Bottom-up vs. Top-down:
Bottom-up means working with the body and the environment first. It does not involve any thinking, point-of-performance decisions, or mental exercises. The expectation is that changes in the body will eventually support improved mental functioning.
Top-down means working with thoughts and mental strategies first. It starts in the head with continuous decisions throughout the day and works its way down to supporting the body.
Example with weight loss:
Bottom-up weight loss strategy would be to take a diet pill that suppresses appetite, so that no choices need to be made about food directly.
Top-down weight loss strategy would be to count calories at every meal and inhibit any excess above daily target intake.
Example with ADHD:
Bottom-up ADHD strategy would be to take medication.
Top-down ADHD strategy would be to use calendars and reminders.
Start with Bottom-Up
A. Circadian Rhythm
The body’s circadian rhythm regulates much more than just sleep. It also regulates hormone levels, eating habits, digestion, body temperature, energy levels, mental alertness, and mental sharpness, just to name a few. Good sleep, on its own, affects multiple systems including major organs, metabolism, immune function, disease protection, mood, stress tolerance, mental sharpness, and attention.
Circadian Rhythm
https://www.nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx
Brain Basics: Understanding Sleep
https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep
The yin and yang of sleep and attention
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803435/
1. Bright sun.
Exposure to at the same time every morning for 15-30 minutes helps set the circadian rhythm. There is an option to use a sun lamp with 12K lux as a subsitute. The substitute may not be as effective as natural sunlight.
2. Five things.
Do at least five things every day at the same time. Possible choices include times for waking, sleeping, meals, mental productivity, physical productivity, exercise, social interactions, exposure to bright sun, and limiting blue light exposure at night.
B. Nutrition Support
1. Protein
(More coming soon.)
2. Omega-3
(More coming soon.)
3. Eating in rhythm.
ADHD has been noted to sometimes correlate with disordered eating. Move towards eating in a predictable rhythm and with interoception. Interoception is the perception of internal sensations and feelings, such as when one is hungry or needs to go to the bathroom or feels tired.
C. Opportunity: Curate
Curate means to carefully and intentionally select, organize, and present items of interest to achieve a certain goal. Curate your environment so it is hard to avoid the non-preferred task. This means taking the time to thoughtfully stage the task.
If you think of a casino, all the slot machines and gambling stations are selected, organized, and presented in a way that would entice you to gamble. The environment is curated to maximize your opportunity to give them money.
1. Physical environment.
Maximize the opportunity for you to perform the non-preferred tasks, and set yourself up for success for that task.
a. Visual cues.
The ADHD brain responds to visual stimuli. If you can see the task, preferably surrounded by bright colors or lights (think casino), you are more likely to get a dopamine hit when you see that task.b. Uncluttered space.
The fewer distractions there are in the space for the task, the easier it is to focus on the task. Set the space up so nothing has to be moved or cleaned ahead of time in order to do the task.
2. Time.
Curate your calendar, and carve out a chunk of time in order to perform the non-preferred task. The time has to be staged and prepared in advance, like the space.
3. Energy.
People talk about time management a lot, but energy management is more important than time. At the end of a long work day, you may have the time to do something, but no energy for it. Curate your energy budget so that the energy is easily accessible. More energy is required for non-preferred tasks than for preferred tasks, so add an energy tax to things you don’t want to do. A common way to curate your energy is to set aside an empty day or empty week. Set strong boundaries to keep it empty. It may seem like it’s an unaffordable amount of energy to set aside, but it’s the ADHD tax one has to pay.If you get done early and with energy to spare, it’s a win-win.
End with Top-Down
A. Gamification.
Adding unpredictable elements is an integral part of the dopamine of gaming. If the gaming industry can hack your brain for their profits, you can hack it in the same way for good.
1. Race.
Make the accomplishments or rewards unpredictable. Using a set time or set distance, you can race against yourself. How fast can I go this time? How far can I go this time? How many math problems can I do in 10 minutes?
2. Random time / random repetitions.
Make the amount of time you spend on a task unpredictable. https://www.randomtimergenerator.com/
Make the number of easily repeatable tasks you do unpredictable. How many sit-ups will I do today?
B. Body Double
The “body double” strategy is to have the quiet, supportive companionship of someone with you while you are doing a non-preferred task. They can either be paying attention to you or doing their own work.
https://add.org/the-body-double/
C. Easy Repetition: Curate the task.
Nothing higher than a 3 difficulty.
Curate the task so that the steps are easily repeatable. Break down a complicated project so that none of the steps are harder than a 3 out of 10 in difficulty.One way to break it down is to write each level-3 difficulty task onto a post-it note. Organize the notes so that you can only see 3 notes at a time. For example, put the notes onto sheet protectors in a binder, and post 3 of the notes on the front of the binder at a time. Make sure you take a long break after you write 253 post-it notes, because breaking a task down by itself requires a lot of executive functioning energy.
Mont Rose Counseling, LLC 