ADHD Refocused: Bringing Clarity to the Chaos

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Advance Praise

ADHD Refocused makes good on the promise in its title. Dr. Sitt brings to bear not only his professional experience but also his personal experience in this lucid, practical, and warmhearted book. Sitt has lived through the ADHD triumphs and travails. With this book he hands the reader a wonderfully written and clearly reasoned account of what he's learned along the way. I highly recommend this book.

—Edward Hallowell, MD, author of Driven to Distraction and ADHD 2.0

If you have ADHD or someone you care about has it, this is a must-read! David Sitt beautifully weaves compelling stories, rigorous science, and practical advice to present a picture of ADHD that is both realistic and optimistic.

—Tal Ben-Shahar, PhD, bestselling author of Happier, No Matter What, Chief Learning Officer at Happiness Studies Academy

Dr. Sitt gets it just right in this book. He does a great job explaining life with ADHD in relatable and understandable ways but, maybe more importantly, shares the strategies that will help you live that better life. He brings a mix of personal experience, clinical skills, and academic foundation to create a readable and useful book. Check it out.

—Ari Tuckman, PsyD, ADHD expert, author, and international speaker

I can’t praise Dr. David Sitt’s ADHD Refocused strongly enough. Dr. Sitt is a talented teacher who has a gift for using humor, clarity, and honesty to explain this often-neglected problem. Dr. Sitt presents a compassionate, practical, and effective toolbox of evidenced-based techniques and invaluable resources for those confronting the challenges and promise of living with ADHD. I highly recommend this book, which I plan to share with my colleagues and clients.

—David Pelcovitz, PhD, author, professor, Straus Chair in Psychology and Education at Yeshiva University

ADHD Refocused is a brave and detailed book written by a savvy, smart, and accomplished psychologist who had to learn things the hard way (so his readers don’t have to). Dr. Sitt has taken his life story, lessons he’s learned, and tools for success and packaged them into this brutally honest and accessible narrative. If you or your loved one has ADHD, this is a must-read!

—Vatsal G. Thakkar, MD, adult ADHD specialist, Chief Innovation Officer at Reimbursify, New York Times and Wall Street Journal op-ed writer

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Copyright © 2023 Dr. David Sitt

All rights reserved.

First Edition

ISBN: 978-1-5445-0635-7

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To my parents, EddieA"H and Frieda Sitt, for their unwavering and unconditional support.

To my children, Ezra, Jonah, Natan, and Frieda—I hope this book will serve as a small inspiration to overcome whatever challenges cross your path on the way to your dreams.

To my wife, Ayla—thank you for helping me refocus on what matters most each and every day.

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Contents

Author’s Note

Introduction

Part I: ADHD Basics

1. My Story

2. Adult ADHD

3. Clinical ADHD Causes

Part II: ADHD and Techno-ADD in Real Life

4. A Closer Look at Symptoms

5. Emotional Byproducts of ADHD

6. Relationship Challenges

7. The Upside of ADHD

8. Rewiring the Brain: Technology, Attention, and Memory

9. Responding to Techno-ADD

Part III: Life Hacks: Behavior Change

10. Get Organized

11. Time Is Energy and Vice Versa

12. Speaking and Hearing Clearly

13. Give It a Rest

Part IV: Change Your Mind: Cognitive Tools

14. Think Differently

15. Change the Frame

Part V: Mindfulness: More Than a Buzzword

16. Cultivating Attention and Awareness

17. Self-Compassion

18. Building a Mindfulness Practice

Part VI: Mind Your Body

19. Biomedical Interventions

20. Exercise and State Change

21. Yoga and Breathing Techniques

22. Organized Chaos for Body and Mind

Conclusion

Acknowledgments

About the Author

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Author’s Note

What follows includes stories of my experience as both a practitioner and a person with ADHD. Wherever those stories include client relationships or anyone other than myself, I have changed the names and details to protect confidentiality. In some cases, I created an amalgamation rather than relying on specific individual stories. These are meant to be realistic anecdotes, and the spirit of each remains true enough that I hope you see yourself in them. Any overlap with real-life situations beyond that relatability is otherwise coincidental.

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Introduction

In typical ADHD fashion, I hacked this book into existence.

After twenty years of knowing I should write a book, and nearly half of that spent procrastinating and dipping my pinkie toe into the treacherous water of writing, I finally seized an impulse to plan once again for the end zone, this time through a brilliant company called Scribe. There, I enlisted the help of a full team of talented people to help me bring my ideas to these pages.

The first phase matched me with a scribe who reviewed all of my previous ADHD-related writings, recordings, and scribbles, and who conducted interviews with me regarding my content. Over the course of several months, he sifted, organized, and helped me produce my first draft. In phase two, I worked with a second scribe on edits, rewrites, and refinements in a very hands-on, collaborative process. In the final stages, we polished the manuscript, got marketing and media materials together, and went to print.

