I recently wrote and printed up a visual schedule for my 9 year old. She was having trouble getting ready for school, resulting in frequent tantrums. A morning meltdown puts me off for the rest of the day; who would want to start their day like that? I decided to try a visual schedule. She does not have ADHD or autism, but, I was desperate for a drama-free morning and thought, what could it hurt? So I took my newfound Canva skills and created the schedule. I included cute pictures and the opportunity for flexibility.
The difference has been incredible. She absolutely loves it and refers to it almost every day. Even on nonschool days, she will refer to it to give her structure to how she should get ready in the morning. Sometimes it’s a game, and we go “backward”. We don’t strictly keep to the time; it took some time for her to understand it’s helpful but, not mandatory.
My Own Checklist
I remembered when I moved from utilization management to post-service review there were some aspects of the job that were difficult for me to pick up. I created a checklist of what I needed to be sure I included in every letter I sent out. Before I hit “send,” I was sure to check my list. The list created a visual routine for what I would check before I declared something “complete”. Over time, I didn’t need the checklist because it became hard coded.
Thinking about physicians with ADHD ( and without)
For many it’s hard to get out the door in time. Morning becomes a blur of events that ultimately end with a rush out the door late to work, school, or an event. The idea of sticking to a routine seems as fantastical as finding the golden ticket. What physicians with ADHD often don’t see is the places in their lives they already created routines. For example, the typical patient encounter is a routine. Greet the patient, get a history, do an exam, and have a discussion about your findings and the plan. That’s the routine. There aren’t many choices or opportunities for distractions so these tend to go smoothly. There isn’t much variability in the order of a patient visit. It’s hard to create a plan before you have taken the history. How long did it take us to establish our visit routine? We got the basics in medical school. Doing a general history and physician took weeks of consistent practice to get down. Then in residency, another few weeks or months of consistent routine practice to get it down. We can do the same in our lives outside of work. It just takes practice.
For people with ADHD and other executive functioning problems getting a routine down can be a larger challenge than for those without those challenges. Working memory is a key aspect of executive functioning. Hard coding a routine comes from repetition. Repetition relies on working memory. Adding a visual schedule helps to augment the working memory so repetition can take place.
Eliminating Options
In the morning there are so many things to do with endless options. Do, I have breakfast or take a shower? Should I get dressed before I brush my teeth or after? I got a notification on my phone, I should check that; it could be work-related. No, it’s just a coupon for 50% off today; let me take a look. Maybe I can get a great deal. It’s no wonder it’s hard to get out the door in time. A visual schedule that shows you what your preferred order is for getting ready in the morning. An idea ( and realistic) time frame for each task’s length. Flexibility build-in: Ten minutes to ensure there are no filed trip or class photo papers to be signed. 15 minutes to check your notifications and answer any urgent messages.
Getting Started
The schedule does not have to be fancy ( no Canva skills necessary). Yes, it has to be written out. Your brain needs something visual to refer to. You don’t have to have the time specified. For some, sticking to a specific time becomes stressful; try it without. I recommend a general start and “get out the door time.” Otherwise, all you need is the order in which you do things.
The schedule should be posted someplace where you can easily see it. I don’t recommend having it on your phone for obvious reasons. Our phones are an immediate distraction. Every time we pick it up, it’s an invitation to seek dopamine. Keep it on paper or a series of sticky notes. Put it someplace prominent. Some of you may be concerned about “what if someone sees it”. I invite you to consider that the “someone” who is seeing it is probably a roommate or partner. That person has been living with you and sees your struggle and may sometimes get caught up in the chaos of your daily preparation to get out the door. I bet they care for you deeply and would be happy to see your mornings go smoother.
The Best Part
Here’s the best part: Once you get a basic routine down you can add one or two things that you have always wanted to do but never could. For my daughter, we have “make the bed if there is time”. I’m someone who makes my bed every day, it’s a habit I would love my daughters to pick up so, we added it. Perhaps you want to get in a 5-minute meditation or a 10 min workout. Once you have your schedule and it’s working well for you, go ahead and add something in. You may be surprised by how well it works!
If you have your mornings down, maybe it’s a get home from work routine, a night time routine, or even a getting into the office routine. I encourage you to take a look around and see where a visual schedule may be helpful. Give it a try; let me know how it goes. If you need help establishing routines, reach out to me.