Managing Energy as an ADHDer

ADHD and Spoon Theory

Introduction

Spoon theory has been widely applied to physical health conditions, such as living with chronic fatigue or pain, as well as to Autistic and ADHD experience. Many Autistic people and ADHDers also have co-occurring physical health conditions (e.g., joint hypermobility leading to chronic pain), meaning that already limited energy levels can become rapidly depleted. Typically, the focus is placed upon conserving energy (‘spoons’) and understanding how energy might be lost (e.g., through too much sensory input; social demands). In this blog, we suggest that whilst this is applicable to ADHD experience, focusing only on conserving energy to manage spoon depletion overlooks aspects of ADHD experience, such as need for novelty, interest-based attention, and pacing differences. We suggest that ADHDers may ‘lose spoons’ without novelty, or if mental/physical energy is not expended, that is, activities typically assumed to be ‘restful’ or ‘energy-conserving’ actively might ‘cost spoons’.

This blog will cover:

·       An overview of a neurodiversity affirmative understanding of ADHD

·       A summary of spoon theory

·       ADHD and spoon theory

·       Compensatory strategies and spoons

Language Note: Unlike the Autistic community, there is not clear consensus in the ADHD community about the preferred language to use when talking about or naming ADHD. Describing yourself as an ADHDer is common, and many others call themselves AuDHD if they are Autistic and ADHD. We have chosen to use ADHDer but this may change over time in line with community preferences. 

A Neurodiversity Affirmative understanding of ADHD   

This way of working views being ADHD as a different way of experiencing the world, not a ‘disorder’ or ‘condition’, conceptualising ADHD in terms of divergent thinking, variable attention, hyperfocus, and pacing differences and recognising the importance of context in understanding attentional styles (link to first blog). ADHD represents an interest-based attentional style based, driven by urgency, novelty, and capacity. Interest-based attention is an attentional style driven by intrinsic motivation, curiosity, and personal relevance. Attention is strongest when a task is engaging, meaningful, or stimulating to the person, rather than being externally controlled. Wise (www.livedexperienceeducator.com) emphasises how ADHDers have differences in sensory processing and filtering, an increased need for movement for regulation, sensory input, self-expression, engagement and learning, as well as communication differences in voice tone, eye contact, verbal processing, interest- and connection-based conversation style.

Spoon Theory

Spoon Theory is a way of conceptualising management of limited energy resources. Incorporating spoon management into daily life can support understanding of our needs and limitations, and in making decisions about allocating and recharging energy resources.

Spoon Theory was created by Christine Miserandino in 2003. Christine had been diagnosed with lupus, a chronic autoimmune condition. She was in a café with a friend and used spoons to explain why she had only limited reserves of energy and the impact that this had on her daily life, with each spoon representing one unit of energy that she had available to meet the various demands on everyday life. Spoon Theory has been embraced and found to be a useful metaphor amongst many communities. Key ideas of Spoon Theory are that:

·       We have a finite number of spoons. A neurodivergent person is likely to have fewer spoons than a non-autistic person of the same health status.

·       Everyday tasks ‘cost’ a specific amount of spoons, although which tasks cost how many spoons will vary according to the individual (e.g., if someone is sensitive to bright light, working in a brightly lit office will cost them more spoons than someone who finds themselves energised by bright light).

·       We can regain spoons by resting or engaging in activities we find restorative.

·       We can pace our energy by planning activities according to how many spoons they are likely to cost or replenish.

·       We can have different amounts of spoons for different tasks and be low on spoons in one area whilst having spoons for another activity. For example, we may run out of People Spoons and need to take a break from any contact with people but have plenty of Spoons in another domain.

ADHD and Spoon Theory

Key ideas of Spoon Theory as commonly applied to ADHD experiences are:

·       Sensory overload, social demands, and everyday stressors of living in a neurotypical world can deplete spoons, as can the executive functioning demands of many activities of daily living (e.g., decision making, planning, organising etc.).

·       Meeting sensory needs, having time for passions/interests, and experiencing hyperfocus can recharge the person’s spoon supply.

·       Hyperfocus is an intense, prolonged, highly focused, interest-based attentional state which can make it difficult to shift attention or switch tasks. Becoming ‘stuck’ in hyperfocus might deplete spoons, for example, if the person is so immersed they are not aware of gradually decreasing energy resources or do not attend to their wellbeing (e.g., eating, drinking).

·       Hyperfocus and/or inadvertently using up energy resources may leave no spoons left for the remainder of the day.

·       Not being able to meet the need for physical or mental activity may also deplete spoons.

·       Energy or spoon levels can be particularly difficult to predict for ADHDers as spoon levels/rate of depletion are particularly likely to vary unpredictably.

