Chris: My clients are a wonderful bunch. One of that lovely bunch is Liz Smith, who has provided us with our article today.
Liz Smith is a counsellor and psychotherapist specializing in neurodiversity, trauma, and post-traumatic stress.
I have a painfully normal brain, so find it hard to understand the lens through which many people see the world. I feel the following article has helped me to further understand why my approach works for some people with ADHD.
Massive thanks to Liz, who is a maverick renegade who I hope to work with for many more years.
Take it away, Liz!
I’ve been lifting since 2019. Since Chris and I started working together, a new dimension has been added to my lifting life – an adult diagnosis of ADHD in 2020.
How this happened is kind of a funny story. I’m a psychotherapist and I started to get more referrals in my newly established private practice last year from adults with ADHD.
It turns out I understood their struggles a little too well. During this time, I was also attempting to do a Master's dissertation – yes, on top of a job and a new practice in the middle of a pandemic.
Taking on all the things at once is also an ADHD trait, it seems. What we lack in focus, we make up for in blind enthusiasm. Or something like that.
The issues I had with my dissertation, along with the fireworks of recognition going off every time a client with ADHD sat in front of me, led me to seek a diagnosis. Sure enough, it was confirmed.
A strength of ADHD is being able to hyperfocus if we’re really into something, which can be a huge boost for training, but it does also come with extra challenges.
I can struggle to concentrate on one thing for long periods, my brain is basically a magpie (“oh look, new shiny thing!”) and I can lose my keys when I had them in my hand two minutes ago. These may seem like lazy, chaotic, or flaky behaviours to neurotypicals, but we have neurological differences in how our brains process dopamine, norepinephrine, and serotonin.
These chemicals play a key role in motivation, emotional regulation, and how we experience reward and pleasure. In effect, having ADHD means having an interest-based brain.
So if you’ve also got the human equivalent of a magpie on your books as a PT or coach, how can you both get the best out of training?
1. Variety makes the neurotransmitters go round
Switch up the workouts, encourage them to cross-train and try new things in the gym regularly.
Yes, it’s important to work on the basics, but ADHDers will really benefit, like I have, from varied programming. Preventing boredom is huge (interest-based brain, see?). Please bear with our regular enthusiasm for new activities, as long as they’re not likely to injure us (yes Chris, I promise you can shoot me if I decide to take up running again).
Chris: I like everyone to have a "fun" element to their training. This approach seems to particularly appeal to Liz's brand of ADHD.
I love using lots of movement variations because I want training to be a lifelong, fun habit for everyone. Having clients with ADHD brains means I get to have even more fun with variety in our sessions.
2. Encourage us to slow it down
Chris will laugh at this because if he had £1 for every time he’s had to go “not yet!” when I’ve been chomping at the bit to go for my next lift after about 30 seconds of rest, he probably wouldn’t need to PT any more.
ADHDers perceive time differently. Clients with ADHD will probably need reminders about the importance of rest – encourage them to use timers when training on their own, or give them some light exercises to do in the rest periods – I sometimes do Pilates or rehab exercises for a shoulder issue between lifts.
Chris: Sometimes in our sessions, I will purposely chat to Liz while slightly in the way of her setting up for her next set because if not (before she was medicated) Liz would go for set after set with no rest, with no awareness she was having no rest.
This was a subtle tactic to gently push the idea of rest upon her as a good strategy was strength gains. Now she is medicated, the issue can still present itself but it is far less obvious.
3. Do enable regular opportunities for PBs/building on previous achievements
Lifting has been great for me because I get a huge buzz from improving my PBs, even if it’s just in small increments.
Regular, small improvements keep me engaged and highly motivated to improve. I was never good at sports at school, so every gym PB is like an extra middle finger to all those PE teachers who used to shake their heads every week at how uncoordinated I was (which can also be a feature of ADHD and other neurological differences like dyspraxia). But be aware that if left to our own devices, there’s a risk we’ll shoot for PBs every session – see point 2!
Chris: I want every client to feel competent in the gym, so my programming is heavily biased towards what people are good at while finding the most tolerable ways to work on weaknesses that may need addressing.
