How I cope (and thrive) with ADHD, by a doctor who has it

Dr James Kustow has spent the past decade unpicking the complex nature of ADHD – and has learnt not only how to live with it, but how to exc

A psychiatrist and integrative psychotherapist working in the NHS adult ADHD service alongside his private practice on Harley Street London, Dr James Kustow is an internationally renowned mental health educator, who also suffers from ADHD himself.
He has spent the past decade and a half unpicking the complex nature of the condition, and shares his management strategies in his new book, How to Thrive with Adult ADHD, 7 Pillars for Focus, Productivity and Balance.
While the book goes into more detail, the following guide will give you actionable insights from Kustow’s “how to thrive” method. 
The pillars Kustow has identified in his book are designed to be followed in a specific order. “From years of working with people with ADHD, I understand the order things need to go in, which is why pillar one centres around mindset. “If you’ve got the wrong mindset from the beginning, you won’t be able to grasp the other pillars,” he says, adding that it includes getting a diagnosis. “For many, getting diagnosed helps reduce the shame associated with ADHD. Years of messing up suddenly diminish as patients realise it isn’t their fault.” 
Having a growth mindset (a term coined by Carol Dwek, a US psychologist) allows you to reframe your perceived inadequacies and deficits as opportunities for learning, Kustow points out. 
An effective way to counter negative thinking traps is to catch them early, scrutinise them and, if appropriate, think of a more accurate and balanced alternative, known as “reframing”.
Kustow insists on using positive and energising language. “When patients work with me, they effectively enter into a contract not to talk down to themselves,” he says, acknowledging that a lifetime of negative self-talk takes practice to turn around. 
Around 80 per cent of people with ADHD report going to bed later than usual and 60 per cent of those end up feeling sleepy during the day, which leads to a number of unhelpful outcomes. Kustow lists a number of tips to optimising sleep, as follows. 
Be guided by your body, he writes. If you are tired during the day then you’re not getting enough good-quality sleep, so try increasing the time you spend in bed by 30-60 minutes, six nights a week for a month. 
Go to bed when you are sleepy: This sounds obvious but heading to bed before you are tired means you will lie awake and overthink. 
Use your bedroom for sleep (and intimacy) only. That means banning all wakeful activities such as watching TV, scrolling and even reading. 
Address insomnia head on: If you are struggling to fall asleep or wake in the night, get out of bed, go to another room and do something relaxing in low light. After doing this for several weeks the bedroom will be strongly associated with sleep only. One of the most successful ways to anchor your sleep, however, is to establish a morning and evening routine. “If you bookend your day with a habitual routine centred around self-care, then everything else becomes easier,” stresses Kustow. 
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Unburden overwhelming thoughts by having a running “dump-all” task list on which you write down everything that arises and needs actioning within a three month period. This helps to reduce the number of things you put on your daily to-do list. For beginners, Kustow suggests switching to a weekly action list.  
The key is not to overstretch yourself or it can be overwhelming. One of the things those with ADHD often struggle with is lateness. Kustow suggests  overestimating how long things will take by adding on 30 to 50 per cent to your initial perception. This includes planning a journey or hitting a work deadline. Avoid skipping meals and try to incorporate breaks every 45 minutes by getting up and moving around. Integrating regular and varied forms of exercise to energise and recharge the system, ideally in fresh air and natural light, is particularly helpful for those with ADHD. Set a timer if necessary. 
Always misplacing your keys or phone? Then make it visual. “It helps to have Post-it notes around the house,” says Kustow. By having a set place for important items such as your keys, phone or your security pass for work, saves untold mental frustration for you and those around you. If you run out of time to get to the gym, leave your kit packed and left by the front door – and lay out your outfit for work the night before. 
Of course, all of the above is difficult if your surroundings are a mess.  Kustow suggests blocking out time to declutter on a regular basis. This goes for your wardrobe and communal areas such as the kitchen, making sure everything has a dedicated place and is labelled if necessary, not forgetting that decluttering your inbox is as crucial to your wellbeing. Do your utmost not to impulsively say yes to every email request, suggests Kustow who says it’s better to say no than half-heartedly commit only to pull out later. For the things you do say yes to, Kustow follows the “agree it, note it, file it” system by immediately inputting all arrangements in your diary. 
The dysregulation inherent to ADHD predisposes one to disordered eating in a variety of guises, such as overeating, bingeing, erratic eating and missed meals, writes Kustow. While maintaining a healthy weight can be a challenge in those with ADHD, restrictive diets are to be avoided as not only are they unlikely to be sustained, eliminating food groups can lead to deficiencies. 
What’s important for those with ADHD is that mealtimes are consistent and if possible scheduled to encourage mindful undistracted eating as those with the condition often aren’t as able to evaluate when they are full and when to stop eating. While red meat should be limited, omega-3 fatty acids are essential for brain health and can be found in oily fish (salmon, anchovies, mackerel, trout, herring and sardines). Walnuts and seeds (chia, hemp, flaxseed) are also good sources if you are vegetarian. 
Overall, Kustow believes food should be delicious, pleasurable and healthy, particularly for those with ADHD. To make it happen, try meal prepping and planning your shopping list in advance to avoid reaching for unhealthy foods in the moment. Having blood sugar-friendly snacks on hand such as dark chocolate, raw unsalted nuts, an apple, or hard boiled eggs is a great hack to avoiding energy dips. As is staying hydrated. Regular exercise, it goes without saying, is a crucial mood stabiliser, therefore find something you like doing and schedule it in. 
Toxicity is a potent driver of inflammation and when chronic, inflammation (as discussed earlier) messes with brain function. There is growing evidence supporting associations between ADHD and chemical toxicity, and while it’s not something to obsess over, reducing your toxic load is important. This could include investing in a water filter and reducing exposure to toxic cleaning and personal care products by using organic alternatives, as well as reducing plastic or metallic bottled drinks. 
To help your body detoxify it can be helpful to soak in a bath of Epsom salts a few times a week, or sweating in a sauna not only flushes out fat-soluble toxins, but helps boost dopamine levels. If you don’t have access to a sauna, you may benefit from investing in a sauna blanket to use at home, available from companies such as Higher Dose. Whereas supplementing with vitamin C, zinc, magnesium and B vitamins, possibly along with pre and probiotics aid in the detoxification process. 
Those with ADHD often feel restless inside, leaving them on edge and unable to settle and relax, which can lead to over-reactivity and mood instability.  Emotional dysregulation can manifest both as stress, anxiety, anger, rage and conversely, shutdown and dissociation. Negative strategies of coping with these feelings include substance abuse, overworking, conflict seeking, disordered eating or social withdrawal. 
Positive ways to cope, however, can include vagus nerve exercises such as slow, deep diaphragmatic breathing, humming or chanting (‘ahh’ , ‘ooh’, ‘mmm’) ear stimulation (gently touching the skin on and around the ear can have a powerful calming effect) acupoint tapping on the head, face and chest, and sleeping on your right side, which new evidence suggests has a positive effect on your heart rate variability. 
How to Thrive with Adult ADHD, 7 Pillars for Focus, Productivity and Balance (Penguin) is available on audio, ebook and paperback. 
To learn more about how to live well with adult ADHD, visit The Grove Practice 
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