I Know Exactly What I Need to Do – So Why Can’t I Start

What’s going on beneath the surface? 

ADHD is increasingly being diagnosed in people in their thirties, forties and even fifties. A diagnosis usually starts from what people report: their own complaints, the complaints from people around them, the inner sense of suffering, and from how long these patterns have been present, and how hard it is to carry through everyday organisation and tasks. 

Why can’t I see what the concrete first step is – what exactly I would need to do to get this task moving? 
In this article, we’ll be exploring those questions. 

ADHD – high-risk zones 

From this angle, it’s worth briefly reminding ourselves what ADHD actually is. 

Many people still assume that ‘attention deficit’ means a child simply didn’t get enough attention from their parents. In reality, that has nothing to do with attention deficit in the diagnostic sense. 

ADHD tends to show up in three main areas: 

1. Control of attention 

The first area is difficulty concentrating – not so much a ‘lack’ of attention as a problem with controlling where it goes. 

If you have ADHD, you can concentrate – but choosing what to focus on, and when, is much harder. 

If your attention keeps drifting off, then every attempt to ‘get started’ on a task feels as if you’re having to begin from zero all over again. 

2. Energy and activity levels 

The second area is difficulty regulating your own energy and activity level. 

An ‘average’ person notices they’re getting tired and it’s time for a break; someone with ADHD often doesn’t register this clearly and only realises at the point of complete exhaustion. 

Hyperactivity is linked to this as well. It becomes really problematic when it can’t be steered towards something engaging – that energy simply spills out in all directions. 

Under those conditions, starting a task is often postponed until you are, literally, about to collapse from fatigue. 

3. Impulsivity 

The third area is impulsivity: a person with ADHD will often act first and only think about the consequences afterwards. 

In a heightened emotional state, you may say things you don’t fully mean. Not everyone finds it easy to acknowledge this later or apologise – and colleagues, managers or family members are not always understanding. 

This inner wave-like turbulence makes it harder to sit down calmly with a task – and to stay there. 

It follows that, in ADHD, attention, concentration and motivation are shaped by specific brain mechanisms. 

This isn’t about simply needing more willpower or to ‘pull yourself together’. 

In many ways, people with ADHD live in a high-risk zone. 

If you’re reading this article, there’s a good chance that you – or someone you know, perhaps a family member – is struggling with these difficulties. 

ADHD – a temperamental supercomputer 

Let’s simplify the picture. 

Imagine an ADHD brain as a temperamental supercomputer with an unreliable Wi-Fi connection. Most of us use a computer every day, so it’s an easy metaphor to grasp. 

You plan a big project: you sit down in front of your ‘machine’, and in your head you know exactly what you need to do – read the post, go through the spreadsheets, reply to emails, prepare the meeting, pull the work together. You get yourself ready to start… 

• the ‘machine’ doesn’t respond 

• the ‘connection’ keeps dropping 

• there’s no inner signal that really gets you going 

• there’s no momentum 

You look for the reason, you get irritated, but you still can’t move forward – and eventually you turn it against yourself: ‘I must have done something wrong.’ 

Then you calm down: ‘It’s fine, I’ve still got a few days.’ You put the task aside and switch to something easier – something you know you’re good at. 

Later you sit down again. For a moment it feels as if the connection is there, you even begin – and then your focus drops out again. You open and close the ‘machine’, you start and stall. 

You may recognise the same feeling when you know you ought to get started on a task, but nothing seems to “switch on” inside you. 

ADHD paralysis (often called ‘task paralysis’) is a step more intense. It’s as if not only the internet connection were unstable, but at the same time dozens of windows were open at once: 

• there are far too many small tasks 

• or one single huge, unmanageable project 

• the ‘processor’ and ‘memory’ are overloaded 

• the whole system slows down and eventually freezes 

The same metaphor has another side as well: hyperfocus. 

Sometimes all the stars line up: the ‘internet’ is fast and stable, the ‘machine’ is lightning quick and cooperative, and the task is exactly the kind of thing that is either very interesting or very urgent. 

