This document provides guidance on managing ADHD during isolation. It discusses the three forms of ADHD, current challenges during isolation like loss of structure and increased distractions, and strategies in three areas: cognitive regulation using external cues and self-monitoring apps, emotional regulation like managing stress, and behavioral regulation with feedback and rewards. Specific tips are given for scheduling work and activities, using rewards, dealing with intense emotions, and managing screen time addictions. Reflection on current routines is encouraged.

1. MANAGING
ADHD
DURING
ISOLATION
PRESENTERS: KAREN MACMILLAN, PHD, R. PSYCH.
MICHAEL LEE ZWIERS, PHD, R. PSYCH.
May 21, 2020

2. Thriving…Not Just Surviving
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3. Attention Deficit Hyperactivity Disorder
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There are three forms of ADHD according to the
DSM-V:
1. Inattentive presentation – disorganized; distracted
(some people refer to this as ADD)
2. Hyperactive/ Impulsive presentation - fidgety;
interrupts
3. Combined presentation

4. The current challenges
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Loss of external structure in our days
“Brain fog” as we try to make sense of the changes in our lives
Increased distractions when working from home
Overwhelming amount of new information
High rates of anxiety in individuals with ADHD
Potential for more conflict due to stress and “togetherness”
More dependence on technological devices

5. ADHD = a challenge to regulate!
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• Cognitive regulation – difficulty shifting attention from
interesting things
• Emotional regulation – challenges handling strong
emotions
• Behavioural regulation - struggles with goal-directed
behavior

6. Supporting Cognitive Self-Regulation
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• Provide general structure and consistency, but also
allow for novelty and flexibility
• Use external cues (e.g., music; make time visible)
• Encourage (age-appropriate) self-monitoring
productivity apps for aduts with ADHD

7. Supporting Emotional Self-Regulation
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• Fill your toolkits (what?; where?; when?)
• Everyone needs to feel good about themselves each
day (e.g., set realistic goals; promote “islands of
competence”; contribute to the family; try something new;
connect with peers)
• Make plans to manage your own stress, so that you
can prevent emotional contagion.
• Timeouts work for everyone!

8. Supporting Behavioural Self-Regulation
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• Provide immediate feedback - build opportunities
for meaningful rewards (and therefore, natural
consequences) throughout the day.
• Set up the systems for the household to engage in
healthy habits (e.g., eating; sleep; exercise; nature) –
everyone pick a goal and keep each other
accountable!

9. Do they know what
to do?
• Lectures
• Warnings
Are they able to do
it consistently?
• Proactively structure the
environment
• Coach/ Scaffold
Knowledge versus Performance
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10. If you (or your child) are
already on medication,
continue this as usual.
• Supports the ability to meet
home expectations and
navigate relationships
• Supports the ability to
complete school work
• Supports the ability to inhibit
impulsivity for physical-
distancing in public.
What about medication?
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11. Keeping the peace
in the family
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choose your battles – what is your ultimate goal?
plan together – collaborate on expectations
avoid power struggles - humor, distraction, and delays
notice the difference between intent and ability –
you can trust one without the other
tag behaviour – don’t set consequences when you are
upset
balance interactions – aim for 3-5 positive interactions
for each piece of constructive feedback

12. Focus on Priorities
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• Prioritize your Relationships at home over
getting things done
• Fun
• Family
• Friends
• Take Turns Supervising
• Manage Motivation
• Focus on getting things accomplished in short bursts
• Plan ahead for success
• Maintain a Sense of Humour
• Don’t take things too seriously, especially yourself!

13. Scheduling for Success – Work Day
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• Plan your schedule the night before
• Schedule challenging tasks when
you are most energized and better
focused
• Schedule challenging things before
easy things. Switch between “low-
appeal” and “high-interest”
activities

14. Scheduling for Success – Work Day
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• Schedule meals and snack breaks
• Schedule movement and exercise
breaks (inside, outside)
• 20 jumping jacks, 10 push-ups, run 5 laps around
the outside of the house, or have a quick dance
party in the living room. Get creative!
• Schedule quiet times

15. Use Rewards
• Plan rewards (and celebrations) once the work is done!
• Identify FIST rewards / incentives to promote desired
behaviours
Frequent
Immediate
Small
Tangible
• Keep rewards novel and motivating
(Pfiffner, Barkley, & Dupaul, 2006)
©
S
T
I
F

16. Types of Rewards
• Things to say…
• “I’m proud of you.”
• “You tried your best.”
• Things to do…
• Help cook breakfast
• Go for a bike ride
• Things to get…
• Sticker
• Part of a toy

17. Structure with Flexibility
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• Allow children to choose which
subject to work on during a work
period (choosing board)
• Expect to take unscheduled Mini-
Breaks when needed
• Write fun activities on slips of paper
and have children draw one at
random to add variety and surprise.
• www.gonoodle.com has short videos
with fun exercises for elementary
school age children.

18. Adults - Working from Home
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• Identify a predictable work space
and tools
• Plan work hours and stick to them!
• Separate personal space from work
space
• Group tasks. Don't multitask!
Group and schedule similar activities
(communications, writing, reading)

19. • Plan time frame to do task.
• Haven't started by the end of your
time? Reduce the amount of
work time.
• Start over.
• Keep reducing the number of
minutes until you actually start!
• If you start and are still motivated by
the end of the time, keep going!
• Schedule the same amount of time in
the future.
Accomplishing Tasks

20. Scheduling – Weekends
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• Plans for special activities, meals,
games, outings you do only on the
weekend
• Plan for family time and fun time
and chores time
• Plan for an electronic-free day

21. Dealing with Homework and Teaching
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• How many hours of school
work in a day?
• Aim for 2 hours a day for
elementary school students
• 3-4 hours a day for junior high
• 4-5 hours a day for high school
• This includes homework time!
• Break work into manageable
chunks
• 4x 30 minutes
• 6x 20 minutes
• 8x 15 minutes

22. 4 Steps to Cope With Intense Emotions
1) Identify triggers
Transitions, chores, homework, electronics, siblings
2) Rate emotions/feelings
(Thermometer)

23. 4 Steps to Cope
3) Get Away – “Know when to talk or
walk” (and when)
 frontal lobe function)
4) Get Active – Use up emotion energy
Brisk walk, play drums, shovel
snow, dance to music, treadmill,
etc.

24. Managing Electronic Addictions
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• Any activities with addictive potential
need to be scheduled, time-limited,
and predictable
• Same time, same place, same duration
• Start on time and end on time
• Provide a 10- and 5-minute count down
• Teach about different reasons for
using electronics: social media, school
work, connecting with family &
friends, entertainment
NOTE: A random schedule will worsen the addiction

25. Ask yourself:
What is working right now?
What is not working?
Can I predict the ‘worst’
parts of my/our day?
How do I ideally want
my/our routines to look?
What is my priority?
Take some time for Reflection
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