Transcript of ADHD & Time Blindness

hello everyone Russ Barkley here with my usual glass of wine don't worry I'm not going to go all John Wick or full Leroy Jenkins on Jordan Peterson in this particular video instead I want to talk about an incredibly powerful concept related to ADHD that can help us better understand the condition the people who experience this condition and things that we might be able to do to help people with this condition and that's the concept of ADHD being a form of time blindness so let's take a look at this video or at this PowerPoint presentation so that you can see what I'm talking about because this idea has now become widespread in our culture particularly in trade media on adult ADHD especially but it really applies across the lifespan to everyone with ADHD kids teens adults and what have you so and that is the idea that people with ADHD have an incredible difficulty with not just sensing but more importantly than that governing themselves relative to time or what we call time management so I illustrate that as you can see here here's a typical clock for typical people and this is what that clock probably looks like with people who have ADHD who cares because people with ADHD are not sensing time and if they do sense it properly they're not using it to guide what they should be doing over time what you would call time management or self-regulation to time and certainly not anticipate when did I first discover this well back many years ago as I was building my theory of ADHD as a disorder of executive functioning one of the things that I was reading suggested that our sense of time is related to our impulse control I hadn't thought of that before but impulsive people seem to sense time differently than less impulsive people and I thought well if that's the case people with ADHD must really have difficulties with their sense of time because they have more impulsivity than typical people do so a high school student Seth koplowitz and I set out to test this idea I was in the middle of a project where we were doing experiments on sense of time and what we would do and what Seth would do is part of this and by the way Seth went on to win the Massachusetts high school science project for the state that year uh so good for Seth that was terrific uh and I was so delighted that he was able to do that with his project but what we were doing is we were presenting time intervals to people with ADHD Seth was studying children we were also doing this again with teens and with adults and we would do this in three ways we would present we'd turn a light bulb on turn it off and say how long was that and that's sort of your perception of time the second thing that we would do is to have we would turn on a light bulb all right and then turn it off and we would say now you do that turn that light bulb on for that period of time and here's what we found their perception of time wasn't so bad they were pretty close to the typical people in the control group in telling us how long an interval was they're not perfect but they weren't quite as bad at it where they really fell apart was in duplicating the time interval well what does that mean it means that even if I can perceive time I can't use it to guide my motor action my behavior now a task is called time reproduction can you reproduce a time interval and they couldn't and we found that this was typical of young children older children teens adults it was bad across the lifespan that we were testing and so one of the ways I came up with to convey that idea was the term time blind and especially with teens and adults with ADHD where time has become much more important in their life than when they were young children they really were time blind when it came to time management time management is one of the major deficits in ADHD and my research showed that no other disorder in Psychiatry seemed to interfere with time management to the degree that ADHD does I mean it is a serious impairment or deficiency rather in people with this condition hence the term timeline for those with ADHD so yet time and time management are increasingly important in our lives three-year-olds don't have to manage time 30 year olds do and if they don't they're going to be very impaired in work in their home life paying bills getting to appointments meeting other people for scheduled dates for instance or or you know periods of time like parties with them so now just think about your life time is a ubiquitous part of all of our Lives time management is one of the best predictors of Occupational and social success and so we can expect then that people with ADHD although there are symptoms of hyperactivity may be declining with age this problem with time is becoming increasingly impairing for them because we are being demanded by life to grow up and be more responsive in our time and time management to be more timely with what we do so expect that as traditional symptoms of ADHD might be declining somewhat we can see that impairment is going to increase with maturity with development because of this problem with time so people with ADHD become increasingly impaired in situations and settings where time management is in high demand and that's especially true in education in college in work but also in cohabiting with other people where we have to coordinate our activities our bill paying getting our children up and out the door on time getting us up and out the door on time for work and other responsibilities also this time blindness means that people with ADHD don't anticipate the future and therefore don't prepare for it as well as other people do I've talked about that earlier in some of my other diagrams when I talked about the motivational deficits that go with ADHD part of those motivational deficits have to do with this valuing the moment and little consequences over valuing the later and the larger consequences but that's going to be part of this time blindness as well and then we're also going to see this when it comes to situations in which people with ADHD have to wait for things now there's a waiting interval here and because if you are blind to time you perceive time as moving slowly or not at all then what's going to happen if you are asked to wait for something you're going to become incredibly impatient in that situation if you're driving and you're asked to wait in line because maybe there's some construction going on these are the kind of people who are more likely to drive on the shoulder of the road or to get up on the sidewalk and to try to make that right hand turn and get around the obstacle because it's painful for them to wait for that period of time I mean it's as if they can't perceive the time and when they what they sense is that it's going very slowly and they're just not going to wait around for it I mean as as one of my patients said you know asking someone with ADHD to wait is their definition of Hell well it certainly is so expect that for children for adults who have to wait in lines for things or just wait around for something to begin expect to see them become more Restless more impatient more frustrated perhaps been more angry and aggressive in those situations in order to terminate that delay my friend Edward sonugubark in England has referred to this this particular problem as being delay averse a very good term for what's going on here so those are the kinds of timing problems that people with ADHD have now what can be done about it well number one although it's not here on the slide research shows that taking ADHD medications particularly the stimulants but the other drugs help too seems to improve this ability to regulate yourself to the passage of time and so