In those moments it’s as if one single programme were running full-screen: the task pulls you in, you’re in flow. You can be astonishingly effective like this – the only problem is that this state doesn’t always switch on at the time you most need it. 

ADHD – attention and childhood signs 

You can probably guess this doesn’t suddenly start in adulthood. 

If you look back at childhood, at school a child with ADHD will often: 

• find it very hard to sit through a whole lesson without starting to talk, giggle or fidget; 

• reach the end of a sentence and not be able to recall how it began; 

• not be ‘stupid’ at all, yet still be unable to learn their times tables over half a year; 

• spend 15 minutes ‘getting dressed’ for school while in reality just staring out of the window – driving their parents mad: ‘Are you serious?’ 

The child ‘gets ready’ for school like this, living time at a completely different pace from the people around them. 

Their performance may drop: 

• partly because of concentration – it’s hard to follow the material; 

• and partly because it’s hard to organise what they’re doing. 

  
  

If there’s no external control, the child simply doesn’t sit down to a subject they don’t find interesting. 

While they’re doing homework, almost everything distracts them – something happens here, something happens there: a ball is bouncing outside, a motorbike goes past, the post arrives, the phone rings, there’s clattering in the kitchen, a spider crawls up the wall. In their head they ‘take apart’ every sound, daydream about it and spin off new thoughts. 

It’s important to know that our attention can be: 

• involuntary attention (automatic, stimulus-driven) – when there’s a flash of light or a sudden loud sound, and your attention goes there straight away. We all have this; 

  
  

• and voluntary attention (controlled, goal-directed), when there’s a task and we consciously keep our focus on it. In people with ADHD, it’s usually this deliberate, voluntary attention that is most affected. 

Many adults with ADHD say their mum actually stood over them while they were studying, supervising them – otherwise their attention flew off to everything else and learning was sheer torture, full of nagging and pressure.  

Already here the pattern appears: the task goes better when there is a “crutch”. In adult life, that role is often taken over by a partner. 

ADHD – LIFE HACK: body doubling 

One ADHD-friendly – and surprisingly powerful – strategy is called body doubling. 

How body doubling works 

You log on at the same time as someone else, often online. There are even specific apps for this, where at an agreed time you’re matched with a partner you don’t know. You agree something like: 

• ‘I’m going to work on my project now.’ 

• ‘I’m going to deal with admin on my laptop.’ 

Then you both sit there, each in a small video window, microphones muted. You don’t chat – you simply know the other person is working, and they know you are working too. 

The mere presence of this other person – even a complete stranger – can have a surprisingly strong activating effect. 

Why it helps 

For many people with ADHD, this kind of ‘body doubling’ develops spontaneously in their relationships as well. They notice that they work much faster and with far more focus when their partner is in the room – even if the partner is just walking about, tidying up or sitting on the sofa. 

A quiet sense of responsibility appears: if your partner is doing something useful while you’re about to slide off into yet another video or Reels binge, it suddenly feels uncomfortable and a bit shame-inducing. 

In those moments, your partner is acting as a live body double: they’re not directing you, not controlling you – they’re simply present, and that presence helps you stay on track. 

In psychological practice, this technique often appears in CBT (Cognitive Behavioural Therapy) groups and ADHD coaching as a form of ‘external executive function’ support. In ADHD–CBT programmes developed by Safren and Solanto, an accountability partner – someone who regularly checks in with you about your tasks – is also a standard element. 

ADHD – attention and adult signs  

Those children grow up, and the context gets tougher: there are more responsibilities, more difficulties – and, crucially, less external control. Parents ‘let go’, and young people are expected to manage on their own. 

The symptoms, however, don’t simply disappear: it’s still hard to follow the material, to pay attention, to sit still, to stay with tasks. 

That’s why things often start to deteriorate at university, where people are suddenly left much more to their own devices. They start studying, stop, take an interruption or leave of absence, go back again, or change course altogether. 

