Episode 77. Managing Out of Sight, Out of Mind in an ADHD World



Is Object Permanence a symptom of ADHD? Are Object Permanence and “Out of sight, out of mind” the same thing? Did you know that Object Permanence is not a recognized medical condition or a symptom of ADHD? What does Donald Trump have to do with any of this? These questions, and more, are answered in this episode with Dr. John Kruse: Neuroscientist, Psychiatrist, and Author. We’ll be discussing ADHD and object permanence versus object constancy, and how these concepts affect those with ADHD. Dr. Kruse provides insights and tips on how to manage the struggles associated with out of sight, out of mind, and maintaining emotional connections with people.

Dr. John Kruse is a psychiatrist that has specialized in working with adults with ADHD for almost 30 years. In 2022 the American Psychiatric Association honored him as a Distinguished Life Fellow. John is also an accomplished and talented writer sharing his gifts online, as well as an avid runner, and he now calls the Big Island of Hawaii home. 

Dr. Kruse Links: Facebook | Instagram | Twitter | Website | Medium | YouTube

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Lindsay Guentzel (00:01):

Welcome back to Refocused, a podcast all about attention deficit hyperactivity disorder. My name is Lindsay Guentzel and today we’re talking about ADHD and object permanence, or is it object constancy? I’m not really sure which way to go, but the good news is we have the perfect person waiting in the wings to clear up any confusion on the difference. That’s coming up next on episode 77, Managing Out of Sight, Out of Mind in an ADHD World. We’ve all played a game of peekaboo before, that look of pure amazement on a baby’s face as we disappear and reappear right in front of their eyes. How did they do that? It’s like you can almost hear them asking that. How did that just happen? Well, for people with ADHD, that feeling is something I would guess many of us deal with on a daily basis. Except for most of us, we don’t notice the disappearing act. Whatever it is, an important piece of paper, our phones, a thought.


It can sneak away from us in an instant and it doesn’t matter how important it is, even something we’ve been hyper-focusing on can just tiptoe out of our reach. I’m sure we’ve all experienced that thought. Well, it’s coming back on its own terms. What we’re talking about, at least when we’re talking about that game of peekaboo is object permanence. It’s a term that refers to a developmental milestone that was coined by Swiss psychologist Jean Piaget. To put it loosely, it’s when children learn things still exist when they’re no longer visible. For ADHDers, you often hear out of sight, out of mind, because neurodiverse brains know that things still exist somewhere. They’re just not in our conscious awareness. Often people use object permanence as a way to explain it. But is that correct? Experts like our guests today, Dr. John Kruse, are pushing for the use of different words, object constancy, for example. Object constancy is the ability to maintain a positive emotional bond with something even when distance and conflicts intrude.


Basically, if something isn’t right in front of us or not purposely kept in view, we forget about it. To complicate things, there are several ADHD symptoms that are often confused with object permanence, like difficulty finishing tasks, forgetfulness, losing track of objects, becoming easily distracted, and challenges with organization and planning ahead. How does object constancy show up in our lives? Well, difficulties with object constancy can look like forgetting to take medication that’s tucked away in a medicine cabinet, forgetting to respond to a text or an email if you don’t do it right away when you first read it, feeling stuck in waiting mode, like you’re not sure what to do next because the plan isn’t laid out right in front of you, and being late or entirely missing an appointment, most likely because you didn’t write it down.


Don’t even get me started on all of the groceries we purchase and forget about until they start to become a science fair project in the back of our refrigerators. How can we help ourselves even out the playing field when it comes to our struggles with out of sight, out of mind? That’s all that we’re talking about today. Before I forget where we are going, I want to introduce you to Dr. John Kruse. Dr. Kruse is a psychiatrist that has specialized in working with adults with ADHD for almost 30 years. It was his expertise and insight from his connection to the neurodiverse community that motivated him to write his 2019 book, Recognizing Adult ADHD: What Donald Trump Can Teach Us About Attention Deficit Hyperactivity Disorder. John received his PhD in neuroscience from the University of Rochester where he focused on circadian rhythms and was involved in the early research on using bright light to treat seasonal effective disorder. From there, he completed his psych residency at the University of California San Francisco.


Since then, has worked in direct patient care, as an educator for psychotherapy interns, and has presented at local, state and national conferences on gay marriage, gay families, and the biology of emotions. In 2022, the American Psychiatric Association honored him as a distinguished life fellow. John is also an accomplished and talented writer as well as an avid runner who now calls Hawaii home, and I am so grateful to have him joining us on Refocused today. In this episode, John not only explains object constancy, he also provides some background on the importance of calling it the right thing. We also talk about how an object can be in sight but have no insight and the many, many different ways this can bring up challenges for all human beings, but especially people with ADHD. We also go back to the basics and John explains what’s a schedule? But more importantly, he paints a great picture on why schedules matter with a nice little reframe on their importance.


