Research Recap: Perfectionism and Executive Functioning with ADHD

Skye: Hi. We are the ADHD Skills Lab Podcast. My name is Skye.

Sarah: And my name is Sarah.

Skye: And we will be your hosts chatting to you about practical ADHD strategies you can use, the research behind some of these strategies, as well as interviewing other professionals with ADHD about how they've developed skills in working through struggles in their lives.

Sarah: You might know us from Unconventional Organisation, where we talk about this kind of stuff all day long. So we're super excited to have you along, and we're going to chat through it together.

Skye: Okay, so this week in the research recaps, we have a couple of papers. We've got one on perfectionism and we have one on short interventions and online self-guided modules. Lots to talk about here. But I wanted to start with the paper on perfectionism because I thought it was interesting. It was kind of sad in many ways.

Sarah: Yeah, I definitely felt that too. And part of it sort of seemed to relate to some research that we talked about in a previous podcast about risk aversion. That was interesting.

Skye: Yeah, definitely.

Sarah: So basically this study was quite large. I think you said it had over 3000 participants.

Skye: Yeah.

Sarah: So basically what they did was they gave out an online survey and the authors were measuring sort of ADHD symptoms and perfectionism and what they're calling experiential avoidance, which basically just means avoiding something based on a previous negative experience.

Skye: Mhm.

Sarah: It basically elaborated on the connection between ADHD and perfectionism. So those with ADHD had high levels of perfectionism, but they had lower scores of things like personal standards and trying to be orderly. So essentially it was we're very perfectionist, have really high sort of expectations of ourselves, but then also at the same time don't strive for anything too large. And so basically what that says to me is we've sort of had negative experiences in the past where maybe we didn't quite measure up to the standards that we expected of ourselves. So now from now on, we're just going to have sort of lower standards, which is really quite sad. And I probably should have mentioned this earlier, but this study is specifically on university age students. That's a really pivotal sort of time in a lot of people's lives, particularly those with ADHD, because it sort of tends to be the first experience that you have as an adult without that external structure to support you. So that can really be a time where people start to experience their symptoms in a different way.

Skye: Yeah, definitely. I mean, I think it's interesting. It sort of speaks to this idea that this might be a point at which and maybe this is earlier, but at least according to this research, this is a point at which people are starting to say, this is what I think I could do, but this is what I'm going to aim for. And that difference between what we go for and what we want to do. We do see it a little bit sometimes in clients coming through, and even our own experiences of that sense of feeling like ADHD is holding you back from achieving your goals, essentially. Yeah, that can be really tough. I'm sure a lot of people out there have experienced that.

Sarah: Yeah, I mean, I personally even understand sort of the barrier to starting and seeing through a project is so tough sometimes that it's like, well, I'm not going to do this perfectly, so what's even the point of trying? Why even bother starting? Just that experience of failure can viscerally feel intolerable. And so that's sort of that experiential avoidance that they're talking about.

Skye: Yeah, I think it's really interesting as well. I mean, it's funny you mentioned it with students, but I will say most of this research is going to be on students. That is the nature of research, to generally be on students. But it's something that I see in lots of people as well, something that we see in lots of different people. And sometimes it's about understanding how to achieve with ADHD in a way that fits with how we work. Because a lot of this—one of the things that they're not necessarily discussing here is the idea of masking. So the idea that what are you achieving? You're achieving something in a neurotypical way, potentially. And academia is a very tough environment for that, because when you're a student, there is a test, you have to take it. There's certain adjustments that can be made sometimes. But at the end of the day, there is this test. A lot of times when I work with very high performing clients, what tends to be shown is that the clients who are doing well tend to be the ones who have embraced their strengths. And they are seen in their workplace as being somebody who is in a different bracket, but a very valuable different bracket.

Sarah: Yeah, that speaks to sort of the ADHD strength that we try to focus on. Perhaps it's a different perspective, different way of thinking, maybe creative, that sort of thing. But basically what they end up saying here is because they're trying to help people, so they do give sort of suggestions on how to try to target this. And so one of the suggestions is Cognitive Behavioral Therapy, which is pretty standard, but also Acceptance and Commitment Therapy, which I had to look up. I actually did know it as the acronym, which is ACT, but I didn't recognize it with the words all written out like that. So acceptance and Commitment Therapy is really big in the substance abuse space. So I do have experience sort of working with that with a different population. It's really heavy on the mindfulness. It's really big about sort of experiencing fully what you're going through and being able to label it. Okay. I am anxious right now. Being able to say I want to change and this is really hard. Not just like I want to change and that is going to be the end of it. So that's sort of where the mindfulness and the self compassion training really comes into this. And I've got to say that's a really big topic in ADHD coaching. We often need this a lot more than we realize.