They struggle to take notes in lectures – they try to hold everything in their head, or, at the opposite extreme, they write absolutely everything down because that’s the only way they can keep their focus. Then they somehow push through to the exam, trying desperately to stop everything from ‘leaking out’ of their mind – and afterwards they’re left with a feeling of complete blankness. 

Everything we say about studying can be mapped onto work as well: you’ve got a project in front of you, you sit down with it, and it’s hard to concentrate. With this kind of background, having to sit down to a new task as an adult can feel just as paralysing. 

In the details you may notice that you: 

• make odd mistakes through inattention; 

• or, to avoid such mistakes, have to slow your work down to a crawl; 

• constantly have to double-check yourself; 

• get badly stuck, especially if your attention is pulled away mid-task. 

The whole thing turns into a long, drawn-out struggle – even though, in theory, the job could be done much more quickly. 

All of this circles back to the same point: getting started on a task and keeping your attention on it costs extra energy. 

ADHD – LIFE HACK: mini-deadlines 

Different things switch different people’s motivation on. 

For some, the brain only ‘wakes up’ when the deadline is already breathing down their neck. Someone learning a foreign language, for instance, might always leave their homework until the morning – right before the lesson. 

For weeks they can’t get themselves to start – then in the very last hour they suddenly do everything, quickly and well. It’s not that they ‘didn’t want to’ before. It’s that only maximum urgency finally switched their system on. 

Try this approach: 

• Break the homework into three very small parts. 

• Set three separate mini-deadlines across the three days between lessons. 

• Each day you only have to do one tiny section. 

Instead of one huge, frightening task, you end up with three small ‘I really need to tick this off by tonight’ jobs. From that point, it often goes much more smoothly. 

You can do exactly the same with coursework, exam preparation or work projects too. 

In CBT-based behavioural activation and graded task assignment protocols (used for depression and ADHD), breaking a large, paralysing task into small, well-defined steps with short ‘mini-deadlines’ is regarded as a core strategy: the distant, intimidating goal is broken down into nearby, manageable tasks that can realistically be completed today. 

ADHD – the underlying brain mechanism 

From the outside, the way a person with ADHD functions can look very contradictory. 

On one side, there is ADHD paralysis – the system is under-functioning. 
On the other, there is hyperfocus – the system is firing far too strongly. 

Interestingly, both extremes are rooted in the same underlying brain mechanism: the particular way the dopamine system works in ADHD. 

How can that be? 

In ADHD, the dopamine system is less stable, and as a result the executive functions – planning, decision-making, getting started on tasks, switching from one activity to another – all demand far more extra energy than average. That extra load is what makes them feel so paralysing. 

And hyperfocus is not a state where a person with ADHD ‘finally manages to pay attention properly’. In hyperfocus, attention regulation has simply swung to one of its extremes as an instinctive coping pattern: 

• it either never gets going 

• or it can’t switch off 

  
  

Caffeine and energy drinks work in a similar way: they don’t remove tiredness, they mainly block your sense of feeling tired. 

It’s exactly this contrast that is so misleading from the outside: ‘You see, you can do it when you really want to.’ In reality, the problem is that the system doesn’t switch on in a predictable way. 

You are never fully in charge of when it turns on – or what it decides to engage with. 

ADHD – hyperfocus 

Hyperfocus doesn’t usually appear when something is unpleasant, difficult or boring. That happens only very rarely. 

It locks on to one single thing that works too well for your brain – and that’s exactly why you can’t easily shift to anything else. 

You drop into a kind of flow state where nothing distracts you, and you can work for 8–12 hours straight without a break. You forget to sleep, to eat, to look after your basic needs – you just keep going and going – and meanwhile you burn out. 

The rest of your life starts to suffer: 

• you neglect yourself and your family 

• you don’t get to the doctor in time 

• you forget to pay bills 

• you miss important appointments and deadlines 

People with ADHD often have a higher apparent energy level, because the ‘brake system’ doesn’t work very well. 

That’s why, for many people with ADHD who hyperfocus, one of the strangest things about office life is the expectation that you leave the office and go home at a fixed time in the afternoon. 