that's going to be helpful now in addition to that the way we look at situations and tasks is going to be important we need to think about tasks and situations as coming to us as what I call ero Arrangements events things coming toward us responses how we prepare for the things that are coming at us in time and consequences the outcomes how do we do were we ready on time or not so ero Arrangements now here's the thing about ADHD right if these ero arrangements are together very closely there's hardly any time between them it's kind of like a video game right then guess what no problem you don't need a frontal lobe to deal with event response outcome Arrangements many organisms can do this particularly animals can do this but other organisms can as well they are schenerian creatures like BF Skinner they respond to stimulus response stimulus response right so if these arrangements are tight together in time your frontal lobe isn't necessary and we can do them easily this is why people with ADHD can play video games for hours and do so effectively because the video game has arranged this kind of very addictive schedule of consequences for engaging with the task and with the environment but the minute you insert time between any of these three parts the minute you insert an interval between the event and the response required for the event or between my response and finding out how I did the outcome you need a frontal lobe because as Joaquin Foster said after studying the frontal lobes of primates all of his career if we can reduce the functions of the frontal lobe in the executive brain to one essential idea it is The Binding of events over time in mind so as to deal with the future we are a Time binding animal nobody no other species does it the way we do so if you put time in these Arrangements you are going to disable the person with ADHD because you are demanding more and more of the time binding from function of the frontal lobe and they can't deliver on that as well as other people can a good example of that is a book report for a child or a teen with ADHD the teacher says okay I want you to read Catcher in the Rye you've got several weeks to do this and in two weeks I want to see an outline a week after that I want to see the book report and a week after that you'll get your grade after I've graded all the class papers wow boy did you just disable that teen with ADHD it's not going to happen his parents are going to have to do this or his parents are going to have to ride hurt on him all the time during that time to make sure that this gets done in time over time on time but they're not going to be able to do this on their own the way another teen might be able to organize themselves over time to get that book report done so I hope you understand that the more we put ourselves in situations and tasks that have time inserted between these components the more people with ADHD will struggle to succeed in that situation the more likely they are to fail so what's the answer minimize these time gaps try to bring the E and the r and EO back together as close as you can we can't make life a video game but we can certainly break the task down get rid of some of these time delays and therefore make the person with ADHD more effective in that situation let's go back to that book report what could you do you could every day have that child or teen read one or two pages recite out loud what was important write it down on a sheet of paper read that back out loud again that's called the um oh I can't think of the name of it right now sorry about that but it involves this kind of oh it's sq4r I'm sorry it's my 73 year old brain getting to me here sq4r so you survey read recite write review okay so we're going to do that with this book and we're to do this every day and then the work starts to get done but notice what we did we shortened the project made it into small quotas with very little breaks more review and the consequences are immediate if you will read the two pages if you will take notes of what's important you will get X tokens points maybe additional allowance or money but arrange a positive event after each of these little short work periods so bring the events and responses and outcomes together for daily tasks we're also going to suggest that you not only chunk them into smaller quotas but that you have an external time device the internal clock in the brain isn't working it's not guiding them even if it is working external timing devices are a very very helpful here's one over at Amazon it's a one foot clock that goes up to an hour and you can set the dial for whatever length of time you want and then the red disc is disappearing as time is passing isn't that wonderful you can use that for ADHD kids and teens even adults on their desk in their workspace to give them an external reference for the passage of time and that will help them with guiding their behavior relative to that time interval but you don't have to use that Amazon clock you can use cooking timers you can use your cell phone you can use technology like this laptop computer you can use watches that may have a vibrating function in them and set them for certain time intervals you can use the watchminder in which you can put things you have to get done over time and it will remind you on time any way you can from you know your outlook Calendar or your Google calendar to whatever that you use to manage time people with ADH are going to be more Reliant and dependent on external timing devices we're going to offload time onto other devices for larger tasks break them into small quotas as I said and do that quota very frequently so a little bit each day over time builds the bridge across the chasm of time and gets us to the other side but don't just point at that time interval and say did you do your summer reading have you done your book report reminders about time are not helpful for this condition but breaking the task down into small units and little Eros is going to be very helpful for even longer term assignments you can chunk them into small daily steps as we said with the book report and then if you do a chunk a day you are able to get across that bridge in time you can also Place yourself around other people who manage time better and work with them in small groups in teams or make yourself accountable to another student a colleague a supervisor as to what you want to get done within that time and then check in with them and show them that you've got it done there's nothing like social accountability for teens and adults to make you more likely to follow through on something than if you just said I'm going to do this now and nobody knows that you're not accountable for that so there are lots of things that you can come up with I'm sure very clever this is just a few of the things when in dealing with the time blindness of ADHD the important thing is one understand that ADHD is time blindness number two understand that we are going to have to change situations tasks assignments and so on in order to compensate for and accommodate this deficit with time blindness and if we do that people with ADHD can be as effective as successful as other people in those situations once we understand the problem we can help compensate for it and as I said that also includes medication not just accommodations and the best solution is to do both so I hope you found this presentation to be useful uh if you enjoyed it please subscribe to my Channel please recommend others as well and come back and see us again I usually try to do at least one or two commentaries a week and at least one review of research weekly if possible so thanks again for showing up hope you enjoyed it be well everybody