When any client hits a PB, we celebrate it and I try to emphasize that while I may have added some direction to things, it was the client who had to put in the work to make the teamwork result in gains
4. Keep us accountable, but don’t shame us for our difficulties
A lot of PTs subscribe to the “no excuses” approach, and I see the reasoning for it. But when working with people with neurological differences such as ADHD, a more balanced approach is needed.
Chris: I think everyone should get a balanced approach and I've always found the "no excuses" concept to be shitty and wrong. Using it is a great way to lose clients too.
Chris has this balance absolutely right, which is one of the reasons a) he’s not getting rid of me and b) I work hard and want him to be proud when I go up there on competition day. He’s seen how my less helpful ADHD traits can impact me at times.
Chris: I'm proud of anyone who gets up to compete. I think Liz will thrive in the competitive environment, which can be one of the positive traits of ADHD, i.e. getting a huge buzz out of high-pressure situations. I can't wait to see her up on the powerlifting platform.
I have a toxic combination of a perfectionistic, overworking tendency combined with a couple of chronic health conditions. Many of us with ADHD are, ironically, perfectionists. Remember how I mentioned earlier that our behaviours can seem lazy, chaotic, or flaky to neurotypicals?
Well, heard those messages a lot in my younger years, so I put a huge amount of effort into not appearing lazy, chaotic, or flaky to compensate. But this can result in a ‘crash and burn’ cycle and stress that can make my health conditions worse and impact my training consistency.
It has helped that Chris has noticed this pattern and talked with me about it, in a non-judgemental and empathetic way (and with his own particular brand of humour!) (Chris: read, swearing a lot and top-level memes), which has motivated me to work on myself to address it.
In fact, just this week I took some sick days instead of pushing myself through and wondering why I end up ill for weeks.
So yes, bring it up if you see your ADHD client repeating self-destructive patterns, but not in a way that’s likely to add to feelings of shame and rejection.
Listen, offer support, plenty of positive reinforcement for helpful changes towards taking ownership of their training (even when it’s a small change it might be huge for them), be a source of accountability and your ADHD clients are likely to thrive.
If your client struggles, even with a supportive approach, to address self-defeating patterns, they might benefit from some ADHD-focused counselling or coaching to give them extra support and tools.
5. Encourage us to set realistic goals
I might have mentioned how those of us with ADHD have a tendency to DO ALL THE THINGS.
Chris: As a coach, I want my clients to be active in as many ways as possible. When ALL THE THINGS get in the way of something like a competition, I've never found it works to say "don't do that."
A far superior method I've found is to suggest something else shiny that won't affect recovery too much but still appeals to the magpie brain.
We know how to get excited about new, shiny things and we’re not afraid to be massively uncool in our unbridled enthusiasm, which is one of the traits I love the most about my neurodivergent friends, colleagues, and clients.
This can be infectious, but remember not to get too caught up in it - remind your client about being realistic. We may want to train every single day because we love it, but we also have other aspects of adulting to do.
If you do get caught up in that enthusiasm and say “Yes! Let’s train 7 days a week!” then all of a sudden when your client finds themselves overwhelmed (because they will) in a few weeks, you’ll have both set yourselves up to fail. And if you set a goal to train 3 days a week and they train 7 and get overwhelmed, see point 4.
Those of us with ADHD can bring lots of strengths to our training – the ability to laser focus sure is handy on competition day, for example.
Your ADHD clients will also be the first ones to cheer for their team members on competition day or consoling them and building them up if something doesn’t go well.
Despite some of the challenges we face, with the right approach, we can be successful in our training and we can achieve the consistency we need to be successful over time and with commitment from both PT and client.
Chris: Working with ADHD clients, raising an ADHD son, and working with ADHD specialists as clients has been an incredible part of my career and life.
You shouldn't be afraid to train neurodivergent and ADHD-type clients. They are as diverse and interesting as everyone else and by learning to accommodate their needs you will become a better, more fulfilled coach.
A massive thanks to Liz for writing the article, I feel like I learned a lot and look forward to working with her for many more years.
Liz Smith is a counsellor and psychotherapist specializing in neurodiversity, trauma and post-traumatic stress and is a registered member of the BACP. Find out more at https://www.counsellingandtherapyinyorkshire.com