For a moment, I considered keeping this process as backdrop or perhaps a small footnote, but I now realize how proud I am of this path. It effectively models the way I have come to organize my personal challenges of living with ADHD. Writing is still agony, but working with a team got me to the finish line. By using tools and techniques like the Scribe Method, we can increase our probabilities of success, appreciate 80 as the new 100, and balance our nows vs not nows to accomplish more and with less resistance than we could by just powering through.

These days, attention deficit hyperactivity disorder seems so commonplace that we use its acronym, ADHD, as a descriptor for any slip in attention, organization, or punctuality. We laugh off minor effects and are baffled by unnamed, undiagnosed, but no less serious effects of ADHD, often blaming ourselves for the perceived inadequacies. (In a recent email apologizing for being late to a therapy session, one of my patients hit the trifecta: OMG running late…I’m soooo ADHD LOL!)

The catch is, ADHD only affects about 10 percent of the population. Why, then, do so many people who neither have nor will ever be diagnosed with clinical ADHD think they might be affected? Perhaps, given the distractions of today’s technological, device-dependent culture, many people who don’t have clinical ADHD actually are more distractible and impulsive. The dependence on technology that’s exploded over the last twenty years has changed how we think and behave. Our brains have literally been rewired as a result of this relatively new, tethered mode of being.

This is a condition I call Techno-ADD—it involves ADHD-like symptoms caused by technology such as smartphones and requires similar coping mechanisms as clinical ADHD. What’s more, Techno-ADD affects both those with and without clinical ADHD, because the conditions are related but are not one and the same. They’re cousins rather than siblings.

Clinical ADHD has a long-standing history from before the present era of technology. It involves hereditary and biological variables and would manifest itself even if smartphones had never been invented. The two syndromes can mutually reinforce one another, without having a one-to-one correspondence. However, there is one very important thing to note for the 10 percent of us: Techno-ADD can intensify the challenges of clinical ADHD.

Because the technology that has become so much a part of our everyday lives can aggravate ADHD, it’s essential for many adults both with and without clinical ADHD to develop strategies to deal with our techno-distractions. This is a critical topic to explore in the context of a book on adult ADHD today, as an experience common both to adults with ADHD and those plugged into their technology and unable to keep their attention on a single task for extended periods of time.

In other words, the question, OMG, do I have ADHD? is just as important as, What do we do about it (besides LOL)?

Someone with ADHD who is trying to focus on writing a report at work might suddenly look up and see a colleague walking down the hall, then start thinking about that person and what they might be doing. Or they might be in a Zoom meeting and suddenly get distracted by what’s happening in the other participants’ background. The mind quickly trails off, and it becomes difficult to pull it back to the task at hand.

Similarly, someone who is very techno-dependent may be working on a report and get a smartphone notification that someone they’re following has just published a new tweet. They get pulled into checking and looking at their phone and, like their ADHD colleague, also have a hard time staying focused on their work.

To add to the chaos, the tendency to hyperfocus on the contents of our screens to the exclusion of all other cues is also common to both ADHD and Techno-ADD.

Finding ways of minimizing the distractions of technology will help anyone with either clinical ADHD or Techno-ADD, and many of the coping mechanisms will benefit both types of people as well.

It doesn’t matter if you check every box of symptoms or simply feel disconnected from your sense of focus. If you’re living with a sense of distraction or hyperfocus that you can’t get under control—diagnosed, suspecting, or curious—the real question is what you are going to do to organize the chaos. That’s what you’re about to discover. Together, we’re going to refocus ADHD.

ADHD and Me: Dr. David Sitt

My own relationship with ADHD is as personal as it is professional. I wasn’t diagnosed until relatively late in life, at age twenty-two, while I was in graduate school. Somehow, I had managed to balance a thousand pages of dense reading a week across five courses, interning at a hospital, keeping my social life afloat, and teaching a full load as an adjunct professor on top of it all. That kind of workload is a lot for anyone. For me, it came with many late nights, close to the edge deadlines, and intense stress. It felt less like balancing obligations and more like constant juggling—that is, juggling ten flaming pins while walking on a tightrope wearing clown shoes over a minefield in the middle of a heavy fog.

I developed coping techniques that took advantage of my ability to hyperfocus, learned to outsource tasks, and developed systems—which you’ll soon learn—to help keep me organized and on track. In this way, I successfully navigated through both college and a doctoral program in clinical psychology.

After completing my doctoral program, I threw myself into learning about my newly diagnosed condition, so as to better help myself and others. Now, in my early forties, it’s easier for me to come to terms with ADHD and the circus it creates for me because I can look back on what I’ve accomplished. Yes, perhaps my ADHD makes me dig four holes that are ten feet deep rather than one hole that’s forty feet deep, but that just means I get to wear many hats. I am a clinician, professor, entrepreneur, author, husband, and father.

