Dr. John Kruse's Guide to Managing ADHD Effectively
Many people with ADHD focus primarily on medications when seeking help. Stimulants remain our most powerful tool for symptom reduction, but they don't change everything - you need to focus on your life as well. I always start with scheduling, which many ADHD patients initially resist.
The part of you making a schedule isn't an evil taskmaster - it's actually the wisest, kindest part of you that understands your bigger goals. Think of it like a mother hen caring for you rather than a slave driver.
Before slotting in work or external tasks, I tell people to establish four basics. Sleep is by far the most critical, especially for ADHD. All successful people with ADHD have found ways to regularize their sleep. The four essentials are:
1. Sleep 2. Eating 3. Exercise/movement 4. "Me time" (relaxation, meditation)
People with ADHD often show distinctive behaviors. In my practice, they were the only ones who would arrive at my home's front door instead of the office entrance despite clear instructions. Another telling sign: many would say "it was 4:00 yesterday and I realized I hadn't eaten all day." Either not getting the right internal cues from their body or not paying attention to them is measurable in people with ADHD.
Regular meal schedules are important. During COVID, many tech workers with ADHD struggled when they lost access to regular work lunches. Some would start a meal, take a few bites, go back to work, and the meal would fragment throughout the day. Others completely forget to eat.
Time management problems are fundamental to ADHD, though interestingly this isn't one of the 18 symptoms on our official diagnostic checklist. Emotional regulation problems also affect about 60% of people with ADHD but aren't acknowledged in official diagnostic criteria.
For sleep, quality isn't just about getting eight hours - timing is equally important. People with ADHD have a strong genetic tendency toward being night owls. Paradoxically, stimulant medications actually help many ADHD patients sleep better, either because the drug wears off at day's end causing tiredness, or because they've productively expended more energy during the day.
To improve sleep, decide on a reasonable bedtime ahead of time and eliminate stimulation. The single biggest modern tool is keeping your phone out of your bedroom. Having support from family members can help reinforce bedtime routines. Cyclic sighing is particularly effective for falling and staying asleep as it engages the parasympathetic nervous system.
Exercise shows some benefits for ADHD symptoms, with research indicating acute aerobic exercise improves executive functions associated with attention. There are both immediate effects and longer-term benefits from consistent exercise routines.
People with ADHD have nearly double the risk of substance addiction compared to the general population - about 40% versus 20%. Interestingly, children who receive proper stimulant medication treatment for ADHD actually have normalized addiction rates later in life. This treatment appears protective against future substance abuse problems.
The caricature of ADHD as just being easily distracted by squirrels trivializes a serious condition. Children with ADHD have a life expectancy about 10 years shorter than their non-ADHD peers - comparable to having diabetes or major depression. This reduction comes primarily from accidents and suicide, with impulsivity being a major factor in both.
ADHD measurably derails education, disrupts social relationships, and impacts earning potential. It isn't just an academic or cognitive problem - it has significant detrimental impacts across all aspects of people's lives.