BY: Louise Hilliar
I recently ran a workshop for university staff who support students with ADHD. Delegates were surprised at the extent of the difficulties which may face these students throughout each day, and at the students’ resilience and determination. As well as discussing potential challenges, we shared ideas about managing ADHD at university. In this post, I present the key points.
Challenges which may face students with ADHD:
1. Getting up on time
- went to bed too late
- forgot to set an alarm
- felt too tired to get up
- had enough sleep but couldn’t ‘get going’
2. Getting ready to go out
- problems with organisation and motivation
- becoming distracted
- inability to find things such as clothes and books
- nothing in the house for breakfast
- the kitchen is too untidy to prepare breakfast
- concerns about the day ahead leading to a reluctance to leave the house
3. Arriving at the university on time
- leaving the house too late
- misreading timetables
- getting on the wrong bus
- getting distracted on the way
4. Getting to lectures, concentrating during lectures, taking and filing notes
- confusion over arrangements
- arriving late
- forgetting equipment such as paper, pens, and lap-top
- flat battery in lap-top
- difficulty with sitting still
- losing concentration
- becoming distracted
- difficulty with ‘picking up the thread’ again once distracted
- falling asleep
- difficulties with retaining information
- inability to identify key points when taking notes
- slow handwriting speed (particularly if dyslexic and/or dyspraxic)
- problems with filing both paper notes and electronic notes
5. Group work, tutorials and seminars
- talking too much
- losing concentration
- difficulties with contributing due to a failure to follow the discussion
- making inappropriate comments
- offering to do a great deal but not delivering
- delivering on practical aspects of tasks, but being unable to complete written work (particularly if dyslexic)
6. Independent study in the library (writing an assignment)
- avoiding going at all
- forgetting or losing brief
- becoming overwhelmed with information when researching
- problems with reading comprehension
- visual stress
- not addressing the question directly
- producing a poorly-structured response
- including too much information
- difficulties with evaluating own work and with proof-reading
- problems with referencing
- failure to submit work in requested format
- missing deadlines
- completing work but failing to submit it
- failure to complete cover sheets
- difficulty with remaining focused on the brief when carrying out research
- problems with time-management when preparing
- confusion over practical arrangements such as times and rooms
- forgetting resources such as memory sticks
- deviating from main points
- problems with assimilating questions
- problems responding to questions directly and concisely
8. Food shopping, cooking and tidying up the kitchen
- forgetting to buy particular items
- impulsive buying
- inability to queue
- insufficient money due to difficulties with budgeting
- cooking is an effort
- burning food due to distractibility
- wasting food due to problems with planning
- resorting to ‘junk food’
- problems with clearing up
9. Personal paperwork and emails
- forgetting to pay bills
- failing to complete forms
- problems with filing paperwork
- overlooking important emails
- lack of motivation
- difficulties with finding (clean) kit
11. Meeting friends
- failing to respond to messages
- problems with getting ready on time
- arriving late
- becoming excitable in company
- becoming bored in company
- difficulty with following conversations
12. Getting to bed/sleeping
- not feeling tired at bedtime
- mind being too active to sleep
- being involved with activities at bed-time (e.g. hyper-focusing on computer games)
- waking during the night
- being too active during sleep to share a bed
- problems with getting up
Strategies for managing ADHD at university:
1. Attendance/keeping appointments
- living on or near the campus
- living with house-mates who have the same time-table
- setting the same time and place for regular appointments
- receiving reminders
- increasing motivation by rating the importance of punctuality in different situations and evaluating the impact of lateness
- creating a time-plan for getting ready
3. Focus during lectures
- sitting near the front
- making lecturers aware of difficulties so that they can monitor levels of focus, provide subtle prompts if necessary, and engage directly with the student
- taking frequent breaks
- reading notes through beforehand
- taking notes
- fiddling with a toy or plasticine
- developing note-taking skills
- annotating handouts instead of taking full notes
- making electronic notes which can be edited
- making recordings
- being provided with a note-taker
5. Filing notes
- having help to set up and use a system to file both paper-based and electronic notes
- avoiding the need for notes by using materials on electronic learning platforms for assignments and revision
6. Following and remembering instructions
- check that the student is listening
- keep it brief
- check understanding
- back up information in writing
7. Checking university emails and using electronic learning platforms
- ensure that emails can be accessed on smart phone
- train in use of electronic learning platforms
- provide reminders to check and respond to emails
- provide reminders to check electronic learning platforms for notices
8. Practical sessions
- check that instructions have been understood
- check periodically that the student is on task
- provide extra time
- engage directly with the student
- avoid putting the student ‘on the spot’
- provide on-going monitoring and coaching
- support with preparation and practice
- help with arrangements such as booking rooms
- encouragement to stay focused on the topic
- repeat verbal questions and give time to prepare responses
- evaluate skills so that areas of weakness are identified, and progress is monitored e.g. ‘Do you make plans for your time?’
- set goals
- make lists
- prioritise activities
- estimate time to complete tasks
- schedule tasks
- incorporate a reward system
- evaluate what is happening e.g. ‘Which tasks do you delay?’, ‘Were instructions clear?’, ‘What support was in place?’, ‘What are the consequences of not doing the task?’, ‘What cues do you use to begin a task?’, ‘Do you have breaks?’
- break tasks down
- use rewards
- work with others
- identify emotional obstacles (such as negative automatic thoughts)
- use external strategies e.g. low level music, quiet place, earplugs, phone on silent
- use internal strategies e.g. novelty, goal-setting, competition, rewards, breaks, alarms
- manage visual distractions e.g. have visual materials out of line of vision, face into a room, use bright colours to attract attention to task, use cue-cards or posters e.g. saying ‘Focus!
