by Michele Berhorst • November 4, 2024
Antonacci (left) shares strategies and techniques for tracking finances, including apps and other technology.
Hailey D. meets with occupational therapist Cami Antonacci, MOT, OTR/L, to work on financial management strategies. Adults with attention deficit hyperactivity disorder (ADHD) experience a variety of difficulties on a day-to-day basis such as initiating and completing tasks, staying on schedule, following directions and organizational skills. According to epidemiological data, approximately 5% of adults have ADHD, which represents over 11,000,000 people in the U.S.*
There was already a steady referral base of adult patients with ADHD when Kaylee Abeln, MOT, OTR/L, and Anna Perlmutter, MSOT, OTR/L, joined Washington University’s OT Services in 2020 and 2021, respectively . “We began to see an increase in referrals in late 2022 following the COVID pandemic. Adults who had been functioning had disrupted routines with the shift to remote work and their children learning at home. They went to see their psychiatrist and were diagnosed with ADHD,” Abeln says. “Some had been diagnosed as children, but others had not. We even have adults who suspect they have ADHD when their children receive their diagnosis.”
For children with ADHD, several support systems are in place to help manage the condition day to day. Doctors provide medications to treat the symptoms of ADHD such as hyperactivity and impulsivity to help children ignore distractions, pay attention and manage behaviors. Schools provide individualized education programs, or 504 accommodation plans to meet needs as well as therapists, counselors or other resource providers. Parents and caregivers provide structure, routine and consistency within a loving and supportive environment that children with ADHD need to thrive. But what happens after age 18?
“How well they learned to manage their ADHD determines how well they navigate the loss of that support when they transition from a child to an adult,” Antonacci says, the team's newest member who joined OT Services in 2024. “However, for someone just receiving a diagnosis as an adult who hasn’t had any prior understanding of what ADHD is and how to manage the condition day to day, it can be overwhelming but also validating.” Antonacci and Perlmutter can relate to the experience; both received their ADHD diagnoses as adults.
With the patient numbers increasing, Abeln and Perlmutter decided to update the existing adult ADHD program to accommodate the growing referral base. “Any medication support is addressed by the doctor and self-management skill development is addressed in occupational therapy. The majority of adults with ADHD experience challenges with maintaining a consistent routine within these key wellness areas: sleep, nutrition, exercise and mindfulness. Before we address patient-specific goals, such as daily planning for work, we want to be sure they understand
that eating consistent meals and getting adequate rest is important to their success,” Perlmutter explains.
Grocery shopping, meal preparation and healthy food choices can be common challenges. “I have patients who struggle with planning meals and shopping once a week because it’s too overwhelming. They either go to the store every day or they eat out each meal, which may not be healthy,” Abeln says. “We use various strategies to break the process down into what is manageable. Apps can find recipes, and Instacart can buy the items online. If the patient works from home, they can chop ingredients ahead of time to make prep easier. Make a meal one day, then have a prepared meal the next.”
Applying that same strategy to cleaning and organization can help adults with ADHD manage their household tasks. “Adults with ADHD can function at a high level of complexity at work, but struggle with maintaining their home, which can lead to social exclusion and insecurity in relationships. There can be feelings of shame or inadequacy if their home isn’t clean,” Antonacci explains. “Again, we break it down. Maybe we start in a specific room or area or clean for a set amount of time each day. It’s about getting the patient into a thought pattern of what they can do so they don’t let it get to the point where it becomes overwhelming, and they shut down mentally and even emotionally.”
“In general, our focus is to support a patient’s ability to identify areas of challenge, then develop and manage strategies for that area. The end goal is that they can complete this process independently,” Perlmutter shares. “With the new program, adults with ADHD will receive up to 20 visits, or less, to address general wellness and management of executive functioning challenges. We start with identifying a patient’s priority areas, which supports the goal development we address in therapy.”
One of Hailey's goals was to work on finances. “She wanted to look at what her spending habits are. A lack of insight into, ‘What am I spending my money on?’ can lead to stress and anxiety. For example, we completed a ‘bean budgeting’ activity during a session that prioritizes spending based on life circumstances, values and goals,” Antonacci says. “Hailey is also using the NerdWallet app to help track expenses. Patients may find apps and artificial intelligence (AI) helpful because they help break down tasks or remove steps to simply them. I am for any hack that makes life with ADHD easier to manage.”
An important distinction of the adult with ADHD program is all patients receive a Confidence and Commitment Contract. “It can be helpful for patients to clearly understand the expectations during the therapeutic process and their role as they actively engage with their therapist in the program. The added level of accountability helps our patients apply strategies that they learned in treatment independently. Once they can do so, they are ready for discharge,” Perlmutter says.
Abeln has just such a success story. “I had a 22-year-old patient who worked a research job with the long-term goal of applying to medical school. But first, we needed to address more immediate goals that were going on in her life that would have made the transition to medical school very challenging,” she explains. “We worked on improving her success with meal planning, household management tasks, time management and social participation. We identified several strategies to assist with these areas such as using timers/alarms, breaking down tasks into small chunks, making a plan before jumping into a task and so forth. She implemented those same strategies to apply to and eventually be accepted into a medical school in New York. As a therapist, seeing that whole progression from start to finish was rewarding.”
* Source: https://add.org/adhd-facts
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