Does this sound familiar?

“I’m busy all day, but I don’t get anything done. I want something to show for my efforts.”

“Everyone in my life is tired of my lateness and unreliability.”

“I can’t get motivated unless I’m facing a deadline, and what I produce isn’t as good as it could be.”

In this episode of A Mind of Her Own with Jennifer Reid, MD, we hear from adult ADHD expert, J. Russell Ramsay, PhD about a new way of viewing ADHD: as fundamentally a self-regulation problem, not an attention problem. The name is misleading. What’s really impaired is the ability to organize behavior across time in order to consistently follow through on what you intend to do.

CBT adapted for ADHD works differently than standard CBT. The focus isn’t on changing negative thoughts. It’s on reverse-engineering the how of not doing things, then building explicit step-by-step plans. The goal is slowing down the executive function deliberately, making implicit steps external and visible.

The Core Executive Functions Affected in ADHD:

* Inhibition (pausing before responding automatically)

* Nonverbal working memory (mental simulation and planning)

* Verbal working memory (internal self-talk and staying on track)

* Emotional regulation and motivation (generating drive in the absence of immediate consequences)

* Reconstitution (flexible, creative problem-solving)

Emotional dysregulation is a core feature, but it’s invisible in the DSM. Emotions don’t appear in the diagnostic criteria at all, yet they drive much of what people actually struggle with: impulsive reactions, difficulty tolerating discomfort, and using guilt as a misguided motivator.

Women are significantly under-diagnosed and diagnosed later. CDC data from 2024 found that 50% of people with ADHD were diagnosed at age 18 or older, and 61% of those were women. Girls’ symptoms often appear on the playground rather than in the classroom, with social disruption rather than academic chaos, making them easier to overlook. Women are also more likely to be diagnosed first with anxiety or depression.

Self-mistrust is a hallmark and often mistaken for low confidence. After years of inconsistent follow-through, many adults with ADHD stop trusting themselves to do what they set out to do. This isn’t simply low self-esteem; it’s a learned pattern of doubting one’s own reliability, often amplified by the unspoken message: it must be something I’m doing wrong.

High functioning doesn’t mean unaffected. Many people mask symptoms for years through compensatory strategies: all-nighters, parental scaffolding, sheer willpower, until the scaffolding is removed or life demands multiply (new job, parenthood, caregiving, perimenopause).

Front-end perfectionism drives procrastination. The biggest cognitive distortion in ADHD isn’t negativity, it’s the belief that conditions must be perfect before starting. Waiting to feel focused, energized, or “in the mood” guarantees perpetual delay. The reframe: Do I have enough to begin?

ADHD also brings real strengths. Creativity, the ability to hyper-focus in stimulating environments, hands-on intuitive knowledge, persistence when engaged, and the capacity for innovative thinking are all genuine advantages, not consolation prizes.

Resources Mentioned

* Book: Once I Get Started: The Adult ADHD Program for Turning Your Intentions into Actions — Dr. Russell Ramsay (Avery/Penguin Random House, May 2025)

* Book: You Mean I’m Not Lazy, Stupid or Crazy?! — Kate Kelly & Peggy Ramundo (mid-90s classic, still widely cited)

* Book: The Power of Habit — Charles Duhigg (source of the “keystone habit” concept)

* Book: The Extended Mind: The Power of Thinking Outside the Brain — Annie Murphy Paul (on environment, cognition, and the need for solitude)

* Book: Living Well with Adult ADHD: Practical Strategies for Improving Your Daily Life — Dr. Laura Knouse & Dr. Russell Barkley (Guilford Press, 2025)

* Researcher: Dr. Margaret Sibley — Professor of Psychiatry & Behavioral Sciences, University of Washington; leading work on adult ADHD diagnosis guidelines through the American Professional Society of ADHD and Related Disorders (APSARD)

* Researcher: Dr. Russ Barkley — foundational work on ADHD as executive dysfunction

* Assessment tool: QB Test (Qbtech) — computerized continuous performance task used to objectively measure attention, impulsivity, and activity

* Website: cbt4adhd.com — Dr. Ramsay’s practice, contact form, and resources

About Dr. Russell Ramsay

Dr. J. Russell Ramsay is a licensed psychologist and board-certified cognitive-behavioral therapist specializing in the assessment and psychosocial treatment of adult ADHD. He was the co-founder and co-director of Penn’s Adult ADHD Treatment and Research Program, one of the earliest and most influential programs of its kind, established in 1999.

Dr. Ramsay is the author of six books on adult ADHD, including his most recent, Once I Get Started (2025). He has lectured internationally, published extensively in peer-reviewed journals, and serves on the editorial board of the Journal of Attention Disorders. He is an inductee in the CHADD Hall of Fame and recipient of the University of Pennsylvania’s Szuba Award for Excellence in Clinical Teaching and Research. He now runs a fully virtual solo psychology practice, licensed in Pennsylvania and credentialed through PsyPact to practice telepsychology across 35+ participating states.

🌐 cbt4adhd.com

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