Students also describe, for example at university in exam periods, deliberately forcing themselves into a hyperfocus state before deadlines: 

• they switch everything off, shut themselves away, and don’t get up until they’ve finished the task. 

In those moments, hyperfocus becomes a kind of ’crutch.’ 

On the one hand it helps you avoid constant distraction; on the other, it demands a very high price: letting go of meals, rest, relationships and any healthy boundaries. 

To make sure hyperfocus doesn’t become destructive, we need to learn how to work with it – how to tame it. 

ADHD – LIFE HACK: external time and external cues 

Adults with ADHD often build external anchors that help redirect their attention: 

• They keep a timer or clock next to them to remind them it’s time to call someone, take a lunch break or step outside for some fresh air. 

  
  

• They set up drop-down or pop-up reminder messages on their computer screen. 

  
  

• They ask colleagues or partners to help pull them out of a task: for example, to let them know when it’s time for a meeting or lunch. 

It’s worth learning to recognise your own warning signs: 

• what kinds of thoughts 

• what kinds of bodily sensations 

usually signal that you’re about to disappear down the ’rabbit hole.’ 

And then, at the very moment you realise you’re in that state, try to: 

• stand up 

• go and pour yourself a glass of water 

• walk over to the window and look out 

• exchange a few words with someone 

For neurotypical people this may sound easy; for people with ADHD it can be genuinely hard. 
But this, too, is something you can learn – to gently lead yourself out of that state from time to time. 

In practical recommendations by Nadeau and Barkley, working with time blocks is also treated as a basic strategy: ‘externalise time’ – make time visible and audible outside your head (for example, with timers, alarms and visual schedules). 

ADHD – paralysis (task paralysis) 

Most of us don’t have just one thing to do in a day. One of the main difficulties for an ADHD brain is that it finds it very hard to set priorities on its own. 

So, you can’t get started – even though you understand perfectly well what you’re supposed to be doing. 

If you live with someone, you may often struggle to explain why certain tasks that look completely simple to them take disproportionately much energy from you. 

For someone else, getting up in the morning and doing a bit of housework feels obvious: I get up, put a load in the washing machine, done. One sentence, one short sequence of actions. 

For you, the same thing can turn into a long internal algorithm. You see every step separately: 

• getting as far as the washing machine 

• opening it 

• sorting the clothes 

• putting them in 

• measuring out the detergent and pouring it in 

• adding the fabric softener 

• choosing the programme 

• pressing the button… 

By the time this whole sequence has run through your head, you simply freeze. 

And it’s very hard to explain this to a neurotypical partner in a way that doesn’t sound like excuse-making – while your brain is quietly saying: 

‘Right, everyone, I’m not taking part in this anymore.’ 

In classic behavioural biology there’s a term for this kind of thing: ‘displacement activity’. 

When does it show up? 

When an animal ends up in a situation with no clear solution. 

Two animals meet on a territory boundary, and it isn’t obvious which one should attack and which one should run away – it can’t ‘decide’ what to do. 

In that moment it doesn’t attack and doesn’t flee. Instead, it starts doing something completely different: 

• it eats 

• it sits down and grooms its fur 

In other words, it chooses an easier behaviour. It ‘displaces’ the energy into some other, out-of-place but safer pattern. 

You can probably feel your own version of this already: 

You’re supposed to be writing a dissertation, a project, a report, or doing some big, important piece of work. You sit down. 

The ADHD brain really dislikes delayed reward. Tasks that don’t bring immediate success, pleasure or genuine interest simply aren’t ‘worth the investment’ at the level of dopamine– so it keeps postponing them. 

Instead, it goes after whatever feels urgent right now – the things that offer instant stimulation. 

As a result, you: 

• scroll aimlessly 

• grab something to eat 

• call a friend 

• shuffle things around on your desk, do some tidying, wash up… 

  
  

If you’re putting something off endlessly, it probably means the task is too big or too complex as it currently stands. 

Break it down to the very first step and ask yourself: 

‘What would I need to do just to bring this task into existence at all?’ 

It might be something as small as: ‘Sit down at the desk.’ 

