Teaching

Society has all kinds of weird ideas about how Bad Thing X is absolutely necessary for teaching children Good Thing Y. If they aren't subjected to X, they won't learn Y, and then they will be miserable and dysfunctional as adults!

Here's an extreme example that I've actually heard people advocate for on multiple occasions.

Kids need to learn not to steal from pet food dishes. In order to teach them this super-important lesson, toddlers should be placed in situations where they are tempted to steal pet food, then punished or otherwise dissuaded when they attempt to do so. This is very, very dangerous--since dogs are often extremely protective of their food and don't necessarily see the child as someone who is "allowed" to take their food, even nice well-behaved dogs may attack a child in this situation--but it's necessary!

No. That's stupid. It's not necessary. It's needlessly dangerous. Think of all the people who never had pets as children or who never wanted to take pet food, yet how many adults do you see going around stealing from pet food dishes? They were able to figure it out without this lesson.

ADHD brain cascade

Today, I had to go to my mom's house after work to pick up an important piece of mail. I was worried I'd forget, so I put a note for myself on my car visor. However, it was dark when I got in my car, so I didn't see the note and was not reminded!

However, as I started up the car, I was thinking about my workday, and my brain went down this path:

• I'm quite dissatisfied with my performance at work today.
• Lately my ADHD symptoms have been worse than normal. (Note: It seems some of the food I've been eating interferes with the effectiveness of my medication.) Although there was some improvement today, it was still very difficult.
• Today's improvement supports my hypothesis about which food is giving me trouble, because I haven't eaten it since Saturday.
• Good thing I've stopped eating that. (Alas, it was tasty.)
• I'll have to eat something else. I don't currently have any of the problem food in the house anyway.
• That reminds me, I don't have much other food either. I have to go grocery shopping.
• Speaking of the grocery store, I've been parking my car in the grocery store parking lot every night for the last week.
• The reason for that is because the management of my apartment complex threatened to have my car towed from the apartment parking lot. I have to park elsewhere to prevent that from happening.
• The reason they threatened to tow my car was because I didn't have the current registration displayed on my license plate. (I've already renewed my registration so it's legal for me to drive but apparently it's against "community rules" to not have the stupid sticker on there!)
• I need to obtain that sticker ASAP. My address with the Motor Vehicle Division is my mom's house, so it'll be mailed there.
• Oh, yeah! I was supposed to go to my mom's house tonight!

It seems really time-consuming when expressed as words, but that train of thought all happened in the space of about one second.

Thankfully my ADHD sometimes solves itself. If only it could do that more often.

Initiation, Motivation, Procrastination

I always have this weird urge to not do things.

That's the best way I've found to refer to it; it's kind of a hard problem to describe. It doesn't feel like a particular emotion at first, but when the mysterious urge to not do a task starts to conflict with my motivation for doing the task, that situation will make me feel bad. The result is that I feel sad, stressed, anxious, and/or frustrated when faced with almost any kind of task or obligation.

Obviously, everyone is reluctant to do things they don't want to do; that's the whole idea behind reluctance. So at first I thought I was just being wimpy when faced with unpleasantness. But a while back, I realized that my emotions in these situations are completely inappropriate for the actual level of unpleasantness.

After some digging, I finally found that this problem is called initiation impairment, or sometimes initiation deficit.

What is it?

It's a form of executive dysfunction. Or to put it another way, it's a secret ADHD symptom.

As background info, executive functioning is the cognitive functions that control your behavior and decisions. Different researchers/psychologists/neurologists will give different executive function categories, but it's generally stuff like...

• Attention control.
• Inhibition (impulse control).
• Working memory.
• Planning and organizing.
• Cognitive flexibility.
• Initiation of actions.

This weird urge to not do things is what seems to be what happens when you have impairment of the "initiation of actions" aspect of executive functioning.

Researchers like Russell Barkley have started to understand ADHD as impairments with executive functioning, but the diagnostic criteria of ADHD only really cover impairments attention control and inhibition. A lot--most? all?--people with ADHD have impairments with multiple areas of executive functioning. (Fortunately, most of us don't have severe impairments in ALL areas of executive functioning. The different problems tend to compound upon each other, so someone with all the problems would be in big trouble.) For people who have executive dysfunction other than attention and inhibition, it's quite possible that they can't be diagnosed with ADHD, even if it seems likely to have the same neurodevelopmental causes as ADHD.