15. Researching for assignments
- support to identify a manageable amount of information
- develop reading comprehension skills
- use text-to-speech software and audiobooks
- manage visual stress (e.g. with coloured overlays, tinted glasses, changing the colour of computer monitors)
16. Assignment writing
- support to develop essay-planning skills
- use appropriate software
- support to develop proof-reading skills
- address procrastination and concentration
- test knowledge
- complete past papers
- separate invigilation
- distraction-free room
- rest breaks
- extra time
Managing ADHD at home:
1. Organisation at home
- have few possessions
- label drawers etc
- use see-through boxes
- set a place for everything
- receive support
2. Keeping track of personal possessions
- name items
- use a check-list of items which are often left behind
- use blue-tooth tags
- purchase inexpensive items
- shop for the same menu each week
- keep a standard shopping list on smart phone
- shop for food online
- make simple meals
- cook in batches
- cook with flat-mates
- use a laundry basket
- have a set day for washing
- set alarms for taking washing out of the machine and dryer
- do laundry with a friend
6. Personal hygiene
- establish a routine
- ask someone to check up on you
- set up a filing system
- have a special place for urgent paperwork
- deal with paperwork immediately
- have a supply of envelopes, stamps etc.
- discard unneeded paperwork
8. Money management
- set up direct debits
- cut up credit card
- avoid online shopping
- seek advice from a money adviser
Managing ADHD in relation to well-being:
- keep it simple e.g. go out running, join a gym near to accommodation
- have a routine
- go with housemates
- establish a routine for having kit laundered and ready
- address sleep hygiene e.g. reduce caffeine, no screens before bedtime
- discuss medication with GP
- seek advice from ADHD clinic
- keep active
- remain social
- seek help
- attend to sleep
- attend to diet
- capitalise upon areas of strength
- development other areas
- recognise that problems are related to ADHD and not laziness etc
5. Mental health
- seek therapy
- engage with specialist mentor
- engage with addiction services if necessary
- explore option of medication with GP
- work with professionals who have knowledge of ADHD
- NICE recommends drug therapy as the first-line treatment for ADHD.
- stimulants include methylphenidate (Ritalin, Concerta), dexamphetamine, and modafinil
- non-stimulants include (atomoxetine, bupropion, clonidine, tricyclic antidepressants, venlafaxine)
- these need to be prescribed by a specialist psychiatrist or nurse
Kirby, A. (2013). How to Succeed with Specific Learning Difficulties at College and University: A Guide for Students, Educators & Parents. London: Souvenir Press Ltd.
Tuckman, A. (2012). Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook. USA: Speciality Press Inc.
Young, S. and Bramham, J. (2007). Cognitive-behavioural Therapy for ADHD in Adolescents and Adults: A Psychological Guide to Practice. West Sussex: Wiley-Blackwell.
BY: Louise Hilliar
This interview with a university student provides some interesting insights into how dyspraxia may affect people throughout their lives. It also shows how, with determination, and some appropriate support, dyspraxia need not be an obstacle to success. Some details, including the student’s name, have been changed.
Louise: How does being dyspraxic affect you?
Paul: Dyspraxia affects motor skills and your physical responses to things. It affects depth perception and the ability to respond at the right time. I’m not as sporty as other people and my hand-eye coordination is weak. Also, I can’t organise myself as well as other people. I’m less aware of deadlines and I don’t always remember them. I also find that it’s a bit more difficult for me to learn my way around new places and that I need some extra time for this.
Louise: When were your difficulties with coordination first noticed?
Paul: I was quite young, aged about ten or eleven. My parents spotted them at first and took me to see the GP. I was then referred to an occupational therapist for an assessment and had some support for a year or two. This involved activities like balancing on a ball and practising throwing and catching.
Louise: When you started school, what, if anything, did you find tricky?
Paul: I was never very good at PE. I used to miss the football if I tried to kick it and I was not good at badminton or tennis. I also ran oddly and used to bend forwards. I could get changed without any problems, but I still can’t tie shoe-laces despite people trying to teach me.
Louise: Is there anything else that you found difficult?
Paul: I also found cutting out difficult and was not very accurate. I found it hard to keep within the lines when I did colouring, and found it difficult to write neatly. Later on, one teacher thought that I was writing messily on purpose, and my work was often compared with hieroglyphics. I began to use a lap-top during lessons at the age of around ten.
Louise: How did you find learning to ride a bike?
Paul: This took me a while and I was fourteen or fifteen by the time I could ride without stabilisers.
Louise: How does your dyspraxia affect you nowadays?
Paul: There are still some weaknesses in my motor skills. I can’t play tennis or badminton, but I can kick a football. My dyspraxia is less obvious now and my balance has improved, but I still sometimes trip over things or slip over. When I cook, I can chop and pour well, but I have the odd accident and cut my finger on a tin recently. I also cut myself shaving this week. I find it difficult to do up clasps on jewellery.
Louise: Does it lead to any difficulties with your studies?
Paul: My handwriting has improved but it still isn’t very good. I sometimes use a lap-top to take notes in lectures and I also have a digital recorder. I don’t get around to filing my notes and I find it difficult to put sheets of paper into plastic wallets.
Louise: Do you have any other special aids or other forms of support?
Paul: I have been given assistive software for my lap-top and a printer. I see a study skills tutor each week. She helps me to plan and edit my work. I also see a mentor each week and she helps me with time-management and organisation. I can talk to her about anything that’s bothering me. This is all funded through Disabled Students’ Allowances.
Louise: Will your dyspraxia affect your choice of career?
Paul: I don’t want it to get in the way of my career.
Louise: Do you tell people about your dyspraxia?
Paul: No, I don’t think that it’s relevant.
Louise: Are there any positive aspects of having dyspraxia?
Paul: Maybe it helps me to see things in a different and interesting way.
Louise: Do any other members of your family have dyspraxia?
Paul: I think that my mum and brother have it. They are both clumsy and often drop things.
Further sources of information:
BY: Louise Hilliar
Note-making is a skill which is always necessary for students and often necessary for employees. It is, however, a skill which is often taken for granted. In this article, I outline the value of making notes, discuss different forms of note-making, and provide some tips about effective note-making.
Why make notes?
It is important to consider the reason that notes are being taken as this will influence the way that this task is approached. Notes may be taken to:
- Provide a record
- Enhance understanding
- Prepare for writing
- Help memory
General tips on note-making
- Be actively involved in the process as this will lead to useful, high quality notes and effective learning.
- Be clear about which questions you want to answer through your note-making and which predictions you want to test.
- Make sure that your notes will make sense when you return to them. If they are too brief, this may be difficult.
- Use symbols and abbreviations to save time. Keep a key and introduce a few at a time so that your notes make sense. Useful suggestions can be found here.
- Leave spaces so that you can add further detail later on.