Sit down. Open the laptop. Open the file. 

From there, something usually starts to move. 

In research and psychological practice this method is often called behavioural activation or a graded task approach – starting with one tiny, doable action to get the system going. 

ADHD – LIFE HACK: A–B–C decluttering your priorities 

When it comes to concentrating, the thing that helps most is knowing exactly what you’re doing: pick the three most important tasks you need to get done today – and do those. 

If all your tasks sit in one single heap, the ADHD brain freezes. 

Instead, sort them into three ‘boxes’, like when you declutter at home and put things into three piles: 

• definitely keep 

• the ‘not sure yet’ pile 

• definitely throw away 

In the same way, you end up with three types of tasks – and three levels of importance: 

• A – Must be done today or tomorrow. 
  If you don’t do it, there will be concrete consequences (money, work, children, official matters, health). 
  This is where your focus goes. 

  
  

• B – Important, but not immediately critical. 
  It needs doing within the next few days, but today the A tasks matter more. Over time, some of the Bs will turn into As. 

  
  

• C – Pleasant, but postponable. 
  Small bits of organising, ‘nice to do’ items and non-urgent tasks. 
  We don’t start with these – we use them as a reward after ticking off an A. 

  
  

The ADHD brain needs visual anchors. Make your tasks visible. 

If you notice that in the morning you’re completely blocked and simply can’t choose what to pull out of the big pile onto today’s list, try writing tomorrow’s plan in the evening, not in the morning. 

If you put it together the night before, in the morning you just get up and follow the ready-made plan – one you’ve already made peace with and mentally ‘rehearsed’ yesterday. There’s no morning ‘prioritisation paralysis’. 

A prepared, written schedule is already waiting for you. 

Time-management author Alan Lakein uses a very similar A–B–C prioritisation system. The well-known Eisenhower matrix (urgent–important) is a close relative in terms of logic – there, too, the first step is to identify what is genuinely important. 

Where next if you recognise yourself – or someone close to you? 

Before you get irritated – before you get angry with your child, your wife or husband, your friend or anyone else – pause for a moment and consider: 

It may be that this person genuinely is not able to do what you expect of them. 
It’s not that they ‘don’t want to’ – it’s that they can’t. 

People with ADHD usually know perfectly well what is expected of them – the difficulty lies in carrying it out consistently. They need to be able to do something many times in a row, reach a result that finally feels satisfying, and then still have enough motivation left to keep going for a while longer. 

That’s how something can gradually turn into a skill – into a habit that really takes root. 

And if you see some of this in yourself, you don’t need to be afraid and you don’t need to feel ashamed. 

Here you can try a short, free online self-screening test (this is not a diagnosis, just a quick self-check): Free ADHD Simple → https://adhdsimple.co.uk/quiz-landing 

…to help you decide whether it might be time to take a closer look at ADHD in your own life. 

After that, talk to a professional. 

The role of a helping professional is to be there for you in the moment when you’re not okay, and to help you find a way through. Don’t sweep it under the carpet, and don’t just shrug and say ‘it’s nothing’. 

This is especially important if you’re a parent and you think your child might be struggling with something similar – take action. Unfortunately, ADHD does not always ‘just get better with age’. In the worst case, you are sent away with a comment like: ‘Oh, come on, you’re doing far too well for this to be ADHD – you’re just overthinking things.’ 

Even that is still better than missing the chance to make your life easier and to improve your quality of life. 

Last updated December 2025 
Written by Olga Karolyi for ADHD Test 

Important: This article is for information only. Diagnosis and treatment are determined and overseen by a qualified clinician. If you feel affected, contact your GP. 

