You're Not Lazy - Your ADHD Support Is in the Wrong Place

I have my day planned out. 2pm rolls around. I’m at my desk. It’s time to work on writing this Blog. I’m staring at my monitor. I have brain fog. No productive thoughts are happening. I decide to play a game of Hearthstone to get my brain in gear. It works! My brain gets in gear. Unfortunately, I get hyper-focused on the game, I lose track of time, an hour goes by, and I make no progress on the Blog.

This might sound familiar to my fellow ADHDers. You've probably experienced this frustrating gap between knowing what to do and being able to actually do it. So, what can help us bridge this gap? What can help us practice and develop our executive functioning skills when and where we need to be able to do so? In the above example, I needed someone there to help me at that point when I was engulfed in brain fog. It would have been great to have someone there to provide encouragement, maybe personal contact which can provide emotional regulation, maybe provide enough of their executive functioning skills to help me to get over the gap. This would have been what is called:  intervening at the “Point of Performance.”

This idea comes from Dr. Russell Barkley, a leading ADHD researcher whose work has transformed how we understand and help people who have ADHD. His research - and my experience working with clients and managing my own ADHD - shows that the most effective help happens right when you're having difficulty getting over that gap. You need help in that exact moment when you're stuck, overwhelmed, or can't seem to start.

As Barkley puts it:

"All treatments for ADHD that are effective are delivered at the point of performance... Any treatment that attempts to teach a skill and then sends the person out into the natural environment to use that skill will fail."

Why Traditional Therapy can be Ineffective at Helping People Develop Executive Functioning Skills.

First of all, therapy can be very beneficial to people with ADHD. In therapy, a person can process accumulated trauma and negative self-beliefs that come from a lifetime of ADHD struggles.This can result in them being generally happier and feeling better about themselves. This can result in their being in general much more emotionally regulated. All of this helps a lot with their being able to access and practice EF skills. But when it comes to directly building practical skills like organizing, planning, and following through? That's where we need a different approach.

Here's why learning skills in an office and trying to use them later doesn’t work very well:

The Transfer Problem Skills you practice in a calm therapist's office don’t usually transfer to real life. You might create a great homework system during your session, but when you're in a noisy classroom or distracting work place, feeling overwhelmed or completely zoned out, those plans and strategies go AWOL. Your cerebral cortex (home of EF skills) has mostly shut down.

Time Delays Work Against You ADHD affects working memory and time perception. Strategies you learned last week (or even this morning) are hard to access when you need them most. In the heat of the moment, when you're dysregulated, that planning from your coaching session: you don’t remember it; it doesn’t even occur to you.

Context Matters Your brain responds to environmental cues. A supportive therapy office is different from the chaotic, distracting environments where you want to be able to use your EF skills. That's why practicing in the actual setting - with support - is much more effective.

What Actually Works: Real-Time Support

I've seen big transformations when people get support and guidance right at the point of performance. I'll use students as an example of how this works. The same concepts apply to getting support in the home and in the workplace. What works:

For Students:

• A tutor who works with them during homework time

• Parents who provide structure, encouragement, and positive reinforcement in the moment (whether that is homework, planning, or doing chores around the house)

• Teachers in small classes who notice when they're stuck and offer immediate help

• Study hall support that provides both emotional regulation and practical assistance

Every time I've seen consistent point-of-performance support, I've watched students develop executive functioning skills and genuine confidence, leading to greater enjoyment of school and greater success.

Practical Strategies 

The key is making support and positive feedback external and immediate:

Visual Cues In the Environment

• A packing checklist taped inside your locker

• Sticky notes on your bathroom mirror

• Phone reminders that pop up when and where you need them

Immediate, Positive Feedback quick recognition when you use a skill successfully. Validating and celebrating successes. 

Environmental Tweaks

• A designated homework spot free from distractions

• Predictable daily routines that become automatic

• Physical setups that support focus

Breaking Down Tasks into Doable Steps

Large tasks become manageable when someone helps you break them into small, simple steps - with positive reinforcement for each step taken towards completion.

Positive Reinforcement is Key

Punishment and criticism just don’t work for ADHD brains. If you take nothing else away from this Blog, I hope you remember this. All it does is reinforce the negative self image and beliefs that most people with ADHD carry, which when triggered, cause them to lose access to their EF skills. Punishment and Criticism is completely counter-productive when working with them. It just makes things worse. 

What This Means for You

If you're reading this and thinking, "Yes, this sounds like what I struggle with," know that you're not broken. Your brain just needs different kinds of help than what you’re getting. That difficulty bridging the gap between knowing and doing doesn’t mean that there is something wrong with you - it means that you just need some help at the point of performance.