We wrap it all up by talking about how where we are currently as a society plays a big role in how detrimental some of our ADHD symptoms can be. Hint, your phone is not your friend. A few things to note, John uses ADHD and ADD interchangeably throughout our conversation. He also nails it when he unknowingly calls out my own object constancy Achilles heel, the never-ending digestion of cat videos. You should also be on the lookout for a surprise guest who made their Refocused debut all the way from the big island, John’s neighbor stopped by mid-interview and you’ll hear them on the podcast today. I could have gone through the effort to cut them out, but it is way more fun to make sure that John’s neighbor gets their moment in the spotlight too. With all of that behind us, let’s dive right in to episode 77, Managing Out of Sight, Out of Mind in an ADHD World.


When we decided that we wanted to talk about ADHD and some of the quirks that can come along with the diagnosis, we made a list of all the things that happen in our own lives and one of the ones that was at the top of the list is object permanence. This kind of idea of out of sight, out of mind and how it can affect the ADHD community. Then we started researching and the great thing about research before you do a podcast is you learn a lot and what we learned is that object permanence might not be exactly what we’re talking about. It is what we’re talking about when we say out of sight, out of mind, but when we’re talking about how it relates to the ADHD community, there’s actually another set of words that’s being thrown around and that’s object constancy. I’m very, very excited to bring Dr. John Kruse into the conversation.

Dr. John Kruse (07:13):

I’m delighted to be talking with you today.

Lindsay Guentzel (07:15):

I want to start, because I’ll be honest, as we were putting together this list, some of the ones that came up were proprioception and movement and time blindness. Then we’ve got object permanence and it’s out there on everything. Every social media platform has tons of posts and videos talking about the connection between ADHD and object permanence. I got to ask when we’re having this conversation, because it’s kind of twofold, we’re talking about object permanence and we have to define it and show people what it is in order to show them that it’s not really what we’re talking about when we’re talking about out of sight, out of mind with people with ADHD. Then we’re bringing in this entire new place to explore called object constancy. From your perspective, what’s the best place to start?

Dr. John Kruse (08:05):

I’m a grammar fanatic and I think words are important and how we use them is important. I think you picked up my Medium article where I was talking about we shouldn’t be using the term object permanence because object permanence is a term coined by Piaget, the Swiss developmental psychologist, and it’s referring to a state of development. Early in development, little kids, when something disappears from their line of sight or from their hearing, it is gone. It’s completely not there and it’s only, the common thinking is around eight months, 12 months, somewhere in that range, that children learn to understand hiding behind the peekaboo hands, the puppet hiding behind the curtain really is existing when you can’t see it and it will show up presumably when you lift the curtain or move things away. Object permanence means that you really truly believe the object is gone and does not exist.


What’s going on in ADHD isn’t people thinking I put my coffee cup down somewhere, it doesn’t exist at all. They know it exists, that’s why they’re looking for it. They just don’t know where it is and it’s as if when it’s not in front of me and I don’t see it that it’s not there. But if you ask them, do you really think your coffee mug is in a different universe or has dematerialized? They’re aware it’s there. I know we use lots of terms, like depression, like mania, maybe even like ADD, colloquially as well as formally. But I think when we use terms inaccurately, then it adds to the confusion, not the clarity. I would say out of sight, out of mind is probably the best term. When I was thinking about this, what’s a better term? I think object constancy is a little closer, but this gets weird.


Object permanence comes from Piaget and developmental psychology and the object there does refer to how we use the word object, that’s anything in the environment. Object constancy though comes from a branch of Freudian psychoanalyst called object relations, and there objects are actually people. Object relations theory, it’s about our drives in life are not just the drives that Freud thought, our drive for sex and drive for love, but it frames more how people deal in terms of their relationships and those relationships we develop templates or patterns early in life, and that we tend to replicate or respond against rebel against those early patterns. Object constancy refers to people whose parenting was so unreliable that when the parenting figure or someone else isn’t there, they no longer feel connected, they no longer feel like it’s really there or really positive or they have trouble holding sort of the whole essence of person in their mind.


They can only remember if the last interaction was bad, then that person’s all bad. I really think our phrase out of sight, out of mind more accurately captures what’s really going on with people with ADD, rather than object permanence or object constancy. The other phrase I’ve tried to coin, but I don’t think it’s that good is an object can be insight, but there’s no insight as to what it is. The other aspect of object permanency, constancy, missing things is the phenomenon of talking about things that we’re not aware of or can’t find once we’re not seeing them. But there’s the mirror phenomena of something is right in front of you, the guy who came home from work one day and threw his jacket on the floor. He is stepping around the jacket all week, it’s there in the room. But by the next hour, if you ask him where the jacket is, he has no awareness. It’s there, so he has the visual information but it’s not penetrating his information. I certainly see that commonly with people with ADD.

