If you work with adults with ADHD, you quickly realize this isn’t simply a disorder of attention or intelligence — it’s a disorder of self-regulation across time. The real suffering often lives in the gap between intention and follow-through: knowing exactly what needs to happen, but struggling to consistently execute it in daily life.

In this episode, I’m joined by Laura E. Knouse to discuss her new book, Living Well with Adult ADHD, co-authored with Russell A. Barkley. We explore how executive functioning science can be translated into practical systems that actually respect how the ADHD brain works. This conversation is less about “trying harder” and more about designing environments, routines, and supports that make follow-through more achievable.

We discuss why traditional productivity advice often fails adults with ADHD, how behavioral science explains motivation problems, and why immediate consequences matter far more than distant rewards. We also examine emotional regulation, shame, identity, values-based treatment approaches, and the role of environmental engineering in improving daily functioning.

Dr. Knouse also breaks down how CBT for ADHD differs from general CBT approaches, where medication helps — and where it often doesn’t — and the practical systems that produce the greatest functional return for adults still struggling despite insight and motivation.

Topics Covered

ADHD as a disorder of executive functioning and self-regulation
Barkley’s model of time blindness and behavioral inhibition
Why procrastination is often an emotional regulation problem
The neuroscience of motivation and immediate rewards
Task initiation and resistance despite intellectual understanding
Environmental redesign and “niche picking”
Common productivity-system failures in ADHD
Shame, self-criticism, and identity development
Values clarification and sustainable behavior change
CBT interventions for adult ADHD
Medication versus skills-based functioning supports
Practical systems that improve follow-through in everyday life

About the Guests

Laura E. Knouse

Laura E. Knouse, PhD, is a clinical psychologist and Professor of Psychology at the University of Richmond. She is a leading researcher in cognitive-behavioral therapy (CBT) for adult ADHD, with a particular focus on executive functioning deficits in college students and adults navigating independent living. Dr. Knouse trained in Russell Barkley’s research lab and later completed clinical training in emerging CBT protocols for adult ADHD, contributing to the refinement and empirical testing of these interventions. Her work integrates executive function theory, behavioral science, and implementation strategies aimed at improving real-world functioning.

Russell A. Barkley

Russell A. Barkley, PhD, is one of the most influential researchers in the field of ADHD and a pioneer in conceptualizing the disorder as a deficit in executive functioning and self-regulation. His work fundamentally reshaped contemporary understanding of ADHD as a neurodevelopmental condition rooted in impaired behavioral inhibition and time-based self-management. Dr. Barkley has authored numerous foundational texts, assessment tools, and evidence-based treatment guides used internationally in both clinical and research settings.