Pen-and-paper or computer
The main advantage of making notes on paper is that it is easier to incorporate symbols and drawings. For particular subjects, it is probably the only option. You may also find that the physical act of writing helps you to concentrate and to remember what you have recorded.
The alternative is to use a computer to take notes. This may be advantageous if you can type more quickly that you can write. It may also be easier to edit and adapt your notes and in some cases, it may be possible to add to on-line course notes or to agendas. As with hand-written notes, care needs to be taken to organise these notes. The use of digital notebooks such as Microsoft OneNote or Evernote can be useful in this respect. Electronic notes need to be backed up on USB sticks or using on-line file storage.
Linear notes are produced when you record information in the order that you read or hear it. Since your notes reflect the structure of their source this may help you to understand information and to locate details later on. Some tips for making effective linear notes:
- Include headings.
- Number points.
- Make the page visually memorable for example by colour-coding particular types of information and including diagrams.
- If writing on paper, spread your notes out on the page so that details can be added later.
Non-linear note-making involves the production of mind-maps or spider diagrams. These begin with a record of the topic area in the middle of the page, with ideas branching out from this which may be repeatedly sub-divided. Mind-mapping software is available and includes MindGenius and iMindMap.
Making notes from text
Tips for note-making from text:
- Put your pen to one side until you have gained a sound understanding of the text.
- Read introductions and summaries first and take careful note of headings in order to identify the structure of the text and key issues.
- Read the text through once in order to gain an overview of the subject matter.
- Based on this initial reading, formulate questions to be answered. These may include issues that you have not fully understood and clarification about the writer’s views, for example.
- At this stage, it is often useful to highlight text or annotate it. For this reason, you may prefer to print documents, buy copies of particular books, or photocopy sections of books.
- Text in electronic format may also be highlighted and annotated. Sections of text, and comments, can then be transferred into a new document for editing and this way of working can be undertaken using Microsoft Word, Read&Write or ClaroRead.
- Referring to your highlighted sections of text and annotations, produce summary notes in your chosen format.
- Ensure that you make a record of the source of your notes. Include page numbers so that you can go back to the original text at a later date.
Making notes from lectures, presentations and meetings
Ask yourself the following questions when deciding how to approach note-making in these situations:
- Is this my only source of information or will I have hand-outs, books or minutes to refer to later?
- How much detail do I need?
- What do I need the notes for?
If, for example, you are attending a presentation which provides an introduction to a new topic and you know that you will be given a hand-out at the end of the session, you may decide to take very few notes but to focus on gaining an overview of the subject.
Some tips for note-making in these situations:
- Prepare for the session by reviewing material produced during previous sessions and reading any available background material such as agendas, reports, and hand-outs.
- Arrive prepared with pens and file paper or a note-book, or a computer.
- Identify your notes clearly including the date, course title, subject and speaker, where relevant.
- If you are provided with a hand-out or agenda at the beginning of a session then you could record your notes directly onto these.
- If hand-outs are provided at the end of a session then you may like to add key points from your notes to these. This will allow you to make use of the speaker’s structure and will provide the opportunity to enhance your understanding of material.
- Be selective about what you record.
- Distinguish between key points which need to be recorded and further explanation which you may not need.
- Key points may be highlighted at the beginning and end of a lecture and may be displayed on a screen or white-boards. Speakers may indicate key points by using particular phrases such as ‘the main issues here _ _ _’.
- Including examples often provides useful clarification.
- Record the speaker’s opinions and evaluation of ideas as this information is less unlikely to be available in other sources.
- Using the speaker’s words can help to save time and may enable you to learn the language associated with particular topics.
- If you have time after a presentation, then it can be useful to go through notes soon afterwards while your memory is still fresh. This will allow you to fill in any gaps and clarify any illegible words so that your notes are clear when you return to them later on. It also helps to consolidate learning.
Support for those who find note-making challenging
Those with neurodiverse conditions often find note-making difficult. They may have problems with simultaneously listening and recording or may have problems with handwriting. If this is the case, reasonable adjustments may be put into place if you disclose your difficulty. For example students may be provided with a note-taker and employees may be exempt from taking minutes at meetings.
BY: Louise Hilliar
Recently I ran a series of workshops for adults with Autism Spectrum Conditions (ASC). In this post, I review these workshops in order to reflect upon their success and to share my ideas with others.
I always knew that running a series of workshops for adults with ASC would be challenging in terms of preparation and meeting the diverse needs of the participants. Even so, I felt that this would be a worthwhile project.
The five sessions that I ran were as follows:
- Putting the past into perspective: understanding the impact of ASC
- Getting things done at home.
- Succeeding at work.
- Communication and relationships.
- Managing emotions.
Having found a venue, I quickly identified eight people who wanted to take part in the workshops. In order to establish whether the potential participants would benefit from the sessions and to gather essential background information, I spoke to each of them on the telephone before offering them a place. This allowed me to get to know a little about each of them including their current situation and their expectations for the sessions. I was aware that many people with ASC dislike using the telephone, but each of them was willing to speak with me and I hoped that this initial contact made coming to the first session a little easier for them.
I began the first session by drawing participants’ attention to some workshop principles that I had drawn up. These addressed issues including respect for other group members, confidentiality, support available outside of workshops, relationships between group members, and addressing concerns about the workshops. We then went on to identify features and behaviours which are relevant to people with ASC, and participants then considered two of these features in more detail – one which had positive associations, and one which had negative associations. Throughout the workshops, I was keen to look at the positive aspects of ASC as well as any difficulties which may be associated with it. In order to reinforce the point that each person with ASC is unique, participants then worked in pairs to identify at least one difference between them. We ended this session with participants making a note of useful sources of support such as books, groups and websites and I put this information together in a document to be distributed during the next session.
I chose to focus on getting things done at home during the second session partly because I felt that this would be one of the least emotive areas to address. I soon learnt, however, that there is often a strong emotional component involved. It should also be acknowledged that some people with ASC are supremely organised and efficient at home. I included a poignant article from The Guardian as a starting point for this session. It is a letter written by a mother to her son who has Asperger Syndrome, and it describes clearly the way that some people with ASC, whilst being highly competent in some areas, find it very difficult to keep on top of things at home. Having read this, participants shared their strategies for managing at home with the other members of the group. They then followed a series of steps which enabled them to:
- Identify any difficulties that they have at home
- Decide which one they would like to address first
- State a goal such as ‘To have appropriate food in the house each day.’