Besides ADHD or similar neurodevelopmental causes, this problem also occurs in people who have executive dysfunction from traumatic brain injury (TBI) or age-related brain trouble. Alas, resources on TBI are pretty much the only places you'll see any acknowledgement of initiation impairment.

Example Situations

Here's the example that finally clued me in that I have a real cognitive issue: giving my pets medicine. I had rats, and they are really prone to respiratory infections, so I had to give them antibiotics and probiotics quite often. Both of these medicines were INCREDIBLY DELICIOUS according to the rats. They really liked taking the medicine, and it was really cute watching drink it from the syringe. The whole process of measuring, administering, and cleaning up probably usually took less than two minutes, twice per day, and was super-easy. But I HATED having to do it.

I was able to force myself to do it because my rats' lives depended on it, but why did I even have to force myself? Why wasn't it easy to get myself to do it?

To clarify this example: There was no physical pain or sensory problems during this task. It was not complex or mentally tiring. I didn't have to worry about my rats trying to escape their cage or anything inconvenient like that. They didn't have the kind of symptoms that made me sad to be around them. The medicine made them happy.

So it shouldn't have been so hard!

That was a trivial example, but it made me realize I'm like that with pretty much everything. It's pretty hard to make myself do anything unless I'm faced with short-term dire consequences. Taking out the trash, mailing my tax forms, changing the oil in my car, putting gas in my car, working toward my hopes and dreams in any way, calling my mom periodically, charging my cell phone. I do have some issues that make many tasks more difficult for me than they are for most people, but even if you disregard "most people" and look at how unpleasant a particular task is specifically for me, my emotional state still doesn't make sense. But just because I know my emotion isn't justified doesn't keep me from feeling it.

In another post, I linked to the Hyperbole and a Half post, This is Why I'll Never Be An Adult, which makes me feel less alone. I figured a problem like this might be why the author has relatively limited "capacity for responsibility," but the post focuses more on the results that happen if you try to fix the problem through sheer force of will. (Spoiler alert: It doesn't work.)

Since then, I was able to read her book, and sure enough, there's a chapter called "Motivation" where she describes this exact thing. I wish I could give a link to the book itself (here's the next best thing: an Amazon link), but instead I'll just copy the first couple paragraphs.

One of the most terrifying things that has ever happened to me was watching myself decide over and over again--thirty-five days in a row--to not return a movie I had rented. Everyday, I saw it sitting there on the arm of my couch. And everyday, I thought, I should really do something about that... and then I just didn't.

After a week, I started to worry it was never going to happen, but I thought, Surely I have more control over my life than this. Surely I wouldn't allow myself to NEVER return the movie.

Then the cartoon picture of herself, standing next to the movie and couch, looking glum, thinking, "...I wouldn't just... NOT do something this easy, right?" Then there's a few pages of cartoons of her arguing with herself about putting away a plate she had food on three days ago.

Sigh. This is totally me. I actually have a library book in my car that was due in September 2013. I put it in my car so I would remember it.

Alas, her technique for dealing with this problem is that she'll allow (or cause) the situation to get so bad that her fear of the consequences of not doing the task are worse than her feelings about doing the task. She doesn't seem to advocate this.

Implications

Having this initiation impairment leads to these problems:

Procrastination until anxiety

Not doing stuff obviously has downsides. For things with a clear deadline, we may get more and more stressed as the deadline approaches. Near the end, the anxiety may finally be enough to counterbalance the urge to not do the task. We still have the urge to not do the task, so we will do it with great reluctance and misery. The task gets done, but we hate it. In many cases, the procrastination probably makes the task even more miserable and unpleasant than it would have been otherwise. Thus, if we need to make ourselves do a lot of things constantly, it will have a hugely negative impact on our quality of life.

Just not doing stuff

What about things with no deadline? I want to start a home business, but I have trouble making myself do projects for it. In other words, I'm not making progress on my hopes and dreams. This sucks.

Doing stuff sometimes, kind of...

Then there's tasks that need to be done but don't necessarily have a particular deadline. A lot of housework and pet care falls into this category, which is especially frustrating because those tasks need to be done repeatedly. There isn't a distinct point where not taking out the trash instantly switches from being acceptable to horrible, it just gradually transitions between those points over time. Taking the trash out tomorrow is only slightly worse than taking the trash out today! Therefore, I might take the trash out a couple weeks after would be the ideal time. That probably means I have to take the trash out fewer times over all, but it also means I have to suffer with the trash in a not-taken-out state for weeks!