Skye: Yeah. It can be really tough. It seems, when you go into coaching as if you're just going to talk about executive functioning and how to do well on the test, for example, in this context. And you do. But there is a lot underneath that. And I think that really this paper speaks a little bit to that. It speaks to how much is underneath just a student not doing particularly well on a test. Maybe they're struggling with past failures, with self criticism from experiencing external criticism from other people and maybe they feel like they can't hold themselves to that standard. Maybe there's some self sabotage and actual executive functioning struggles as well. So it is tough and I think this paper does really speak to that. So yeah, a tough paper, but a good paper, I think. A good conversation to have.

Sarah: Yeah. Anything that draws attention to this space can be very validating in the community.

Skye: Yeah. So the second paper and the third paper actually, they're both similar. They're talking about interventions that target executive dysfunction and what it means to have ADHD and actually find that you're doing something and it's helping to support your executive functioning, basically. They had an eleven session hybrid online and in person intervention. It sounded very similar to what you would do in an ADHD coaching session. They were working on a lot of similar things, similar goals, working on improving self selection, selecting goals, understanding what executive functioning is, understanding how to break down goals. And then they also had a three month follow up. And in this study what they found was that they did find some positive results. So the results of the study showed that a brief, largely online delivered intervention can significantly improve work performance, work satisfaction and quality of life in people with ADHD, and that these improvements actually lasted at least three months. It was however, quite a small study. I can't remember exactly how many people were in it. Sarah, do you know?

Sarah: Yeah. So it said that there were 46 adults. They were divided up into a couple of groups. Each group received a different type of intervention. So one group received the synchronous telehealth interventions, the other group completed the intervention after a period of waiting. That was really important, and they did all have ADHD. I wanted to mention that because to me that shows there wasn't really a control group.

Skye: Yeah, that is interesting. It is always interesting as well when looking at these studies to really break down. Okay, but how many people did they have how many of those people had ADHD? Because sometimes people will say, this was a study of 2000 people, 50 of which had ADHD. And that makes it a very different study because it's a study of 50 people and then a control group, essentially. So, yeah, that's just something to look out for. For those of you who read academic articles as well. Yeah, it was interesting, it was small, but essentially what it did was it added to the body of work that we have that say if you attempt to support executive functioning, you will potentially receive results. And I think that's good to have and good to know. Yeah. Did you have any thoughts on this paper specifically, Sarah?

Sarah: Yeah, so it said that the most common goals that the participants sort of chose for themselves were either around meeting deadlines or following daily or weekly routines, which I did find really interesting because that is pretty much what we do in coaching, wrapped up in a bow. At least that's sort of why people tend to come to us and then they start digging a little bit and they're like, oh, there's more here.

Skye: That is so true. I mean, I think there's that one and then there's just like time management. That's the other one, but very much wrapped up in there. It is interesting to see that even in the smaller thing, it was very similar. The struggles that we have, they are often very similar. So if you're struggling with these things, you're not alone. I did wonder about that three month follow up. We're going to have another paper in a minute that we're going to discuss. It also had a follow up. Because they were sort of like showing that, hey, it works because in three months we followed up and people were still improving. As a person with ADHD myself, I have used various accountabilities. Obviously, it's what we show, what we provide, and also something that I personally love and use all the time. I do wonder if knowing that in three months there was going to be a follow up would have made an impact on making sure that at least for the next three months was something that you continue to do. It's just an interesting conversation about is knowing that there is a follow up in three months a version of accountability rather than just an ongoing follow up. It does show that at that point it would have been potentially a habit. So definitely very cool. So the third paper was about self guided online modules being effective at improving symptoms and quality of life for people with ADHD, so that even really low intensity, low cost, incident limited interventions could be helpful. And for those people who cannot afford to do something that is going to be at a very high level, like one on one coaching, the idea that that other stuff could still be helpful was indicated in this study, which is interesting. And for those of you who are interested, we do have online courses ourselves so that people can get that sort of support. It was an interesting study, very similar to the other one, but focused more on that idea of being self guided and also the idea of having a couple of follow up measures. So what did you think of this article, Sarah?

Sarah: I think the thing that struck me the most was how few people actually completed the modules.

Skye: Yeah.

Sarah: It did say that around 71% of participants did not continue with the modules, most of them dropping out around module five. I really personally wanted to know sort of why that might have been, maybe look at the ordering of the modules and sort of like, maybe module five got really heavy.

Skye: Can you tell that you work in this business?

Sarah: Yeah, so I really wish I had that data. But yeah, I think that's what struck me the most about this one. We want to be able to provide people with the information, but it can just be so hard even still to access it because of the executive functioning challenges.

Skye: Yeah, I think it is hard. I mean, I know that a lot of times with online courses, it can be hard to have people finish them for a variety of reasons. And in our courses, if you're not active for seven days, we send you a little email saying, hey, what's up? Here's some things you could try.

Sarah: I actually just got that email a couple of days ago and I was like, that's so nice. I'm glad we're doing this.