- Identify differences or difficulties that are involved in the problem
- Consider which solutions may be helpful
- Plan their chosen solution
This process was based on the work of Valerie Gaus and as well as providing handouts during each session, I indicated which books I had used for preparation and brought relevant books along for people to look at.
Session 3 began with a review of the progress that participants had made with their plan to get things done at home. We then turned to the main focus of the evening which was ‘Succeeding at Work’ and started with listing the positive qualities that people with ASC bring to the workplace. Participants then discussed the issue of disclosure; this can be a difficult issue and some group members shared negative experiences. Participants then discussed sensory issues related to the workplace with a partner and summarised their discussion, sharing it with the rest of the group. As an introduction to this activity, we looked at a quote from a book by Sarah Hendrickx in which an employee with Asperger Syndrome describes his difficulties with having people look over his shoulder, his sensitivities to light, noise and motion. We then went on to look at small talk and communication style. Following this, we discussed bullying at work which is an important issue as those with ASC may be more likely to be targets of bullying. A further activity involved participants reflecting upon aspects of work that people with ASC may find stressful, and ways of managing these stressors. Finally, as a group, we discussed reasonable adjustments which may be put into place in the workplace.
The fourth workshop focused on communication and relationships and I began this by asking participants to reflect upon positive features of their communication style which may be related to ASC. I then suggested that social skills involve the three elements of social intake, processing and social output, and participants reflected upon experiences they had had which related to weaknesses in one or more of these areas. I concluded this task by referring, again, to some of Valerie Gaus’s work. She points out that those with ASC are more likely to experience difficulties in one or more of the three steps involved in social skills and that this can lead to unwanted responses from other people, from being ignored to lacking friendships. We then went on to consider the ability to read other people and began with the question of empathy. By breaking empathy down into four steps, it helps us to see that those with ASC do not necessarily lack feelings of empathy, but that difficulties at different points mean that they may not always show it.
The four steps are:
- Thinking about another person’s experience.
- Identifying the emotion that she or he is having.
- Feeling the same emotion.
- Expressing this feeling.
Our next activity involved sharing tips on conversational skills. I provided some tips and then asked participants to share further ideas. Following this, we discussed issues related to friendships and reviewed some ideas produced by Genevieve Edmonds and Dean Worton about how to maintain friendships. Then we briefly considered issues related to intimate relationships. I ended this session by reminding participants that they need to be aware of their own safety and that of others in social situations, particularly as ASC may lead to social naivety. Whilst I felt that this session was useful in some respects, if I ran it again, I would emphasise more strongly the experience of the participants, and would focus more on the fundamental issues of making friends and meeting partners.
The final workshop session focused on managing emotions. Participants began by comparing differences between the emotional lives of people with ASC and neurotypical individuals. We then discussed the function of emotions and two main areas where problems may arise, namely the ability to monitor and adjust emotional responses, and the ability to understand and interpret the emotions of others, express feelings to them, and use their help. Participants used a five stage model to reflect upon a situation which has involved a strong emotional response. The aim of this was to become more aware of environmental triggers, automatic responses, and helpful coping strategies. We then moved on to consider mutual regulation, and participants shared tips about ways in which they could manage the emotions of other people, express their emotions to others, and ask for help. We looked at a technique which involves inserting a ‘feeling’ word and a ‘need’ word into the sentence ‘I feel _ _ _ _ _ , therefore I need _ _ _ _ _.’ After this, we considered the nature and management of meltdowns, beginning with some ideas from Deborah Lipsky. We then turned to the topic of depression, an important issue as those with ASC often experience poor social support and chronic stress which may lead to this condition. Participants reflected upon a time when they had felt particularly low and shared ideas with the rest of the group if they felt comfortable to do so. We discussed ways of managing depression including cognitive behavioural therapy, medication, and mindfulness and ended the session with a quote from Nick Dubin:
- Embrace your gifts. Recognise your common humanity and brotherhood with others while celebrating your individuality and creativity.
- Dare to dream! If you can dream it, you can achieve it.
- Follow your passions and successes will follow.
- Don’t lose hope. Our life’s purpose is often hidden to us. Maybe you are here to help others expand their perspectives and discover new possibilities.
- Be a leader. Help other Aspies recognise their potential and realise their dreams. Help society at large recognise us as positive, contributing members of our communities. As Ghandi once said, “Be the change you want to see in the world.”
The sessions as a whole, were characterised by honest, open and sometimes humorous discussions, and it was often commented upon that participants benefitted from sharing experiences. The group members listened carefully and patiently to each other and I would hope that this helped them to feel valued. I ended the series of workshops feeling that, for most participants, it had been a positive experience and knowing that, for me, I had been privileged to take part in this project which had deepened my understanding of ASC. Several participants kindly completed evaluation forms which will enable me to improve the workshops in the future.
BY: Louise Hilliar
Procrastination can certainly be the thief of time for those with a neurodiverse condition. In this post I discuss the nature and consequences of procrastination as well as strategies for tackling this common problem.
Neurodiverse conditions and procrastination
Individuals with dyslexia often delay beginning tasks which involve literacy skills. Those with Asperger Syndrome and ADHD often find it difficult to engage in activities which do not interest them and those with ADHD often have particular problems with getting tasks started. Those with dyspraxia, Asperger Syndrome and ADHD often have weaknesses in executive function. This is our ability to direct or steer ourselves in order to achieve particular goals. Executive skills include inhibition, working memory, emotional regulation, planning, and attention.
The consequences of procrastination
Procrastination can be frustrating due to the amount of time that is wasted and because of the practical and psychological consequences of failing to get things done. As well as affecting the individual themselves, it affects those around them who may take the view that the individual is being lazy or uncooperative. It can be difficult to understand why a person who seems intelligent and capable has problems in this area.
Shifting from one activity to another
Procrastination can often take the form of a disinclination to stop doing one task in order to begin another. In order to tackle this, it may be useful to develop an awareness of which activities an individual gravitates towards when delaying other tasks. Once such an awareness has been reached, it may be helpful to avoid particular activities altogether until other tasks have been completed. Alternatively, the time spent on these may be limited by setting external reminders such as alarms. Apps are available which can be used to limit the time spent on social media sites.