Reduced fun

Even though it's easier to make oneself do fun stuff than it is to do non-fun stuff, sometimes I still can't make myself get started on fun things. (Never mind the fact that all that procrastinating reduces how much time is available for leisure.)

Similar or Related Concepts

Inertia

This term is applied metaphorically to describe that inclination you feel to continue doing whatever you're doing. If you're sitting on the couch watching TV, you probably feel at least a little bit of an urge to continue watching TV, even if the show is boring. Most people probably have this to some degree, but some people have it worse. I've seen some discussion from people with autism that this is a common problem for them. Here's some info on inertia for typical people.

Paralysis of Choice or Paralysis by Analysis

When you procrastinate on something because it's hard to make a decision regarding it.

Procrastination

Lots has been written on the topic of procrastination. Sometimes authors even try to pass something or other off as the ONE TRUE CAUSE of all procrastinating, and by fixing that problem, you'll be happily productive. They almost never put something like this as the cause though.

Still, the waitbutwhy.com posts about procrastination (or the TED talk by the same author) have some advice that's probably worth your time to read.

Spoon Theory

The spoon theory refers to the idea that, even if an illness or disability doesn't completely prevent you from doing a task, it can still make it way harder, and that difference matters. I have certainly found that it's easier to make myself do something if I haven't already made myself do a bunch of other things today.

I was able to spend a lot more time working on my hopes and dreams when I didn't have a job.

Reticulating splines

The splines theory is built off the spoon theory and autistic inertia. It refers to the idea that it's easier (takes less spoons) to do a task that's already a common practice for us, even though the same task might be difficult in another circumstance. Quote from Luna Lindsey's blog:

... when I ran Sapioscape, an online retail business, I ran to the post office every day, shipping 3-5 boxes at a time. I was efficient, and it was even a pretty fun. Sometimes I still miss those days.  

Now, when I need to ship just one box? I procrastinate forever and the task seems impossible. Because I have to reticulate every single spline related to packaging a shipping and item. It's a rather complex task for me, because my memory has stored each step as a separate thing that I have to recompile.

I suppose this has something to do with executive functioning. I'm not sure, but I think this study regarding ego depletion (loss of willpower) and the cognitive control theory might be touching on the same idea.

Motivation

Sometimes when people write about having this kind of problem, other people write back saying that we actually just don't want to do the things we think we want to do. Sometimes they mean it some kind of laziness-related moral judgment, e.g. shame on us for not wanting to do our useless homework, but sometimes they're encouraging us to stop trying to do the tasks in question. Apparently, the secret to success is to give up on my hopes and dreams! Also, give up on having money, food, or housing.

Yes, it's easier to do fun things than it is to do miserable non-fun things. That doesn't mean that wanting to do something is all it takes to be able to do it without trouble.

Mood disorders

Depression can often cause "motivation" issues, in that you're too sad, apathetic, and/or tired to be able to make yourself do stuff. If you have some kind of anxiety or phobia, that can often cause "motivation" issues because your anxiety/fear of something about the task impedes you.

With initiation impairment, you may have a normal motivation to do the task but simultaneously have an urge to not do it FOR NO REASON WHATSOEVER.

Of course, it's possible to have all three problems at once, or any two of them. If nothing else, it's quite likely that the initiation impairment will cause you to feel sadness or anxiety just because this problem really sucks. Because of that, and because initiation impairment is so poorly understood, doctors are likely to just think you have some kind of depressive disorder if you try to tell them about this problem.

Counterwill

Counterwill is a completely normal reluctance toward doing stuff that other people are trying to make you do. (Maybe when you were a kid you experienced some situation like this: You were about to get started on some household chore or homework. Then your parent, who doesn't know that you were about to do that task anyway, comes by and commands you to do it. Then you think, "Geez, now I really don't want to...") This develops around age three or so, and though it may be super-annoying to our parents, it would actually be pretty unhealthy if you didn't have this trait at all.

Generally, other than small children, we can all resist counterwill when it behooves us. We'll still do the task; we'll just be grumpier about it.

Unlike counterwill, initiation deficit applies toward tasks that no one else is trying to make us do.

Related term: reactance.

Other keywords?

If you're itching to do more research on this, here are some terms that might be relevant: behavioral activation, salience, task saliency, volition, ego depletion.

