure (think: clothes hangers for limp garments; a trellis for rambling plantlife) you can devise for the times between more clearly structured enterprises, the less like "Transitions" these phases will seem to be.

If the advice to AD/HD adults is to delegate tasks which must be done, but for which they are not designed to do particularly well, and to devote more time to the things they do well and bring them satisfaction and success — well, how can we apply that principle to Transitions?

Having a shepherd isn't exactly delegating the Transition itself, but it does delegate some of the arrangements, and that's a help. But supposing there's no "other" to whom to delegate the arrangements. Here's a new idea: some of the elements of Transitions can be delegated (or relegated, maybe) to different categories of activity.

Like this: if one of the problems in making a change of activity is in getting your bearings in the new situation, why not set up the new situation ahead of time, so that it is not-new? If a woman has trouble switching from her evening reading to getting to bed, and the elements of that Transition consist of a short list of small tasks like turning out lights, brushing teeth, and such, she can arrange to turn out all the lights earlier in the evening, except the one she is using to read by. She can brush her teeth with her kids, or with her husband. When it's "bedtime," there's a lot less in the category of Transitional tasks to be done. She can have her pajamas on, even; and with the right kind of lighting and furniture, she could even be in the bedroom, so all she needs to do to turn on a dime and jump into bed is flip off the light switch!

If she can't get started on a sewing project, she can set up the sewing project any old time, but not when she's trying to get started doing it. Lighting, thread, machine, pattern, scissors, everything she'll need (it helps to pretend she's setting it up for someone who will arrive at her house after she's gone out, and won't know where to find the needed materials; there will be no "Oh, I can do that later," fibs; everything will be gotten ready, and nothing missed). Then, when she wants to sew, she has no Transition (she can turn on a dime, again — and we know this is fun to do) except to hop over that one last rock and into the chair at the sewing table, because it is ready for her.

Another example would be leaving for work. Putting your stuff in the car tonight for tomorrow's departure isn't part of Leaving, because you're not leaving! It's just a little chore having little to do with anything, so it's not loaded with extras. Just put your briefcase and the overdue library books in the car now. It's rather like any habit you have finally gotten down: if you do already put your keys in the same spot, reliably, then you have the complete liberation of not having to think about them, and can walk out the door knowing you have them with you, right?

Same with laundry: just bring the basket downstairs to the kitchen, as an isolated task. Nothing more. Later, when you go to the basement, you don't have to do the laundry, just take the basket down. Just take the basket. That's it. Just pick it up, carry it, and put it down. Period. That's all. You may go ahead and do the laundry then, and you may not; but it is not a trick to get yourself to do the laundry; it's a technique to remove preparation tasks from the Transition phase of things to some other time. Then, when you go to do the job, or go to work, or to bed, or start sewing, there's virtually no Transition. Just turning on dimes, lots of them. Doing things piecemeal — like your mother told you not to — sounds more fun all the time, eh?

(It begins to look, more and more, like Transitions -- in addition to being those very-short periods of time when there isn't any map or plan -- are about Preparation, about Getting Ready; and what could be more boring than that?)

There is nothing quite so mind-numbing as the boredom of these miserable little interstitial tasks, without which life would be hopelessly snarled up; so they are necessary to getting any job done, any Transition from one activity to another accomplished. But many of them, we see, do not have to be attached in time or space to the activity itself.

The best proof of that is in how so many people with AD/HD can just get up and walk away from something without cleaning up after themselves, putting things away, or tying up loose ends. Clearly that's proof positive that the endings don't have to be connected in time or space to the job itself; why not the beginnings, too? In fact, an awful lot of the beginnings are just handling the now-stale leftovers, the endings, from the last time, aren't they? No wonder it can be so hard to get started, if it means stopping one thing (and heeding, or ignoring, but either way, being plagued by, the "clean it up," voice in the mind) and starting another (and finding the cold, stale evidence of that unheeded voice from whenever we didn't clean up last time)!

Next: May 2004 Online Newsletter >>


Vol. 2, #11,
May 2004



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Patricia Quinn, MD
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