Identifying problem areas
One of the first steps in tackling procrastination is to identify which activities an individual tends to put off. Keeping a diary of tasks which were delayed or avoided during a particular week may be useful. For each task, the following questions may be asked:
- What type of task (e.g. work-based, domestic, social) was it?
- Was the task chosen or allocated?
- How long a project was it?
- What information was available about the processes involved?
- What was the degree of familiarity with the task?
- What support was in place?
- What were the consequences of completing or not completing the task?
Making active choices about which activities are undertaken and the way that they are carried out is likely to enhance motivation. This requires a degree of self-awareness in terms of interests and effective ways of working, for example.
Break it down
Longer term goals can seem unachievable but by breaking them down and focusing on one step at a time, they may become more manageable. A project that needs to be finished by the end of the day could be broken down into half hour activities. A project that needs to be finished by the end of the week could be broken down into tasks to be completed each day. Then the sub-tasks for each day could be divided further into half-hour or hour-long tasks. Often projects need to be spread throughout other tasks and, in this case, it can be useful to plan to dedicate particular times to this project, record this on a calendar, and then plan sub-tasks when the time arrives.
Breaks and rewards
It is important to have planned breaks during activities. How often these need to take place varies from person to person and task to task. It may be useful to monitor the length of time that concentration can be sustained and then plan a break shortly before this point is reached. This is likely to make it easier to return to the task following the break. Rewards should also be incorporated into plans. This may include smaller rewards along the way such as a snack break when a sub-goal has been achieved and a larger reward such as going out for the day when the longer-term goal has been achieved.
Cues and start-times
It may be useful to do repetitive tasks at the same time each day (such as after a meal) as this can help to cue the start of the activity. Setting alarms on mobile phones can also be helpful. Providing a start-time can also be effective. This is a count-down between the cue and the time that you actually begin an activity.
Support from others
When faced with an unfamiliar task, it can be useful to seek advice from someone who has tackled something similar. Completed assignments or projects may provide helpful models. Drawing upon the support of a coach or mentor is often critical for those with a weakness in executive function and the obligation to let someone else know how a task is going to be tackled and what progress has been made can be a great motivator.
A history of failure or negative comments from others may lead to emotions which contribute to procrastination. An individual may, for example, feel anxious or demoralised when faced with particular tasks. There may also be an opposition to completing tasks which has its roots in childhood. The way that we think about events influences our emotions and behaviour and although our thoughts about events may be accurate and helpful, they may also be inaccurate and unhelpful. Automatic thoughts may be identified by noticing when distressing feelings arise, labelling the feelings, and then identifying the associated thoughts. Examples of negative automatic thoughts include all-or-nothing thinking such as ‘If I don’t get this perfect then I am a failure’ and over-generalisation such as ‘I didn’t complete this task successfully so everything has gone wrong’. Having identified inaccurate and unhelpful thoughts, these may be challenged through an evaluation of the evidence, and they may be replaced with more positive thoughts.
Techniques based on mindfulness may help us to become more aware of feelings and thoughts which lead to procrastination. This technique involves labelling avoidance in the moment and acknowledging negative feelings and thoughts in a non-judgemental way.
When facing the challenges associated with procrastination, it helps to adopt a compassionate approach. This involves using kind and warm self-talk of the type that would be used when encouraging a friend. It may also involve the creation of a mental image of a figure who offers compassionate support.
BY: Louise Hilliar
In this post, I explore ten common myths about autism.
1. You can be mildly autistic.
In my view, it is a mistake to label someone as being mildly autistic as you either meet the diagnostic criteria, or you don’t. Those with autism vary a great deal in terms of their cognitive functioning, however, hence the term ‘autism spectrum’.
2. You can tell that someone’s autistic simply by looking at them.
My experience is that you can sometimes guess that someone may be autistic based on the way that they behave or dress, but that it is often difficult to tell that someone is autistic without carrying out an in-depth assessment. This is why it is important that teachers and health care professionals learn about the characteristics of autism and make appropriate referrals.
3. There are as many females with autism as there are males.
I would agree that there is under-diagnosis of females with autism. This is perhaps because people do not expect females to have autism, because they hold a stereotypical view of autism which relates to the way that it presents in males, and because females are more likely to be able to ‘hide’ their autism. Even so, research carried out in 2009 suggests that autism is found in 1.8% of males and just 0.2% of females.
4. People with autism don’t have other conditions too.
There is an increasing awareness that people with autism are more likely than those without autism to have other conditions such as dyslexia, dyspraxia and ADHD. They are also more likely to experience anxiety and depression and many of the clients that I see have struggled with mental health issues for some time before realising that differences related to autism were contributing to their distress.
5. People with autism aren’t sociable.
People with autism are often sociable and like to be with others. They may find it difficult to know how to behave at times, however, and may need more time to themselves than neurotypical people.
6. People with autism don’t develop close relationships.
People with autism often have very close relationships with members of their family and often form successful partnerships.
7. People with autism don’t have empathy for others.
People with autism often do have empathy for others and some describe themselves as being very intuitive. However, it may be the case that some people with autism take longer to pick up on cues enabling them to understand things from another person’s point of view or that they need to know a person well before they understand them. In addition to this, it may be difficult for people with autism to respond as might be expected when they feel empathy.
8. People with autism don’t make eye-contact.
Those with autism often find eye-to-eye gaze uncomfortable and may avoid it. They frequently learn to make use of eye-contact as they realise that it is a social expectation but may find it difficult to judge how long to hold eye-contact for. Some people with autism look at the area around the eye rather than at the eye itself – a useful strategy.
9. People with autism can’t develop effective social skills.
Those with autism often learn to interact very effectively with others in a range of contexts. This can be demanding, however, and a day at work, for example, can be very tiring for an individual with autism.
10. People with autism don’t like sport.
Many of the people that I’ve met with autism don’t like sport. It’s not uncommon for them to have dyspraxia, and the social aspects of sport can present challenges. Even so, I have met some people with autism who love sport and who play a team sport regularly.
BY: Louise Hilliar
In this post, I briefly describe the characteristics and possible causes of dyspraxia, the ways in which it manifests itself in adulthood, and how it may be identified.