References: 

Key UK guidance 

• National Institute for Health and Care Excellence. (2018, last reviewed 2025). Attention deficit hyperactivity disorder: Diagnosis and management (NG87). https://www.nice.org.uk/guidance/ng87 

  
  

• National Health Service. (2025). ADHD in adults. https://www.nhs.uk/conditions/adhd-adults/ 

  
  

• Royal College of Psychiatrists in Scotland. (2022). ADHD in adults: Good practice guidance (CR235). https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/cr235-adhd-in-adults---good-practice-guidance.pdf 

Further reading  

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association 

Overviews, diagnosis, epidemiology, guidelines 

• Bellato, A., Perrott, N. J., Marzulli, L., Parlatini, V., Coghill, D., & Cortese, S. (2025). Systematic review and meta-analysis: Effects of pharmacological treatment for attention-deficit/hyperactivity disorder on quality of life. Journal of the American Academy of Child and Adolescent Psychiatry, 64(3), 346–361. https://doi.org/10.1016/j.jaac.2024.05.023 
  (Systematic review and meta-analysis in child and adolescent samples showing that medication for ADHD improves not only symptoms but also functioning and quality of life. A useful counterpoint in “medication vs. skills training” debates, illustrating that medication can “take the brakes off” the nervous system, while day-to-day strategies are still needed.) 

  
  

• Caye, A., Rocha, T. B. M., Anselmi, L., Murray, J., Menezes, A. M., Barros, F. C., Gonçalves, H., Wehrmeister, F., Jensen, C. M., Steinhausen, H. C., Swanson, J. M., Kieling, C., & Rohde, L. A. (2016). Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: Evidence from a birth cohort supporting a late-onset syndrome. JAMA Psychiatry, 73(7), 705–712. 
  (Long-term birth cohort study following ADHD trajectories from childhood into young adulthood, showing that symptoms often change form rather than disappearing and providing evidence for possible “late-onset” ADHD.) 

  
  

• Faraone, S. V., Bellgrove, M. A., Brikell, I., Cortese, S., Hartman, C. A., Hollis, C., Newcorn, J. H., Philipsen, A., Polanczyk, G. V., Rubia, K., Sibley, M. H., & Buitelaar, J. K. (2024). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 10(1), 11. 
  (Very recent, comprehensive review covering genetics, brain networks, clinical presentation, comorbidities, and treatment; a key “umbrella” source for viewing ADHD as a neurodevelopmental condition persisting across the lifespan.) 

  
  

• Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E., & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723. 
  (Landmark representative survey demonstrating that ADHD is common in adults, associated with marked functional impairment and comorbid psychiatric problems.) 

  
  

• Kuriyan, A. B., Pelham, W. E., Molina, B. S. G., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., Babinski, D. E., Walther, C., Cheong, J., Yu, J., & Kent, K. M. (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of Abnormal Child Psychology, 41(1), 27–41. 
  (Longitudinal study linking childhood ADHD to higher school drop-out rates, fewer completed qualifications, and more unstable work trajectories in young adulthood.) 

Executive functions, motivation, time management, procrastination, hyperfocus 

• Altgassen, M., Scheres, A., & Edel, M. A. (2019). Prospective memory (partially) mediates the link between ADHD symptoms and procrastination. ADHD Attention Deficit and Hyperactivity Disorders, 11, 59–71. 
  (Shows that difficulties in prospective memory – remembering to start tasks at the right time – partly explain why higher ADHD symptom levels are associated with greater procrastination.) 

  
  

• Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65–94. 
  (Classic theoretical paper arguing that impaired behavioural inhibition is the core deficit in ADHD, disrupting executive functions such as planning, self-regulation, and time management.) 

  
  

• Barkley, R. A. (2011). Executive functions: What they are, how they work, and why they evolved. Guilford Press. 
  (Comprehensive volume on executive functions and their role in everyday functioning, providing a strong theoretical backdrop for framing “ADHD paralysis” as an executive function problem.) 

  
  

• Brown, T. E. (2013). A new understanding of ADHD in children and adults: Executive function impairments. Routledge. 
  (Presents ADHD primarily as a disorder of executive function and vividly captures the lived experience of knowing what to do but struggling to initiate action.) 

