For many adults with ADHD the gap between wanting to do something and actually completing that thing can be huge...and heartbreaking.  

I was having a conversation the other day with an adult with ADHD.  She was talking about the heartbreak she feels as she compares what it is that she wishes to do...and what she actually feels capable of doing.  "I hear about a really interesting study and I want to read it.  I come across a new course or idea for work and I would like to pursue it - it sounds really interesting.  I know I need to sit down and get more educated about financial issues...and that I need to be thinking more carefully about my next job.  I really want to be able to do these things.  I know I should do them.  I know others do them.  Yet when I get around to thinking about how to do them and trying to feel motivated enough, I just can't muster up the energy to actually start.  Or, sometimes, the project feels so big that it feels overwhelming.  Looking for a job is one of those...It makes me feel terrible about myself."

"But you can break the job or task down into little pieces, then do one at a time to make it less overwhelming," I noted.

"Yes, I know that...but even getting organized enough to create an action plan that breaks things down into little pieces feels overwhelmingly large.  Plus I don't have this sense of motivation.  It's hard to describe...I don't feel like...moving."

Dr. John Ratey and others note that anxiety plays a role in whether or not we can get our selves motivated into action.  "Just enough" anxiety, and we feel that there is a reason to make the effort to move forward.  Too much anxiety, and we are overwhelmed and paralyzed.  Too little anxiety and we stay hanging out on the couch...oblivious to what needs to get done.  I find it an interesting way to think about ADHD and motivation.  Particularly because peoples' anxiety levels inherently change when we are feeling confident or when we are lacking confidence.

This person happens to be lacking confidence at the moment for a number of personal reasons.  She has become very easily overwhelmed...and it's having the effect of paralyzing her.  She also sounds depressed.

Medication can help in situations like this.  Under this theory, you would want to find a medication that helps you feel "just anxious enough."  As it happens, this woman was not taking her meds regularly...and that was surely having an impact on her ability to feel the urgency necessary for motivation.  When she gets good coverage she does seem to get into that "good" anxiety zone and is capable of getting done some good proportion of what she intends.  Yet without she had moved into a cycle of feeling down and unmotivated...and started to lose faith in herself.

Meds are just one part of it.  Another is getting the non-critical support of others around you.  This woman needs to "hear" it when people compliment her on her accomplishments.  Right now she listens much more closely to her inner voice of doubt.  Partners and co-workers can help ADHD spouses when they reiterate what's good in your joint lives, at the workplace, and in what the person with the ADHD is doing.

But the most important thing is, still, changing "I wish" into specific, physical action.  No matter how heartbreaking the situation, you simply can't "think" or wish your way into closing this gap between desire and actual action.  That means that the ADHD person has to take a hard look at him or herself, identify this gap as a problem, and get help in finding the right skills to close the gap.  Often that means professional help from a coach or therapist.  Sometimes it means getting back onto a previously prescribed medication regimen.  Sometimes doing a temporary "borrow" of a partner's organizational skills can help.  (As one concrete example, if an ADHD partner has trouble figuring out the steps needed to complete a repetitive tasks, a more organized partner can help lay out the steps so they can be turned into a check list for future use.)

As it turns out, just talking about this problem helped this woman identify it clearly and provided the gentle nudge she needed to change direction.  The day after this conversation she started her meds again, and made an appointment to talk with her doctor (which she hasn't done in quite a while).  She also made an appointment with a sleep specialist -something she has meant to do for quite some time.  It's a good start.  And I will try to support her gently by appreciating that progress and encouraging her to continue with that momentum.