What is dyspraxia?
Dyspraxia (or developmental coordination disorder as it is often known as outside of the UK) is a lifelong condition. It is characterised by weaknesses both in fine motor skills such as those involved in writing and using scissors and in gross motor skills such as those involved in dancing and riding a bike. Infants with dyspraxia are often slow to learn to crawl and walk, and affected children often fail to present their work neatly at school, find sport and games challenging, and struggle with self-care. Dyspraxia is found in those of all levels of cognitive ability and is different from other motor disorders caused by cerebral palsy and stroke, for example.
Those with dyspraxia may have unclear speech due to difficulties controlling the muscles in their mouths and may find it difficult to moderate the volume of their speech. They may have difficulties with organisational skills and with aspects of social interaction such as interpreting facial expressions and understanding jokes and sarcasm. Affected individuals may experience difficulties with eye movements and may be more likely to experience visual stress than others.
Perceptual differences may be present. These are varied and may include under-sensitivity to stimuli, over-sensitivity to stimuli, and weaknesses in spatial and temporal awareness. Cognitive differences may also be present. These are also varied and include difficulties with planning and organising ideas and weaknesses in working memory and concentration as well as a slowness in processing information. These differences may lead to problems with following instructions, structuring written work, multi-tasking, and working under pressure of time.
What causes dyspraxia and who is affected?
The precise cause of dyspraxia is not known but it is possible that it results from inadequate reinforcement of particular neural pathways. Dyspraxia is more common in males than females and there is some evidence that it is inherited. It is not uncommon for those with dyspraxia to have co-occurring conditions such as dyslexia, Asperger Syndrome or ADHD. There is overlap between these neurodiverse conditions and those with dyslexia and dyspraxia often share the same pattern of cognitive strengths and weaknesses with relative weaknesses in working memory and processing speed. Dyspraxia is thought to affect up to 10% of the population.
How does dyspraxia manifest itself in adults?
Adults with dyspraxia frequently report difficulties in the following areas:
- arriving to places on time
- carrying drinks
- following conversations
- laboratory work
- learning to play instruments
- remembering instructions
- riding a bike
- self-care (e.g. cutting nails and putting on make-up)
- speaking quietly
- structuring written work
- taking notes during lectures or training courses
- understanding jokes
- working quickly
How is dyspraxia identified?
In childhood, dyspraxia is often identified by a paediatrician or occupational therapist. Since dyspraxia has only been recognised for the last 20 years or so, we can expect that there will be many undiagnosed adults. Adults are less likely to be referred to an occupational therapist than children and the difficulties that an adult experiences are less likely to be related to motor coordination and more likely to be related to differences in cognitive functioning. For this reason, dyspraxia in adults is often identified by psychologists.
Recently published guidance on the assessment of dyspraxia in clients within educational settings emphasises the importance of providing evidence of a history of motor co-ordination difficulties and taking account of physical and educational aspects of dyspraxia. Appropriate assessments may include tests of visual-perceptual skills, visual-motor integration, processing speed, working memory, fine motor skills and handwriting speed.
Further sources of information
Colley, M. (2006). Living with Dyspraxia: A Guide for Adults with Developmental Dyspraxia. London: Jessica Kingsley Publishers.
Grant, D. (2010). That’s the Way I Think: Dyslexia, Dyspraxia and ADHD Explained. London: Routledge.
BY: Louise Hilliar
For this post, I have interviewed a fifty year old male who was unaware that he was dyslexic until he was in his thirties. His name has been changed to protect his identity.
Louise: What was your early experience of learning to read and write?
Chris: I found this very difficult and was behind my peers. Other children seemed to find that reading came naturally and didn’t have to revise much for spelling tests. I worked very hard but this wasn’t reflected in my performance.
Louise: What did you think about this at the time?
Chris: I simply thought that I wasn’t very clever.
Louise: Were there any other early signs that you were dyslexic?
Chris: My speech was slow to develop and now I know that this is quite common in people with dyslexia.
Louise: How did your dyslexia affect you as you grew up?
Chris: As I got older, I continued to misread words and had problems with word retrieval. My problems became particularly obvious when I was taking exams as I had difficulty interpreting questions and always ran out of time. As well as being dyslexic, I have visual stress, and this makes reading very tiring.
Louise: Did your difficulties with literacy skills affected your self-confidence?
Chris: Yes, definitively. I thought that I wasn’t very bright. Now I realise that I was quite clever but that I have a specific learning difficulty.
Louise: How do you think that school would have been different for you if you had known that you are dyslexic?
Chris: Just knowing the reason for my difficulties would have helped. I probably would have had extra support at school and at home as well as having extra time for my exams.
Louise: Has being dyslexic affected your career?
Chris: Yes, I joined the armed forces at a young age and was a good soldier but I couldn’t pass exams and this limited my career. I moved on from the forces sooner than I might have done and eventually became a paramedic.
Louise: You must have needed to sit a lot of exams to become a paramedic, how did you manage?
Chris: I needed to revise by ‘cramming’ just before exams to avoid forgetting things. I find revision hard work but I’ve developed some useful techniques such as producing summaries on index cards and testing myself. When we were at the training college, I would stay up late revising whilst the others went to the bar and then on to bed. It was tough.
Louise: How did you manage activities which involve reading and writing when you were a paramedic?
Chris: I organised my equipment in my bag carefully so I knew where to find each drug. I also produced a clear aid memoir which helped me to ensure that I administered the correct drug and the correct dosage. All drugs are checked by a colleague before giving them and this provided another check. I was able to complete my paperwork to an acceptable standard, but I needed to work hard at this and it took me longer than other people.
Louise: Did anyone at work suggest that you might be dyslexic?
Chris: No, no-one picked up on this, despite my difficulties.
Louise: What do you do now?
Chris: I work as a fitness instructor. I’ve always chosen practical jobs and this is perfect for me – lots of activity and not too much paperwork.
Louise: Outside of work, how does your dyslexia affect you?
Chris: I tend to avoid reading as I am very slow and can’t absorb information. I’m also slow to send texts and emails.
Louise: Do you feel that there have been any benefits of being dyslexic?
Chris: It has encouraged me to develop other skills such as becoming a good team-player and being well-organised. The challenges that I have faced mean that I’m not shy of hard work.