Lindsay Guentzel (12:03):

The one example you used in your medium article that hit home for me was the person who was folding laundry and then the doorbell rang. They got up to answer the door and then they came back to get ready for bed hours later and the bed was still covered in clothes. That has happened to me more times than I probably care to admit. I want to go back, you mentioned if scholars were listening to this and they heard us saying these words about certain things, they’d be like, “People with ADHD are a little crazy to think that there’s this alternate universe,” but sometimes it can feel that way. It can feel so powerful to have something slip your mind to the point where when it comes back, we’ve all had that moment of going, “Oh my gosh, how did I forget this?” I’m wondering if we can talk about some of the things that you’ve seen working with patients and how you help them work through that?

Dr. John Kruse (12:50):

It sounds like you’re asking for some tools and tricks and approaches. I think the biggest element you mentioned is everything should have a place and you should help put it in that place. Actually paying for an organizer to come and do everything for you is usually a less effective approach than paying an organizer and do it with them as they’re setting it up. Someone could set up a completely logical, organized system. Most people with ADHD are very visually organized, they could hear a description, you put a key chain there and you put the coat rack there, but unless they’re seeing it and using it just doesn’t sink in the same way as intellectually hearing the words and knowing it’s there. Life is more about getting back on track than about worrying if you got off track.


Your comment about the guy who does have a place to hang his key or his jacket but didn’t do it one day and then was lost and back at sea and as confused as ever. My approach there is don’t throw out the system, it’s how do we get back on track? How do we go back to using the system? If it’s consistently failing, then finding a way to repair or make it more efficient or effective. But so many people with ADHD will see a perceived failure or something getting off track and then that will lead to spiraling into I’m hopeless, I can never do this, I can’t get my life organized. Those thoughts, one, I would say are usually inaccurate, and two, they’re definitely not helpful in terms of moving forward and getting back together.

Lindsay Guentzel (14:18):

I want to touch on something that you said right there for a second because we are in this phase of having so many more later in life ADHD diagnoses. I think for a lot of people, myself included, there’s this desire to move forward in a better way, but there’s always so much behind us. I’m wondering how do you prepare someone for that? Because there is this point where you have to put a pin in what you’re going to do and decide that enough’s enough with certain stuff in your past and be okay with that. Because I think sometimes we hyperfocus on making things perfect and moving forward really just one of those things that you just have to do.

Dr. John Kruse (14:52):

I usually tell people, and this is broader than just people with ADD, other than the seven perfect people on this planet, and I say it that way because it’s so trite and such a cliche to say nobody’s perfect. When you say that nobody ever listens, but if you say, “Except for the seven perfect,” they’re thinking, who are those people? Then they come to their own… Life is more about getting back on track than about whether you got off track, even if it was 37 years off track. The next book speaks more to this, the title or the theme of the next book is what I call quest, not test. By that I mean whenever you’re feeling like a failure, whenever you feel something’s wrong, whenever you feel bad, it’s because you’ve framed it as a test. Our educational system, 12 years or more that all of us are imbued in, reinforces that. You don’t get to fourth grade till you get to third grade.


You don’t get to medical school unless you pass intro chem. But it’s not just the educational world, it’s our sports world. What do we call the second-best team in football? It’s not the runners up to the Super Bowl, it’s the losers of the Super Bowl. We create these tests and the detrimental thing about tests, one is that it’s letting someone else decide what’s success or failure in your life. That may be real and unchangeable as a third-grader insists I’m going to fourth grade without the adult’s permission. But right now as an adult, you get to define what’s success in life, nobody else gets to say that’s a failure. Two, with the test approach instead of a quest approach, if you’ve failed chemistry, if you do this, it’s a bad mark on your career and it’s there, you can’t erase it. But if you’re framing things in terms of what is my quest? What is my goal? What am I trying to achieve? Then these are just events along the pathway, there’s no permanent ending.


Then the other parts of a test is that even if you pass it, say you get a gold star, you get 100 on… What do you do next? It tells you absolutely nothing about helping direction, it’s just over. I would argue there’s almost no quests until you’re dead, could you have failed that? You may be blocked, you may be stymied, there may be not able to go forward the way you want to go. But if you get back to what you’re trying to achieve, you’ll figure out what it is. For you, in terms of what 30 plus years of living with ADD means, again, I would focus it more in terms of what are you trying to achieve and how can you use your knowledge of your ADD to know how that will either support the direction you’re going or put in challenges or put in challenges that I know I’ll need to do this and this and this extra that someone else might not need to do if they didn’t have ADD to overcome or to move closer to what I’m trying to do with my life?