I struggle with the idea that I have a disability or disorder, where I’d rather use my diagnosis to better understand how my brain functions. Creativity and the ability to hyperfocus are gifts that correlate to ADHD. Those abilities are the reason I’m able to stand in a classroom of five hundred college students and deliver a creative lecture laced with humor, all while picking up the signals from everybody’s facial expressions to make on-the-fly adjustments to my presentation. This constellation allowed me to jump into action when the NYC mayor’s office reached out to me during COVID’s second wave to help set up community-wide testing sites in Brooklyn within twenty-four hours (long story for another time). It’s also how I could spontaneously propose to my wife by romantically spray-painting, Ayla will you marry me?? outside a construction site on Fourth Avenue in Manhattan after every other plan I’d made fell through. (Joining the ranks of NYC graffiti artists was definitely a rush, and though a security guard for the construction site nearly foiled the risqué endeavor, he gave me the nod to proceed once he heard the backstory.)

ADHD has made my life difficult, but it has also made it incredible.

The definition of ADHD on a personal level varies from person to person. More than What is ADHD, we have to ask, What’s my relationship to it? To what extent does it define who I am?

As a father, I think a lot about my own children, particularly my seven- and five-year-old sons who have both shown probable signs of the ADHD diagnosis. Where most parents hear about the disability and the challenges, I see a complex future. I see kids who are wonderful and creative, but who will likely suffer through school and struggle to succeed if they don’t figure out how to cope with and get proper treatment for it early. It’s a hard thing to wrap your head around as a parent. It’s even harder to process as an adult looking back over your own life if the diagnosis was missed and you struggled all the way through.

That’s why it’s so critical to refocus ADHD.

The first step is psychoeducation: learning what ADHD is, separating fact from projection, and seeing the upside as well as the downside. Over the years, I’ve enlisted the help of many other professionals who have become part of my living with ADHD team. There have been two psychiatrists, three psychologists, and three life coaches in total. That’s aside from friends, family, and colleagues who have lent their advice and support as well. In twenty years as a therapist, I’ve spent thousands of hours with clients, with the privilege of becoming one of the early experts in adult ADHD. And through this book, I’m honored to join—or become the founding member of—your support team.

ADHD and You: Diagnosis and Treatment

ADHD diagnoses have increased dramatically in recent years. However, current research believes this is not because more people now have ADHD, but because more people are recognizing and being treated for it. Yet, due to ADHD’s early onset, the focus of ADHD research and literature has traditionally been on children and adolescents. Very little attention and few insights are offered for those children who enter adulthood, ADHD in tow, with all its gloom and glory.

For those adults—especially those who get a diagnosis late or not at all—it’s not just resources that they lack. They often find themselves without support, understanding, and most of all, compassion.

A judgmental, unsupportive environment can impair the confidence and creativity of anyone with ADHD, from ages five to eighty-five. If you or someone you care about is diagnosed with ADHD, suspend your judgment—especially self-judgment—of the condition and uncertainty about its treatment long enough to learn that it is not a curse. There are undeniable benefits associated with ADHD, including resourcefulness and imagination.

If you allow negative emotional reactions to lead your actions, especially with children or with yourself, you may trigger the exact stigma you wish to protect them from. What’s required is self-compassion, not self-judgment.

Thankfully, there is an extremely diverse toolbox of ADHD treatments to choose from along that journey, beginning with psychoeducation, as mentioned a moment ago. Coping and living more effectively involves understanding what’s at the root of the challenges you’re facing. Someone with ADHD needs to understand what ADHD is. What does it look like, feel like, and sound like?

There are tools for becoming more self-aware and tuned in to the present moment that can help improve functioning. These all come down to developing mindfulness—which we’ll look at in depth—as an overarching philosophy of both treatment and life. We’ll also draw from cognitive behavioral therapy (CBT), physical exercise, diaphragmatic breathing, and tools for time/task management, as well as medication.

Some of these will be more helpful than others, and some will be more or less helpful at different times and under different circumstances. One size does not fit all, and what works for you will be very personal and almost certainly change over time.

Allow time for the benefits of techniques and treatment plans to unfold. Give yourself the love and support you’ve always needed, and permit yourself to receive that support from others. Continue exploring the strengths and weaknesses of your brain, long after you’re finished reading here. Most importantly, know this: countless people with ADHD live happy, productive lives, realize amazing achievements, and organize their chaos. You can too.

ADHD Refocused: A Multilens Perspective

As a professor in the department of psychology at Baruch College, part of the City University of New York (CUNY), I’ve taught thousands of students with varying attention levels. As a therapist, I help my patients refocus. And seeing a real and unmet need across both sets of people, I decided to write this book as a handbook to help adults with ADHD—as well as their families and friends—organize their chaos.

The book is divided into six parts, each of which contributes to another angle or lens of this comprehensive perspective. In Part I, ADHD Basics, we deal with psychoeducation, descriptively detailing the characteristics of ADHD in adulthood, the causes, and the effects. Whether you’re asking yourself, OMG, do I have ADHD? or have already been diagnosed, Part I is meant to increase your awareness and knowledge of ADHD.

Part II, ADHD and