Louise: What advice would you give to a young person who feels that they may be dyslexic?
Chris: Find out as much as possible about how it affects you, explore ways of managing your weaknesses, seek specialist tuition, and enquire about access arrangements for exams.
You can find out more about dyslexia in adults and how it is assessed here.
BY: Louise Hilliar
In this post I aim to outline the nature of visual stress, briefly discuss methods of identification and treatment, and point the reader towards further sources of information, as well as indicating where appropriate help may be sought.
When I heard that the actor, Paddy Considine who has starred in films including Hot Fuzz and Dead Man’s Shoes experiences visual stress, I immediately found out more about him. This is because I am aware that visual stress is more common in those with neurodiverse conditions than the rest of the population. I soon discovered that Considine is also said to have been diagnosed with Asperger Syndrome.
When I meet a client who may have a neurodiverse condition, I am always aware that they may also experience visual stress. It’s important to identify this condition and to provide advice about how it can be addressed. The signs can be fairly obvious, for example when someone enters the room wearing dark glasses or asks for lights to be turned off. On the other hand, they may be more subtle, for example when someone needs to use a guide to keep their place when reading. There may be no obvious signs of visual stress during an assessment, and I often only become aware that a client may have visual stress by asking particular questions about their experience of reading.
The symptoms of visual stress were identified in the early 1980s by two people working independently of each other and unaware of each other’s work. They were Olive Meares and Helen Irlen. Both had found that visual perceptual difficulties experienced when reading appeared to be alleviated through the use of coloured overlays placed on the page. Helen Irlen went on to experiment with coloured lenses and set up Irlen Institute whose centres are licensed to supply the coloured lenses that she devised. A description of her work can be found in her book entitled ‘The Irlen Revolution’.
In his book, ‘Reading Through Colour’ Arnold Wilkins describes himself as the scientist responsible for developing the idea of visual stress as a neurological disorder. He claims that visual stress occurs when some nerve cells in the visual cortex of the brain fire too strongly and cause others to fire when they should not. Professor Wilkins reports that the symptoms of visual stress are often evident when reading and that these often include:
- movement of print
- blurring print
- letters changing size
- doubling of letters
- letters fading or becoming darker
- patterns appearing in print or ‘rivers’ appearing to run through text
- illusions of colour
- nausea, dizziness, discomfort or even pain, associated with glare
Professor Wilkins has found that as well as reporting some of the above experiences, those with visual stress may show physical signs such as:
- moving closer or away from the page and frequently changing position when reading
- often looking away from the page
- tracking text with their finger
- rubbing their eyes
- blinking excessively
- reading slowly or hesitantly
Importantly, Professor Wilkins points out that these signs and symptoms may be due to factors other than visual stress such as:
- refractive error (corrected with glasses)
- difficulty adjusting focus
- difficulty coordinating the two eyes (often treated with eye exercises)
He says that, for this reason, it is essential that anyone who experiences these signs and symptoms consults an optometrist or orthoptist.
Professor Wilkins acknowledges that Helen Irlen’s discovery was significant but also refers to concerns which have been raised in relation to her work on the basis of its commercial emphasis and because Irlen diagnosticians are not trained optometrists. He highlights the importance of evaluating new treatments in a scientific manner and of discovering why they work. In return, the Irlen Institute cites evidence which undermines Wilkins’ methods and the equipment that he has developed.
The symptoms of visual stress may be reduced through the use of coloured overlays which can be purchased freely via the internet. It is important to pin-point the precise overlay that works for you, however, and therefore it is advisable to consult a professional with experience in this area. This could be an optometrist (the most common type of eye care professional), a behavioural optometrist (specialist optometrists who focus on the ways in which visual problems affect human performance) or an orthoptist (based in hospitals and investigate, diagnose and treat defects of binocular vision and abnormalities of eye movement). Alternatively, it could be an Irlen Screener, Irlen Diagnostician, teacher, or psychologist.
Wilkins describes a procedure for selecting overlays which could be used by a range of professionals. This method is based on the Intuitive Overlays which he developed and are supplied by iOO Sales. It can be readily adapted for use with Cerium Overlays which are similar and are supplied by Cerium Visual Technologies. Helen Irlen takes a different approach and stresses the importance of undergoing a screening process with a trained screener. Irlen overlays are available to purchase from providers such as dyslexic.com. Crossbow Education also produces coloured overlays as well as a Visual Stress Assessment Pack.
If you benefit from using coloured overlays, then you may like to consider the use of tinted glasses. These can be helpful when reading from a distance and may also help with writing. The colour of glasses can be chosen more precisely than the colour for overlays which means that better results can be achieved in terms of reducing the impact of visual stress. Wearing tinted glasses does not usually mean that individuals see their environment in a different colour.
The Intuitive Colorimeter was developed by Arnold Wilkins. It is a machine that illuminates a page of text with coloured light. The light can be adjusted according to hue, saturation and brightness and therefore any shade of colour can be selected. With the support of a computer program, coloured trial lenses are made up to match the selected shade of colour. The patient tries out the trial lenses under a variety of light sources and lighting intensities and once an acceptable combination of trial lenses has been chosen, the tinted glasses are ordered.
The system used by Irlen Diagnosticians to select tinted glasses or ‘Irlen Spectral Filters’ involves the use of a lens kit which contains each colour in the spectrum and allows colour combinations to be created which suit the individual. The diagnostician establishes which part of the light spectrum needs to be filtered and the extent to which it needs to be filtered. Once the individual’s optimal colour has been determined, they try out the lenses in a range of situations including reading and looking at a computer monitor.
The use of coloured overlays and tinted glasses are among a series of measures that can be implemented to make life easier for many of the clients that I meet through my work.
Detailed information about who you can approach for an assessment for visual stress can be found on the British Dyslexia Association website.
BY: Louise Hilliar
I recently assessed a woman in her 40s and found that she met the criteria for a diagnosis of Asperger Syndrome. She kindly agreed to an interview which allowed me to explore some issues related to employment in those with an autism spectrum disorder. Some details, including the client’s name, have been changed to protect her identity.
Louise: I would like to begin the interview by asking some more general questions. When did you first become aware that you might have ASD?
Sarah: I was seeing a life coach last summer and she suggested that I might have Asperger Syndrome because she knew someone else who had been diagnosed with this condition and recognised that I had some similar traits.