·       Meltdown or shutdown can happen when spoon levels reach critical levels or runout totally.

·       Many ADHDers are routinely in a spoon deficit because of the demands of everyday life.

·       Burnout can happen when a chronically critically low level of spoons is reached.

For example, an ADHDer will wake up with a finite number of spoons for the day, typically less than a non-ADHD person of a similar health status. This might be less than they usually have, for example if they slept poorly, had a meltdown the previous day, or had a particularly busy and/or challenging day. Activities throughout the day will result in incremental spoon loss. If the person has a health appointment (likely to cost spoons) they may need to ensure they have sufficient spoons to manage the appointment by monitoring energy expenditure prior to the appointment. For example:

Spoon loss 1: Completing the morning routine, so spoons are lost even before leaving the house. If they have particularly few spoons that day, it might be that some parts of the routine simply are not possible (e.g., they might need to skip the shower).

Spoon loss 2: Executive functioning demands of planning, and following the journey to a health appointment, particularly if it is at an unfamiliar location.

Spoon loss 3: Anxiety about the appointment / rehearsing how to explain the issue to the practitioner understands

Spoon loss 4: Sensory overload on the journey.

Spoon loss 5: Finding the appointment location in the hospital building.

Spoon loss 6: Loud and busy waiting room, which is very brightly lit.

All these things cost spoons, and before they know it, the person has very few spoons left to navigate the appointment itself. They are likely to find it difficult to explain their needs, process or retain information, let alone complete the rest of their daily activities. They might just about reach home on their last remaining spoons but end up in meltdown or shutdown in the safety of home because they have no spoons left and are completely overwhelmed.

Often, the focus of writing about energy management focuses on conserving and replenishing energy with an implicit assumption that ‘rest’ is restorative and/or is protective against spoon depletion. We suggest that this is not the case for many ADHDers – spoon loss may occur due to lack of novelty, or if mental/physical energy is not expended. That is, activities typically assumed to be ‘restful’, or ‘energy-conserving’ might actively deplete spoons, rather than maintain or recharge energy levels. 

Given that ADHDers attentional system is typically driven by interest, activities that are dull, not of personal interest, or routine are likely to lead to hypofocus (often described in terms of ‘distractibility’, ‘forgetfulness’, ‘difficulty completing tasks;). We suggest that hypofocus both reflects, and results in, a loss of energy resources (i.e., spoons). This can soon become a vicious circle in which the person has less energy resources available to support their attentional capacity and thereby becomes more hypo-focused, which in turn contributes to further loss of energy resources (spoons).  Trying to stay focused on dull tasks or those that don’t provide novelty, interest, or meet pacing differences (or movement) costs spoons. Externally it may look like the person is not expending energy, but a great deal of energy resources is being taken up trying to stay on task, or by repeatedly switching attention onto multiple tasks to try and gain novelty. On top of this, being unable to engage in the mental or physical activity that many ADHDers need, actively costs spoons.

In sum, inactivity or monotonous tasks results in spoon depletion, meaning that ADHDers often need to expend mental or physical energy at a level greater than non-ADHDers even to maintain spoon levels, let alone recharge spoon levels. For example, many ADHDers report that exercise is beneficial and a vital part of daily management but might find that other people may find it difficult to understand that their gym workout, or long bike ride is not merely enjoyable but essential to their energy levels or maintaining well-being over and above being an interest or hobby.  However, they may also need to balance the need movement with other competing needs (e.g., avoiding sensory overwhelm in a busy gym by running outside, trying to find a less overwhelming workout/gym environment, only going at quieter times). Meeting the need for movement/novelty may recharge spoons but may also cost spoons in terms of the executive functioning demands of planning/organisation of activities that meet these needs.

Spoons and compensatory strategies

Compensatory strategies are techniques or methods that help individuals manage challenges by using their strengths or adapting their environment. There may be scaffolds put in place that the person does themselves (e.g., setting alarms; having a ‘system’), something someone else does for them (e.g., a partner helping by being the one to start the task first), or environmental adaptation (e.g., finding a job role that matches their attentional and processing style). Whilst compensatory strategies can be an effective workaround (e.g., for executive functioning differences) and help support spoon expenditure, it is also important to recognise that embedding these systems can also deplete spoons and not be possible at times of greater energy depletion. It can be difficult to balance the spoon cost of implementing various compensatory strategies with their potential spoon conservation.

Summary

Understanding ADHD using spoon theory can support us to manage and restore energy resources in a way that works with an interest-based attentional system and pacing differences, rather than attempting to impose neuro-normative expectations of rest and energy management which typically work against ADHDers attentional and pacing differences.

Author

Dr Anna Day and Adj Prof Davida Hartman