Skye: Well, we're trying, we're trying to do little check ins and obviously the community as well. They found that at the intervention, at the three months follow up, effects on ADHD symptoms were maintained. They found 45% of the intervention group demonstrated reliable change at post treatment and 58% at follow up. So they did find that there was an improvement in ADHD. So basically they did executive functioning criteria and saw if there was an improvement. And there was.

Sarah: I actually found the outline of the modules. So as it turns out, there was seven of them. So five of the seven is not bad. So the first one was basically just an introduction, sort of goal setting and things like that. The second one was on mindful awareness, sort of like being in the moment and that sort of thing. Module three was on inhibition training, basically impulsivity techniques and things like that. The fourth one was on emotional regulation, which was sort of my prediction that that's where things would get heavy. And then module five was on planning and organizing daily life. So it's like thbbt.

Skye: Why do you think that one would be the one that people didn't do?

Sarah: Oh, personally, I think that that is way too much for one module.

Skye: That is so true. We broke that up into, like, what if you're an ADHD coach and you train with us? It's like 15 modules just on that.

Sarah: Yeah, absolutely. It's like planning and organizing are not the same. Planning and doing are not the same. I think that's just way too much for one module. So maybe in case they're listening, break it down. Chunk it out.

Skye: There is something there. But, yeah, you're right. I think there's a lot of people not completing it. And if this study were to be done again, it would be interesting to see what would happen if they tried to make and I assume they did on some level, but if they continued to improve on the ADHD friendliness of the online interventions.

Sarah: Yeah, that's the main issue with many of our treatments, is that they're not always specifically accessible.

Skye: Yes. Gosh, we could put a whole podcast on that topic, for sure.

Sarah: Yeah.

Skye: Okay. But yeah, but still interesting to see the results. And really interesting and really cool to see people doing this. Obviously, this, like, all of the studies that we talk about has come out this year. So it's very new research, and it's really cool to see that people are talking about interventions and online interventions and testing all of those kinds of things. The last thing I wanted to check was why this study was designed. Is there any particular kind of financing? So they were financed by NRC through Intramet, so a university hospital. I can't really see anything else. So we'd have to kind of go through and look up because sometimes you do have to be aware that some of these studies are being done by the people who are selling a particular product. In this case, they're selling an online course, and so they do a paper on the benefits of this particular online course. It's not a bad thing. Like, at some point, maybe we will do a paper on our online courses to show its effectiveness. It is good. It's still peer reviewed. But it is still good, if you ever look at these papers and you want to review them or use them for some reason, to go down to the declaration of competing interests. So they did say here the authors declare the following financial interests and personal relationships. Two of the authors had designed and created the internet delivered intervention but derived no economic profit from it. That is kind of there, and they put it plainly for you to see if you want to.

Sarah: And if you are interested in reading this article, obviously the link to it will be in the show notes.

Skye: Yeah, you can always have a look for yourself. Okay, cool. So those are the three papers, the perfectionism one, and those two intervention papers that we wanted to just come on and discuss today. Do we have anything interesting that kind of wraps it up or any additional thoughts on it before we head off in this research recap today, Sarah?

Sarah: I think I'm just going to say that sometimes starting is more important than finishing. 

Skye: Yeah.

Sarah: I know we had a little discussion around who didn't finish the online modules and things like that, but you know what? If it comes between sort of starting and not finishing or just not starting at all, I'd say it's much harder.

Skye: Yeah, the interventions indicate that even if you started and you did some of it, you would still be getting some of the benefits. And I will put my hand up and say that I am the kind of person who jumps in and chooses different sections and comes back. So definitely, yeah, give it a go. And also, if you are somebody who is working on something and you're holding yourself to a really high standard, but you're not going after those goals that you want to achieve, kind of connecting to the perfectionism side as well. Definitely, definitely talk to somebody because you're not alone. A lot of people feel that way. And there is a way to start working on developing and reaching closer to what you view as your potential without it being too scary. Like it's baby steps. It's skills and ADHD friendly ways of doing things and baby steps so it doesn't have to be too confronting. Definitely reach out to somebody and chat about it.

Skye: Thanks for listening. If you'd like to reach out or connect with us, you can leave us a message at admin@unconventionalorganisation.com.

Sarah: You can also find out more about our ADHD coaching organisation, read our free articles, or sign up to our online courses at unconventionalorganisation.com. That's organisation with a Z or an S, they both will get you there.

Skye: If you'd like to learn more about what we discussed here today, or you want to read the transcript, you can find that at our Show Notes page at unconventionalorganisation.com.

Sarah: If you've enjoyed this podcast and think someone else might find the strategies and stories helpful, the best thing you can do is share episodes using the Share button in the podcast player, or leave a five star review on Apple or Spotify or your podcast player of choice, letting them know why you've benefited from this podcast.

Skye: Thanks so much for listening, and we'll see you back in the ADHD Lab next week.