(This was part of a three-part series I wrote on how I got through nursing school with ADHD)

When trying to study and pay attention with ADHD it helps to understand optimal stimulation theory. Here’s an article to read if you want the nitty gritty, but I’m gonna break it down the way I understand it. This is the idea that ADHD is actually a disorder of an under-stimulation, and that you have to increase stimulation to increase attention. It has to be just enough though, as too much stimulation also reduces attention. The problem is research into the specifics has gotten mixed and inconclusive results. The best advice is again, for each person to do what helps them.

So put on some educational videos at home and try a bunch of different things out. Whatever helps you pay attention to the speaker most is what you should do. Here’s some things I’ve tried and how I choose the right activity for various situations. It should give you somewhere to start.

Basically I split my brain and senses into four parts that all need to be occupied. These are my eyes, my hands, my ears, and the ability to think/process itself. Different tasks need different parts, so the best complementary task varies. Tasks also tend to be less stimulating as they’re repeated, so sometimes the effect will wear off and I have to try something new.

Lecture

So lecture uses the processing of course, and it uses the ears, but it uses the eyes less often and barely uses the hands at all. So I need something that will occupy my hands and occupy my eyes but that I can look up from as needed. Here’s some examples:

• Knitting or crocheting
• Adult coloring books
• Doodling simple, repetitive shapes like little circles, squares, spirals, or wavy lines. I can’t draw complex objects or shapes and still pay attention, just simple repetitive ones.
• Fidget spinners & cubes - They don’t occupy your eyes in the same way but they do occupy your hands.
• Handheld puzzles like rubiks cubes
• Jewelry - a lot of people use beaded necklaces/rosaries just to occupy their hands. I’ve also seen spinner rings and necklaces with the time turner from harry potter.
• A lot of people download the outline or powerpoint ahead of time when and take notes on top. That never worked well for me personally but again, figure it out for you.
• Some simple phone games/apps but only very specific ones. You want something with
  • a lot of color and shapes
  • no reading or complex problem solving
  • mindlessly easy & repetitive
  • untimed, like I said, so you can look up
  • little or no sound/can be muted so both you and your classmates are not disturbed
• Here’s some great examples (I’d love some recommendations from apple users): 2048 - Water sort - Ball paint - Art Blitz - Tangle Master - Sort N fill

Rules for fidgeting

• Respect your classmates’ right to learn. Fidget quietly and, wherever possible, out of sight (this is less of an issue with virtual lectures, but keep it in mind).
• Be honest with yourself about what works for you. The most effective fidget usually isn’t one that feels fun (in fact that often indicates the fidget is too stimulating). It should be just stimulating enough to make work easier to pay attention to.
• An important part of teaching is verifying that students are hearing and understanding. This is why open communication is so important. Talk to your instructors about what you need and what you paying attention looks like. Fidgeting with a phone is convenient, but more traditional teachers might understand doodling better. I talked about effectiveness and whether or not fighting them on this is worth it in a previous post.
• If these things help you it will show. If you still answer questions and work on assignments, most instructors understand.
• If you’re going to fidget in lab & clinical, the biggest concern is being sanitary. Knitting (as an example) can’t be sanitized properly. I also had the instructor reviewing my accommodations tell me fidgeting would not be accommodated in the lab/clinical setting. In practice this just meant I was responsible for making sure my fidgeting was not disruptive and in fact barely noticeable.
  • Bad Lab Fidgets
    • Knitting - not sanitary
    • Fidget jewelry - not sanitary, ligature/choking risk
    • Fidget spinners and cubes - borderline. Easier to sanitize, but has to be done quietly under table/in pocket
  • Good Lab Fidgets
    • Doodling - but depending on what else is on the paper, be prepared to shred it at the end of the day
    • Small hard plastic pocket fidgets

The Reverse, Reading the Book & Doing Homework

So what if you need your eyes and your hands like if you’re reading or working on an assignment? Well you do the reverse and occupy your ears!

• I recommend music without lyrics. I like electronic dance music, but you can find instrumental music in almost any genre.
• A lot of people listen to video game music because it was kinda designed to aid attention.
• You could also listen to white noise. Lots of white noise generators have options like a coffee shop with people talking in another language in the background.
• Experiment a little and see what works best. If you need to read something music or white noise occupies your ears but you might also need to fidget with your hands (see above).
• Part of this is building a pavlovian response in yourself. If you don’t have a sound to start with that puts you into “study mode” work on studying to a particular sound until you do (more on this in the next section).

To sum up optimal stimulation, think about what you’re doing and what parts of your brain the target task occupies. Then think about what parts tend to distract you and how to occupy them with a small task. Be willing to experiment to find the level and activities that suit you best.

Fun fact: although not directly nursing school related, there are many mindless chores you will still have to do during school. Tasks like laundry or dishes occupy your hands and eyes, but rarely your ability to think deeply. This makes your laundry or dishes a great fidget for studying so you can get two things done at once.

Self Soothe and the Five Senses

So this is actually another DBT concept. I mentioned pavlov and his dogs in the first post and here it is again. The dogs drool when the bell rings because they’re used to eating when the bell rings. The only difference between you and those dogs is you get to pick what you want to be trained to do when the bell rings. Find something to be your bell, and train yourself so to go into study mode when it rings.

Your attention or relaxation or whatever other conditioning you want can be trained to respond to any of your five classic senses. For best results, use multiple or even all five at once. Here’s some examples of things you can use (copied from another, similar post of mine):

• Sight - Curtains open to daylight or full spectrum white light lamps are abt $50 on Amazon if you live somewhere with little sunlight like the NW US or near the Arctic circle. You may be able to do this with some of those fancy new color changing light bulbs, but I suspect that’s more expensive.
• Sound - upbeat music, white noise recording or generator of a coffee shop (best if any talking is in a language you do not speak)
• Taste - coffee / tea, chewing gum
• Smell - a simulating essential oil like citrus, keep the coffee grounds in a cup, scented lotions or lip balms
• Touch - it may help to do some light exercise like stretching or yoga, but I really recommend putting on real clothes. For instance I have a hard time studying if I’m not wearing a bra.

This is kind of a repeat from the first post but for many people the best thing is not being in the same place where they sleep and watch Netflix while they’re trying to study. It’s a great strategy, but there are other options as well (and you may need them in this new COVID world). A similar strategy for people who are restricted to their rooms would be to have a desk or chair where they sit during the day and the bed is still reserved for sleeping. You could even curtain off this area or use one of those folding room dividers to create a separate area. You may be able to find these pieces of furniture secondhand for cheap.

Conclusion

I hope this really helps all of you. I put a lot of work into making sure I included everything but that it was still readable. Look in the comments if you wanna read more. Lots of people have been sharing their own experiences and what does and doesn’t work for them.

Best of luck in your schooling and careers!