Louise: How did your diagnosis come about?
Sarah: After the life coach suggested that I may have Asperger Syndrome, I watched You Tube videos about this condition and read ‘Aspergirls: Empowering Females with Asperger Syndrome’ by Rudy Simone, which is a brilliant book. I felt strongly that I have Asperger Syndrome and wanted a diagnosis. When I explained this to my GP, I was told that I could be referred for an assessment through the NHS but that there was a waiting list of about a year. Since I did not want to wait, I sought an assessment privately.
Louise: What difference (if any) has having a diagnosis made to you?
Sarah: It was a brilliant relief and wonderful to have an explanation for the way that I have behaved throughout my life. I have always had problems making and keeping friends, have had some problems getting along with my boyfriend, and have also had problems keeping jobs because of problems with colleagues. Now I know why I struggle with small-talk, banter, teasing and irony. I also know why I find multi-tasking difficult.
Louise: Turning to your work life, and beginning on a positive note, what useful characteristics do you have that you bring to the workplace?
Sarah: I am conscientious and keen to do a good job. I can focus particularly well, give tasks my full attention, and am very good at proof-reading, for example. Although some people think that Aspies (I like this term) do not have emotions, I am helpful and friendly at work, and I empathise with service users. I have a feeling of satisfaction when I have helped others. I like things to be well-ordered and to be up to date with my work.
Louise: How do you feel that your Asperger Syndrome influences your ability to get things done at work?
Sarah: I prefer to do one task at a time. For example, I don’t like having to break off from filing to answer the telephone. I do really well at tasks when I can focus on them without being interrupted.
Louise: What type of environment do you prefer to work in?
Sarah: I like to work in a small, quiet office with a pleasant atmosphere. I pick up on negative atmospheres and dislike office politics and gossiping about colleagues. I benefit greatly from positive feedback and like to be told that I’m doing a good job.
Louise: What happens when you find yourself in an environment that doesn’t suit you?
Sarah: If the demands placed upon me are too great then I become overwhelmed and stressed. I am irritated by noise such as the radio or other people speaking on the phone and can concentrate better if it’s quiet.
Louise: How do you find getting on with colleagues and customers?
Sarah: I can manage some interaction with customers but struggle with too much, and can become stressed on a busy reception desk. If I feel overstretched then I may become irritable and abrupt when interacting with colleagues.
Louise: What about the practical issue of travelling to work?
Sarah: I find the journey to work stressful and worry about being late. I tend to be anxious and hyper vigilant on buses. I dislike the way some people smell and become uncomfortable if people try to engage me in conversation. Also, I become concerned that people may find out about my daily routine and where I work.
Louise: Do you manage to maintain a work-life balance?
Sarah: I find that work tends to take over my life if I am full-time. I get very tired and stressed and this affects my relationship with my boyfriend. I also find it difficult to keep up with my household chores and things begin to get on top of me.
Louise: How do you respond to change at work?
Sarah: I can manage small changes, but if I’ve got used to doing tasks a certain way and then all my duties are changed, I tend to find this very stressful. This happened to me recently and I was required to carry out tasks which I felt very uncomfortable doing because of my Asperger’s traits. I was placed in a customer-facing role on a busy reception, taking a high volume of incoming calls and working in an open-plan office. These changes led to be being signed off work with anxiety and stress by my GP.
Louise: How to you manage with learning new tasks?
Sarah: It helps if I make step-by-step notes and I like to be able to ask a colleague questions as I go along too so that I don’t like feeling that it’s all down to me.
Louise: Have you had any periods of unemployment which you feel may be related to your Asperger Syndrome?
Sarah: I have often left jobs because of difficulties with relationships and feeling that I don’t fit in. Although I try to be friendly, I think that people may see me as being withdrawn, quiet or aloof. I prefer to spend my lunch-break alone, don’t like to socialise out of work, and I don’t want people to find out too much about me.
Louise: We know that each individual with Asperger Syndrome is different, but is there any general advice that you would give to those with this neurological difference about how to succeed at work?
Sarah: I would encourage them to accept their differences and limitations such as not wanting to make small-talk as this does not come naturally for Aspies. I would also encourage them to look for work in an environment where they would be comfortable and not to push themselves to work in situations which are too difficult and would cause their health to suffer due to anxiety and stress. Like me, they may find working in an open-plan office too distracting and may be best-suited to working in a quiet office where they can focus and concentrate.
Louise: What advice would you give to employers?
Sarah: I would ask them not to judge employees who quietly get on with their work instead of taking part in office banter, and to find out why they behave in the way they do. I would like employers to understand that Asperger Syndrome is fairly common, that it is linked with a neurological difference, and that just because someone can be quiet, this doesn’t mean that they are completely disinterested in other people. Employers need to understand that people with Asperger Syndrome often work very well under the right conditions.
In my experience of supporting those with neurodiverse conditions in employment, successful outcomes are often possible provided that a thorough initial assessment is carried out which establishes the needs of the employee, a suitable role is found, and appropriate support is put into place.
There are organisations that provide support for those with Asperger Syndrome to find and sustain employment, and for their employers. These include the National Autistic Society,Remploy, Working Links, and the Brandon Trust. Disability Employment Advisors at Jobcentre Plus will be able to give advice about agencies that may be able to offer help in your area as well as government-run programs.
Financial support may be available for those with Asperger Syndrome to help them with employment-related issues. Access to Work grants help to fund practical help for those with a disability and Employment and Support Allowance may be available for those who are unable to work.
If you are an employer in the Bristol or Bath area and feel that you would be able to provide suitable job opportunities to those with Asperger Syndrome, then please contact me as I am keen to forge links with local organisations.
Useful books on this subject include:
- Bissonnette, B. (2013). Asperger’s Syndrome Workplace Survival Guide: A Neurotypical’s Secrets for Success. London: Jessica Kingsley Publishers.
- Bissonnette, B. (2012). The Complete Guide to Getting a Job for People with Asperger’s Syndrome: Find the Right Career and Get Hired. London: Jessica Kingsley Publishers.
- Hendrickx, S. (2004). Asperger Syndrome and Employment: What People with Asperger Syndrome Really Really Want. London: Jessica Kingsley Publishers.