I will add more as I find them, or possibly give them their own detailed paragraph.

Help or Solutions

Unfortunately, I don't know how to deal with this.

Medication

I take Adderall for ADHD, and it's not perfect, but it helps with this problem quite a bit. I have also heard some anecdotes about Strattera helping with "motivation," which is probably the same thing.

Alas, since this problem isn't officially an ADHD symptom, it's quite possible for someone to have this problem and further life-ruining levels of executive dysfunction and still not meet the diagnostic criteria for ADHD. As far as I know, there is no condition in the DSM or ICD that entails this problem in any way. (I don't know of any proposed conditions that entail the problem either, although pathological demand avoidance syndrome comes close.)

Actually, I feel like it's possible for you to twist the explanation of initiation impairment so that it sounds like an attention problem. (Trouble concentrating? Anyone would have trouble concentrating on a task when their soul is screaming at them not to do it.)

I get the feeling that it's not a high priority for drug researchers to even try to fix this. The problem is really subtle; I keep thinking that all I need to do is try harder. Compared to the other ADHD symptoms, this one is less of a problem to the authority figures of ADHD kids. The fact that it's not clearly spelled out in the DSM symptom list doesn't help.

Minimize other problems

There are all kinds of factors that might make a task unpleasant or difficult. This initiation impairment combines with those problems, i.e. it will still be easier to make yourself do a mildly inconvenient task than it will be to make yourself do a task that's legitimately unpleasant in its own right. Thus, if you can't reduce the initiation impairment, you may still benefit from reducing other obstacles.

Some generic ideas:

• Listening to music while you do a task might make the task less unpleasant. (If the task involves reading or writing, pick music without lyrics.)
• Higher quality tools might make the task less difficult.
• If you have ADHD, you'll benefit from treatment and coping techniques that address your other symptoms, even if they don't help with initiation.
• Even if you don't have ADHD, minimizing any distractions might help free up more "brain power" for the task. (In some cases, this might mean you can't listen to music.)
• For overwhelming or vague tasks, think of concrete individual steps and make a to-do list of those steps.

There are often cases where you can choose between a large number of small tasks or a single large task. (For example, you could wash your dishes after every meal, or you could wait and do them all once per week.) Conventional wisdom says that frequent small tasks is preferable, but that may be harder for us since it means initiating more often. However, the larger task may be unpleasant enough that it is too hard to initiate, so you may have to do some experimenting to find out what works best for you. Just don't assume what works best for you is what works best for everyone else.

Timing

I've found that the problem affects me a little less right when I first come home from work, so I can at least get some household tasks done by scheduling it for that time.

I think the key feature of this time period is that it's a point of transition but it's not a transition to anything in particular. I have to stop the "commuting from work to home" activity and start another activity regardless of what that activity is, so the new activity might as well be taking out the trash or something. (However, my crap EF skills couldn't handle taking the trash out right before going to work in the morning.)

In order for this to work, I need to plan out the task previously. I guess my right-after-work self isn't really up for both planning and doing.

Do less

I'm sad to say this is my number one coping technique: try to set your life up to have as few tasks as possible.

I use disposable cutlery, paper plates, and microwaveable food so that I almost never have to wash any dishes. I buy clothes that can all be washed together on the same washing machine setting so that I don't have to do any sorting, additional laundry loads, or other special treatment. When my laundry comes out of the dryer, it goes haphazardly into a basket, and it stays in that basket until I wear it.

I have my pay check direct-deposited. I pay most of my bills by automated payments. I efile my taxes even though it costs more than mailing. I make my poor roommate get the mail and deliver the rent payment. I don't visit friends much. I don't travel unless it's required for my job.

I don't have kids even though I want kids. I don't have pets even though I want pets. I'm optimistic that I might be able to handle pets some day.

Cueing

This page about TBI suggests it can be helpful to have someone or something tell you to start. I'm actually not sure the cuing would be too helpful for me, but either way, it is definitely important to avoid "nagging," like it says. Nagging triggers counterwill, which will be yet another emotional obstacle in the way of doing a task.

Did I mention this sucks?

Hopefully those of you with initiation impairment got some benefit out of this post, if only to put a name on the problem and know you're not alone.

Feel free to leave any links or book names to anything else that has any help regarding this problem. Honestly, I'd be relieved to see more mental health professionals even acknowledge this problem existing.