July 25, 2022

The Complexity of ADHD, with Dr. J. Russell Ramsay

The Complexity of ADHD, with Dr. J. Russell Ramsay

ADHD is more complex than just a summarized diagnosis in a diagnostic manual. There are many accumulated small behaviors physicians don't always identify that remain untreated.

In the first of this three-part series, we speak with Dr. J. Russell Ramsay, co-founder and co-director of the University of Pennsylvania's adult ADHD treatment and research program and associate professor of clinical psychology in the department of psychiatry at the Perelman School of Medicine. 

Dr. Ramsay has authored numerous peer-reviewed professional and scientific articles and has written five books about adult ADHD, including his most recent book, "Rethinking Adult ADHD: Helping Clients Turn Intentions Into Actions".

The Diagnostic Assessment of ADHD

The diagnostic assessment criteria for identifying ADHD include developmentally inappropriate inattention, hyperactivity, and impulsivity levels. The self-regulation view of ADHD is how efficiently one follows through on what they want to do.

Time management organization also translates to financial management motivation, behavioral initiation, and emotional regulation, which is not anywhere in the official diagnostic criteria. Money is a highly charged matter; telescoping out, it also ties in with the workplace, job loss, and some other risks for ADHD.

The Self-Regulation Model of ADHD

The self-regulation model resides within our executive functions. It's the equivalent of willpower, much like spending all day not eating ten chocolate chip cookies, but at 10:59 PM, you cave and eat them all. That's what's known as inhibitory fatigue. Using the analogy of eating as it relates to spending when you log onto Amazon.com.  You spend all day not buying the item, even taking it out of your cart. Still, in the end, you click the one-click shopping and buy the item.

It's part of what the executive functions allow us to do by working toward delayed rewards. Any investment for which we have to buy in, we know we'll be better off. We want it, but it's hard because there's often some short-term cost. We would rather spend the hundred dollars today on something that we can have now than put it into the retirement fund for later.

Having a Plan

So what is your plan? What are you trying to do or not do? Be specific and make sure it's reasonable. Don't try to change everything, like training for a triathlon or deciding to go vegan.

Keystone habits are the routines and practices by which someone operates. They mark the base level of what you do without any need for willpower or persuasion. Whether positive or negative, each of these habits has a ripple effect across everything you do in life and business.

Sticking to the Plan

For people with ADHD, sticking to a plan is a challenge. They may follow it for a day or two and then start anticipating flaws. For example, you plan for your evening walk, and while putting the dishes in the sink, you start thinking, "You know what? It's a little chilly tonight. I'll start tomorrow."

Task interfering or escape behavior like that can also tie back to your financial planning by anticipating what could be some of the risk factors with a financial plan. Make informed decisions, predict and catch when we invariably start slipping up whatever the expense might be and if there’s a possibility of undoing it.

You will still slip up. We all do. What matters is catching it early and containing it, so it’s just a slip and not a total relapse.


Dr. Ramsay's book: Rethinking Adult ADHD: Helping Clients Turn Intentions Into Actions

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