Lindsay Guentzel (17:33):

I love that you took it there because I’ve been sitting here thinking of all the tests I’ve been creating for myself. Even things like if I can’t run for 30 more seconds, I’m not a great runner or I’m not worthy of being here. These tests we create for ourselves, I think it’s fantastic and I can’t wait for you to dive more into that in the book. I want to ask just a little bit about how people can manage their feelings when object constancy affects their relationships. I know that one of the things that you talked about in your Medium article is when death is involved. I actually, reading your article, it brought up a lot of feelings of losing my father. There are days where I feel like I can’t remember anything about him. Hearing you explain it in that way of no, you are just holding on to certain memories, certain things, the last time, sometimes it is the bad things.


But it also can affect how you have relationships with people who are in your life because you can get on this roll and you’re so focused on what’s ahead of you and what’s happening that if there aren’t reminders that you have these people in your life that you want to see, then you don’t make plans with them. I’ll say the unfortunate reality of the after effect of that is being a person with ADHD who’s very sensitive and has a lot of fears of rejection. When they don’t make plans with me, then I feel bad. But then I have to remind myself that I also didn’t try and make plans with them because I was so hyperfocused on my path and I forgot that they existed.

Dr. John Kruse (18:56):

I’m more from the telephone era where we’re used to say the telephone works from both ends. If you’re feeling left out, you’re always allowed to pick up your end and initiate things. It’s not unique to people with ADD, but I think it’s stronger there that if they can see it’s more real. I actually encourage people, particularly if they’re not living with their partner or their important people aren’t there that they’re seeing every day to really have pictures of them or the screensaver on their phone should be…


Not should, but it would be helpful if it is a picture of these people. Hopefully a nice picture because nice pictures tend to evoke the nice, positive feelings. It seems strange, but it is easy for all of us, but again, maybe more so with the ADD, to have that out of mind, and again, have the last interaction, particularly if it was a negative one, poisoning some of that space we have. It’s harder to capture the whole person, but a picture is an entryway into that rather than a specific incident which is already colored by whatever happened or what didn’t happen because the connection fell through because one or both ends weren’t pursuing it strongly enough.

Lindsay Guentzel (20:03):

I also have seen that sometimes because there’s so many ways to connect with people. You mentioned you’re the generation of the telephone, that was it. If you wanted to get ahold of someone, you either wrote them a letter or called them on the telephone. I have chains of communication with the same person in multiple different apps. I’ve got text messages and messages on Instagram and I’m sure there’s Facebook messages and we have emails and you’re constantly adding to it and that just again becomes more to manage.

Dr. John Kruse (20:32):

I would agree. Third part of my book on Trump and ADHD was actually about how our whole world is pushing all of us to be more ADD like. Social media is certainly one of them, it’s just such a large flow of information that you can’t possibly process it all. That pushes us to be more, as I say, reflexive rather than reflective. We have to respond. You have to give an immediate, not thought out, no context, just what’s going on in the moment. That’s sort of like the extreme of ADD, uninhibited, devoid of context, just blurt out what you feel and that has some value at certain points, but it can also be poisonous to longer term or deeper connections sometimes.

Lindsay Guentzel (21:12):

One of the things I’d like to ask you from your experience working with people who fit into the neurodiverse community, when someone comes to you and they’re explaining things that to you fit in with this idea of object permanence. They’ve got difficulty finishing tasks, they’re forgetful, they’re losing track of objects, they become easily distracted. Then, of course, we can talk about the challenges with organization and planning ahead. How do you explain to them how their brain works?


I think that’s an interesting way to start talking about object permanence and object constancy. Because I think, for me, I didn’t truly understand that I could have this conversation with you, walk out the door, get distracted by something, and my conversation with you, which 15 minutes earlier had been right front and center. It was all I was thinking about, now it is tucked so far back in boxes of stuff I haven’t thought about in years that I don’t know when it’s going to come back around unless I’ve got a note or something sitting out. Does that make sense? It really, to me, I think the magnitude of how easily we get distracted and then the ramifications of that is so powerful.

Dr. John Kruse (22:21):

Again, my being a stickler for words and part of what you were saying prompted me to talk about lots of other people who have mentioned this. Part of the problem is I think what a lousy label ADD is and particularly the attention deficit and the common view that this is a deficit of attention. I think more commonly we’re using the framing that these are executive function deficits. If there is a deficit or problem, it’s in control of attention and less ability to switch it when we need to or stay on track when we need to or step back and look at the bigger picture, rather than being focused on the little picture. I use the concept of executive functions a lot in helping people understand how their brain with ADHD works differently.

