A mindfulness prescription for adult ADHD

Psychiatrist Lidia Zylowska shares how people with ADHD can manage their restless minds.

“My mind is always busy,” exclaimed Carolyn. “If you ask me about one thing, that makes me think of a million other things.” 

“I noticed,” I thought to myself. Carolyn was in my office for an evaluation of possible ADHD, and it was a struggle to keep her focused. Many of my questions were met with long descriptions and too many details. Other times, she veered to another topic. She seemed to be insightful, and her answers were often interesting or humorous—but they didn’t always address the question.

Along with a restless body, a busy or restless mind is common with ADHD. This can be a curse and a blessing. Having a restless mind can make it difficult to focus and follow through on one’s tasks without getting sidetracked or lost in thought. On the other hand, having lots of thoughts and ideas can lead to making unusual and intriguing connections between things. Many adults with ADHD exhibit “out-of-the box” thinking and creativity due to their incessantly curious mind.


The ADHD Mind

In ADHD, thought flow is often irregular. Ideas can frequently branch out or jump from place to place. On the other hand, there may also be a tendency to get stuck in one way of thinking or to obsess about something—a kind of inflexible flow.

With frequent jumps in thinking, the content of ADHD mind may sometimes look like a disorganized closet and sometimes like a zigzaggy road that ultimately reaches a novel insight. Sometimes the content of the ADHD mind is out of balance or skewed. For example, the thinking may be overly optimistic or overly pessimistic.

Self-Perception and ADHD

Accurate self-perception seems to be difficult in ADHD. For example, positively biased self-perceptions—reporting higher competence than what the actual performance shows—are common in ADHD children. This kind of overestimation in children is found across the board in social, academic, and behavioral domains. It may be in part a result of certain cognitive deficits, and it may have a protective role in early years; however, its full impact is still unknown. (At the same time, children with ADHD are typically accurate in their perceptions of others’ performance.)

The problem with accurate self-perception is also shown in adults with ADHD. In a 2005 study adults with ADHD self reported higher competence as drivers than their observed performance and their driving record showed.3 In contrast, a 2007 study among college-aged students, by contrast, suggested that ADHD students tended to underestimate their academic performance.

In my clinical experience, many adults with ADHD, before even being introduced to mindfulness, are able to notice or joke about their mental process. Perhaps the repeated experience of living with an unruly, frustrating, and skewed mind makes it easier for them to see their thoughts as somewhat separate from themselves. However, despite this general knowledge, it can still be difficult for people with ADHD to notice the very moments when their mind jumps or gets stuck in unbalanced thinking.

Mindfulness of Thinking

The mindfulness-based approach to thinking is different from traditional psychotherapy in that it teaches us to experience a different relationship to our thoughts before attempting to focus on their content. Mindfulness first invites us to watch or witness the flow of thinking. Instead of being caught up in the narrative in our head, we are invited to observe our thinking as an everchanging stream, similar to watching clouds float across the sky. This shift in perspective weakens the grip of unhelpful thinking.

A 2007 study by Norman Farb at the University of Toronto showed that mindfulness training can weaken the tendency to be caught in an inner story and analysis of yourself and promotes focus on direct experience. This is important since habitual self-analysis can make one more vulnerable to unhelpful rumination, anxiety, and depression. In contrast, focus on present-moment experience, as in mindfulness, has been demonstrated to promote well-being.

Exploration 5.1: Mind Like a Sky

  • Sit comfortably and close your eyes. Become grounded in the present moment by noticing your breathing
  • When you feel settled, imagine a spacious blue sky with white clouds floating across it.
  • Sense your awareness as being like the blue sky, vast and spacious, larger than the passing clouds. With such awareness, you can watch your thoughts and feelings asif they were clouds coming and going.
  • As you watch them, label your thoughts and feelings without personalizing them—for example, “oh, there is worry,” “sadness,” “remembering.”
  • Notice that, just like clouds, your thoughts may go by quickly or slowly. They may be linked with each other or floating separately. They may appear light and fluffy or dark and heavy.
  • As you watch your thoughts flow, see if you can sense the space between them. This space—the space of open awareness—is a place where you can observe your mind without being pulled by it. It is the space from which you can note thoughts and feelings but choose to not act on them.
  • As you do this exercise, it is easy to get lost in thinking—to go into the clouds and become enveloped by the content of your thoughts and feelings. Whenever that happens, become aware of your breath and reground yourself in the present moment. Then return to watching your mind.

Excerpted with permission from The Mindfulness Prescription for Adult ADHD: An 8-Step Program for Strengthening Attention, Managing Emotions, and Achieving Your Goals, by Lidia Zylowska, MD (Trumpeter; 2012). The book includes an audio program of guided exercises. Click here to purchase the book.

For more ADHD-related information here on Mindful.org, read The Family ADHD Solution.

Photo © Flickr.com/Daniel Oines