Lindsay Guentzel (23:10):

I’m glad that you touched on this idea of it being called the wrong thing, because I think that also plays into kind of the stigma and the misinformation that’s out there. That’s one of the problems with seeing so much about object permanence is that every time something goes out that isn’t correct, it just fuels more and more to be creating things that aren’t correct. One of the things that we’re seeing is a lot of people are turning to the internet, whether that’s a website that’s got fact-checkers and maybe doctors behind it or TikTok. I’m wondering when you see people talking about object permanence, what is the most important reason why we should be really changing the narrative behind it?

Dr. John Kruse (23:47):

My focus on it is again is if we’re using it incorrectly, it’s implying a greater, more serious or pervasive deficit than is really there. The one that’s there, as you’ve pointed out, leads to big enough problems. You miss your flight because you couldn’t find your plane ticket. There’s all sorts of real life immediate consequences from the out of sight, out of mind phenomena that again, I think those words sum it up pretty well and the people understand it right away. When you use object permanence or object constancy, why don’t like it is it right away, it’s like you’re assuming a greater knowledge of what’s going on inside the brain and the mechanisms by which this is failing. Although I have a PhD in neuroscience and we’ve had our decade of the brain, almost all of what we know are simplifications and metaphors at the genetic level. 10, 15 years ago, they’re saying, “We have dopamine receptors that are apparent and genes for dopamine receptors and transporters, that’s what’s causing ADHD.”


Now, when we look at the genetic picture, we’re looking at hundreds if not thousands of genes each with a tiny propensity. Clearly there is a very strong genetic predisposition to ADHD, clearly there are also additional factors. A few years ago, all the popular sites and Attitude Magazine were pushing you have problems with dopamine receptors and dopamine transporters. That may be a tiny part of the process for some people, but when you offer it as an explanation and it’s not accurate or it’s inaccurate because it’s so incomplete, that just bothers me. I guess I have a higher threshold for uncertainty and holding on to uncertainty. I get it, most people like nice clean explanations, but I think life is more complicated than that.

Lindsay Guentzel (25:35):

When we’re talking about control of attention and even things like short-term memory, are there ways that people can make their control of attention or their short-term memory better? I’m not talking putting out notes or pictures or reminders or things like that, but actual ways to be working your brain.

Dr. John Kruse (25:56):

All of the sort of general taking good care of your brain things. Number one is clearly good sleep and good sleep isn’t just sufficient sleep, it’s sleep at the same time. My PhD is on circadian rhythms, but we’ve had data from the very beginning when we give up public health announcements about you need eight hours of sleep, you need eight hours of sleep. It’s every bit as important to get the same eight hours each night. Sleep, diet, exercise, meditation. For people with ADHD, if the medications are helpful, taking their medications. All of those have measurable impact on these executive functions, on things like being able to track what’s in front of you and remember where you put it, or to hold on and finish the task instead of allowing yourself to be interrupted. They have measurable benefit for improving daily functioning.


The other direction from what you said is what I think is really interesting, we focus so much on attention in attention deficit and yet we treat a related executive function problem, dementia is a memory problem. So often, the two are actually indistinguishable. If you’re not paying attention, information doesn’t get encoded properly or as well or as thoroughly. We view people, usually it’s older people, this must be a problem with their memory. The other thing I’ve been thinking a lot more about in terms of attention is there’s a psychiatrist and neuroscience researcher by the name of Iain McGilchrist, who’s written about the left brain and the right brain. His basic thesis is that there’s two different types of attention and he frames it as that our right brain’s attentional process is scanning the whole environment looking for danger and that this is evolutionary, there way before humans.


It’s a pervasive looking at everything, but it’s there to pick out who’s going to eat me. The other form of attention he ascribes to the left brain, so the right brain is this global looking for danger, unfocused focus. Whereas the pragmatic, I need to get food so I need to pick up that berry, I need to kill that rabbit, I need to direct very narrowly, very specifically, is a left brain job. Part of the reason the brain assigned those to the two different hemispheres is you can’t do both at once, you can’t simultaneously be scanning everything and focused on picking up something very specifically. I think we have a little data that part of what’s going on with ADD is less fluidity in terms of switching between left brain mode and right brain mode. The concepts themselves aren’t completely agreed upon or used by a lot of neuroscientists, so there isn’t a lot of formal research on that.

Lindsay Guentzel (28:47):

I’m really glad that you went down this path when you mentioned how we look at dementia and memory issues and thinking about how when we’re not paying attention, I can visualize my brain not encoding something properly. When you said that I just had this moment of oh yes, because it’s true. We laugh because my grandfather hated his hearing aids, but he loved them when we were in a big room, he had nine children and when everyone was over he’d be in the corner and he’d flick them off. He could just sit there and it was like that was his way of not paying attention by choosing to. But I think for people with ADHD, sometimes things are coming at you from all different angles and it’s hard to focus on what is the most important thing at that moment.

Dr. John Kruse (29:30):

I’m glad you brought up an issue of selective attention or selective ignoring people, because I think it is a significant contributor to some of the stigmatization of ADHD. Because so many people feel he didn’t hear me or he wasn’t listening to me, that it’s personal, it’s directed and intentional. I think it particularly in couples where one has ADHD or sometimes when both have ADHD, that’s one of the most important concepts to carry through. I think couples therapists who don’t have any awareness of ADHD should absolutely never be allowed to do couples therapy where one or other persons have ADHD. Because invariably, they ascribe behavior to intentional, he’s slighting you, you should feel angry because he didn’t do this. Rather than trying to understand he is processing information differently than you do, and he or she did not have that information.


It is not an intentional slight, also not a subconscious dig or passive-aggressive. With adults being diagnosed with ADHD and adults during COVID or particularly in the last few years, we’ve seen a surge of this. I’ve written a little bit about this on Medium and it’s interesting because I get, even in a friendly audience, there’s some amount of pushback. Particularly from other medical professionals saying, “These people really don’t have ADHD, they’re just anxious or they’re just depressed or they’re just upset with their current circumstances because they’re working from home and they want stimulants.” My thesis is that we are seeing more ADHD because we are creating more by our environment. Yes, there is a strong genetic component, but we know this is something that exists on a spectrum. People who in a perfectly supportive, benign, nurturing, organized environment, maybe on the borderline. If you put them in an environment where there’s no support, where they’re being inundated with information, where the demands on their time and other things or intrusions in your space, it’s not just that this looks like ADHD or resembles it, it is.


The same mental health experts who said in the early days of COVID, ‘We’re going to see more depression, we’re going to see more anxiety, we’re going to see more PTSD, we’re going to see substance abuse, we’re going to see spousal violence.” None of them said, “We’re going to see more ADD,” and there’s almost a pushback. No, ADHD is a biological, genetic condition, why would we see more of it a time like this? Again, we should be because our environment is pushing us this way. There may be a stronger genetic component for ADD than for some of these other conditions. But all of those conditions have both a biological underpinning and are always an interaction of a person with their environment.

Lindsay Guentzel (32:12):

I was a great elementary school student. Once the responsibility fell to me, I got to an age where I was supposed to remember to do things, that my mom wasn’t unpacking my backpack at the end of the day and taking out parent permission slips. Well, that’s when the wheels fell off. I would say I was maybe a 25% success rate on getting things done on time. I remember once I forgot to have my planner signed and I had forgotten multiple weeks in a row. I thought I was real sneaky, I was going to forge my mother’s signature in fifth grade. Of course, I got busted, I got in trouble. But now as an adult, I’m looking back and seeing where it started to happen, where it started to become an issue.


The coping mechanisms I put in place, which a lot of the times were trying to cover things up, which was not the healthiest way to handle it. I am working on that. I had this realization the other day of why I really loved waiting tables, I loved working in a restaurant and it’s because there was a routine, I knew exactly what had to happen for my job to be successful. I’m wondering how do you start to have the conversation with your patients or just in general when you’re talking about establishing routine and how that plays a role in object constancy? Because it isn’t just about setting reminders because you have to be able to remember to set the reminders and that’s routine.

Dr. John Kruse (33:30):

My biggest emphasis is often on the calendar or on the scheduling. Scheduling isn’t something that only adults with ADHD do, it’s what everyone needs to do. The difference is that people with ADHD tend to have more challenges with this. It tends to be more difficult for them, but it’s not that they are freaks and need to do this and nobody else needs to do it. These are recommendations for everyone to function better, so I think that to begin with helps frame it differently. Then the other metaphor I really like using or playing with that most people with ADHD, either because the school system or the parent roles felt authoritarian or imposed upon them and maybe because their minds are less linear anyway, have a pretty strong rebellious streak or independent streak or I don’t want to be told to do it that way.


Part of it is because your way might not work for me. Almost all them view the schedule as the slave master on the Viking ship with a big whip. The schedule is there to make you row faster, to make you do something you don’t want to do, but you have to do it. My view is what is the schedule? What is a schedule really about? A schedule is aligning what you need to do, what you want to do, what your own goals, your own values, your own life, it’s finding the time and place to do it, so it’s likely to happen. Rather than viewing it as this evil imposition from above, viewing it as the mother hen who’s counting all her chicks around her and making sure all of them are in place before she hunkers down and takes care of them, she’s nurturing them.


The schedule is your way to nurture yourself because it knows what your values are, what your goals are, and is trying in the moment to make what you’re doing in the moment match that. Part of what happens with ADHD is what often happens in the moment is what’s more entertaining or more interesting, or I’ll watch 17 more cat videos rather than move my car, even though I know they’re going to come by in an hour and give tickets because that’s parking day. Again, the schedule is to help you achieve what you want to in your own life. The part of you that’s making the schedule is, again, the most benevolent, caring, nurturing part of you.

Lindsay Guentzel (35:37):

I love that you talked about us being rebellious because I chuckled to myself, that is very spot on. But I have to admit, I got a little bit PTSD when you brought up the parking tickets and having to move your car because I may have had that exact moment in my twenties. There may be parking tickets that are still not necessarily paid off because, of course, I put them somewhere and they went to that universe we were talking about where things just disappear to. Great little trip down memory lane to remind myself how far I’ve come and how grateful I am to have a driveway that my car sits in and no one can do anything to it. I want to talk about the phrase you mentioned that you’ve been using sight, but no insight. Explain to me a little bit more about it and the concept of it? Because I find it to actually be very fitting.

Dr. John Kruse (36:24):

I think I was using it mostly in the mirror situation of out of sight, out of mind, where someone’s searching for something and then realizes I searched that pile of clothes on the dresser six times. But actually, it was there right on top. In computer science, when we’re searching for objects, we often have a specific template. I think what’s going on here is that the template we had when we’re looking or searching just didn’t match what… Either the object was switched around or it was a book and we know what the front and the back cover are, but we are only looking for the front cover. When it’s sitting there back cover up, even though, yes, intellectually we know that’s the same book, it just didn’t register, it didn’t fit. I don’t know if some of this also is getting back to the left brain, right brain, global searching and context versus functional honed in on a specific thing that I’m going to use and do focus.


I was on a school trip when my kids were in second grade, we have to drive to find snow in San Francisco. It was a week-long ski trip to the mountains, they were supposed to pack their lunch. This kid who very clearly had ADD and was not diagnosed, everyone else, it’s lunchtime on the bus, “My mom I don’t think packed a lunch.” Why don’t you check your backpack, actually? I could see him, I was right there. He’s looking inside, pack of cards, a Nintendo game, Jacks, some flashcards. He searches, “I can’t find the lunch.” It’s not a big deal because other kids can share. I was new to that kid, but after the next two days where I’d seen ADD behaviors all the time, and his mother also had ADHD, so there was a chance she didn’t pack his lunch. But I was pretty sure by the second day and I reached in, I could reach in and said, “I feel this is an apple, this is a square sandwich in a plastic bag.”


I could find his lunch in his backpack two days later without looking at it because my search template was different. Yet somehow this kid, and I think he really wanted his lunch, not particularly to share, and he didn’t do it because Joe’s bacon, lettuce, tomato sandwiches better than his PB and J, he sincerely didn’t think it was there. Partly also, this brings up your expectations. If you don’t think it’s there, you don’t search as intently. It goes back to one of the things you’re saying at the beginning, having a system, having an organization where each item has a place. You don’t throw your jacket on the floor, it goes on the hook so that you don’t have to wade through 14 things in the wrong place, which are part of why it’s harder to find the one thing you’re looking for.

Lindsay Guentzel (39:07):

I want to wrap up by touching on the reflexive versus reflective. I hadn’t heard it explained that way and it makes a lot of sense. I think I’m in this place right now where I’m feeling overwhelmed by all the different platforms I have and all the different messages I have, sometimes with the same person in multiple areas. It can feel like you have to respond immediately. I love this idea that you’re saying we all need to take a step back and try to be more reflective versus reflexive. Because there is a level of stress that comes from feeling like you have to respond to somebody immediately that I don’t think we talk about, I don’t think we really fully know the ramifications of this idea of feeling like we have to always be on.

Dr. John Kruse (39:53):

I get into some of that in I should call it the third half of my book, and particularly in reference to Donald Trump. Whether you like him or whether you don’t, his ADHD I think pushed our whole society in a more ADHD direction because he would say 16 outrageous things before lunch. If you didn’t respond to the first one, whether it’s a thumbs up or a thumbs down, he’s onto the third or fourth or fifth one before that. Part of the pressure is his own reflexiveness, lack of reflectiveness, pushes everyone around him to respond in that way because he’s already on the next thing. He’s not the only one or the originator of this, but he is both a product of the system, because that style of interaction would’ve been inconceivable even 20 years ago.


Looking further back in time, probably the most famous speech by a politician in American history is the Gettysburg Address by Abraham Lincoln, it’s 15, 20 minutes. When Lincoln gave that speech, it was dismissed at the time. The guy before him talked for two hours, that was considered a good speech. Anyone taking timeout to make a speech as long as the Gettysburg Address right now would be zoned off, they’d be tweeting or their blogging about something else two minutes into it and onto the next thing. When you were talking about the constant flow of information through social media or through the news, one of the things I tell my patients is to treat that as a medication. By that I mean you need to get the right dose for you. That might be only listening to the news 10 minutes, twice a day. I might be listening to it once a week. Treat it as something that has a range of dosages and get the dosage that’s right for you.

Lindsay Guentzel (41:30):

I like how John set that up. All of these things are available and all of these things are things that we can have in our lives. I think it is important to ask should we have them in our lives? I know it’s a question I’ve asked myself before and should probably revisit. It feels like a nice little challenge that that’s what John chose to share as we wrapped up our conversation. I’m so grateful to the time that John gave to us, for joining us on Refocused and for sharing his expertise. We were able to take this conversation to places I had not expected. I did not think we were going to talk about the Gettysburg Address. But when you lay it out that way yeah, a 20-minute speech today… I’ve been at weddings where there have been 20-minute speeches and people are not happy at the end of it. That’s a great little analogy for all of us to think about, but even better, it’s a nice easy one to understand.


I did not think we would get our first cow on Refocused. Yes, the neighbor I referenced at the beginning who stopped by unannounced during our interview was in fact a cow. If you heard the mooing, you are not going crazy, it was in fact a cow. If you’d like to learn more about the work that John is doing, I highly recommend going to his website, it’s drjohnkruse, that’s D-R-J-O-H-N-K-R-U-S-E .com. It includes links to all of the incredible pieces he’s written for Medium, including the one that sparked this conversation. You can also find all of those links in the show notes. Without a doubt, the biggest takeaway for me from my conversation with Dr. Kruse is the idea of reflexive versus reflective and how that controls so much in life without us thinking about it too often.


Unfortunately, our phones are probably the biggest players in that dysfunction. How often are we in the midst of something and maybe we are focused and on task and feeling good, and that pesky little notification goes off and we feel the need to look at it immediately and then respond. Then before you know it, it’s 20 minutes later and you’ve been having a back and forth conversation with whoever it was that messaged you because we’ve been led to believe that we need to respond immediately. Again, that idea of reflexive versus reflective and before you know it, your project or work, the one you were just so involved with and time has somehow just disappeared. Well, I’ll just be honest, I’m having a severe case of déjà vu and I know I need to work on it. It’s like I know what I need to do, I need to turn off notifications, which I did for emails a while ago.


But I’ve also realized that I forget I have email when I’m not getting notifications, or if I remember I have email, more accounts than I would like to admit right now, I’m constantly checking to see if something important has come in, which defeats the entire purpose of turning off the notifications. If I’m just going to check my inboxes whenever my brain thinks it’s appropriate, it’s a problem. If you have found something that works for you, I would love to hear about it. I’m all about working smarter, not harder, and I do not need to recreate the wheel. You can share tips, tricks, and ideas or just a lovely email full of commiseration by connecting with us directly at [email protected]. Of course, we’re on social @refocusedpod and @lindsayguentzel. Refocused is a collaboration between me, Lindsay Guentzel, and ADHD Online, a telemedicine mental healthcare company that provides affordable and accessible ADHD assessments and treatment plans, including medication management and teletherapy.


A huge thanks to our managing editor, Sarah Platanitis, who’s been instrumental in building these conversations. She’s the ying to my ADHD brain yang and we are so lucky to have her on the team. Our coordinating producer, Phil Rodemann is incredible and he does everything in his power to keep me on track. It is a monster task, and I’m so happy he came out of retirement to give podcast life a go. [inaudible 00:45:54] Chaplin is our go-to for all things social media and the work they have been creating is incredible. I want to encourage you to go check it out, give it a like, give us follow @refocusedpod. A big thanks to Mason Nelle over at Deksia in Grand Rapids, Michigan for all of his help in getting our videos ready to share with you guys. Refocused couldn’t happen without my partners turned friends at ADHD Online, high-fives to the ones I bugged the most, Keith Boswell, Claudia Gotti, Melanie Mile, Susanne Spruit, Tricia Merchant Dunny, and the entire team at ADHD Online and Mentavi Health.


Our show art was created by Sissy Yee of Berlin Gray, and our music was created by Louis Inglis, a singer-songwriter from Perth, Australia, who was diagnosed with ADHA in 2020 at the age of 39. Our sound engineers are the incredible duo at EXR Sounds and Vision, Eric and Amanda Romani. Links to all of the partners we work with are available in the show notes. To connect with the show or with me, you can find us online @refocusedpod, as well as @lindsayguentzel. You can email the show directly at [email protected]. That’s [email protected]. We’ll see you back here next week. In the meantime, take care of yourselves, and please, in an effort to reduce the unbelievable amount of stress we all carry around with us unnecessarily, be a little kinder to yourself this week.

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