  
  

• Garcia Pimenta, M., Gruhnert, R. K., Fuermaier, A. B. M., & Groen, Y. (2023). The role of executive functions in mediating the relationship between adult ADHD symptoms and hyperfocus in university students. Research in Developmental Disabilities, 144, Article 104639. https://doi.org/10.1016/j.ridd.2023.104639 
  (Explores how executive functions mediate the link between adult ADHD symptoms and hyperfocus, supporting the view that hyperfocus can function as both a strength and a vulnerability.) 

  
  

• Hupfeld, K. E., Abagis, T. R., & Shah, P. (2019). Living “in the zone”: Hyperfocus in adult ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 11(2), 191–208. 
  (Empirical study directly examining hyperfocus in adults with ADHD – its frequency, contexts, and the point at which it stops being helpful and becomes counterproductive.) 

  
  

• Oguchi, M., Takahashi, T., Nitta, Y., & Kumano, H. (2023). Moderating effect of attention deficit hyperactivity disorder tendency on the relationship between delay discounting and procrastination in young adulthood. Heliyon, 9(4), e14834. https://doi.org/10.1016/j.heliyon.2023.e14834 
  (Shows that higher ADHD tendency strengthens the association between delay discounting – preferring immediate over delayed rewards – and procrastination in young adults.) 

  
  

• Sonuga-Barke, E. J. S. (2003). The dual pathway model of AD/HD: An elaboration of neuro-developmental characteristics. Neuroscience & Biobehavioral Reviews, 27(7), 593–604. 
  (Introduces the dual-pathway model of ADHD, combining executive function deficits with delay aversion, and providing a theoretical link between reward-driven hyperfocus and paralysis around delayed goals.) 

  
  

• Utsumi, D. A., & Miranda, M. C. (2018). Temporal discounting and attention-deficit/hyperactivity disorder in childhood: Reasons for devising different tasks. Trends in Psychiatry and Psychotherapy, 40(3), 248–252. 
  (Discusses how children with ADHD discount future rewards and why diverse experimental tasks are needed to capture these patterns.) 

  
  

• Wiwatowska, E., Pietruch, M., Katafoni, P., & Michałowski, J. M. (2023). “I can't focus now, I will study tomorrow”: The link between academic procrastination and resistance to distraction. Learning and Individual Differences, 107, 102364. 
  (EEG-based experimental study showing that chronic procrastinators have more difficulty sustaining task focus, even in the face of relatively mild external distractions.) 

Neurobiology, brain networks, risk profile, and outcomes 

• Chang, Z., Lichtenstein, P., D'Onofrio, B. M., Sjölander, A., & Larsson, H. (2014). Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: A population-based study. JAMA Psychiatry, 71(3), 319–325. https://doi.org/10.1001/jamapsychiatry.2013.4174 
  (Swedish population-based cohort study showing increased risk of serious road traffic accidents in adults with ADHD, with risk reduced during periods of stimulant treatment.) 

  
  

• Dalsgaard, S., Østergaard, S. D., Leckman, J. F., Mortensen, P. B., & Pedersen, M. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: A nationwide cohort study. The Lancet, 385(9983), 2190–2196. 
  (Danish nationwide cohort finding higher rates of premature mortality in people with ADHD, particularly due to accidents and suicide.) 

  
  

• Faraone, S. V. (2018). The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neuroscience & Biobehavioral Reviews, 87, 255–270. https://doi.org/10.1016/j.neubiorev.2018.02.001 
  (Detailed review of how amphetamine derivatives and methylphenidate act on dopamine and noradrenaline systems and why they improve ADHD symptoms, with discussion of implications for comorbid psychiatric conditions.) 

  
  

• Hart, H., Radua, J., Nakao, T., Mataix-Cols, D., & Rubia, K. (2013). Meta-analysis of functional magnetic resonance imaging studies of inhibition and attention in attention-deficit/hyperactivity disorder: Exploring task-specific, stimulant medication, and age effects. JAMA Psychiatry, 70(2), 185–198. 
  (fMRI meta-analysis showing altered activation in inhibitory and attentional networks in ADHD, and examining how stimulant medication and age influence these activation patterns.) 

Psychoeducation, CBT, skills training, DBT elements 

• Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press. 
  (Not ADHD-specific but provides core emotion regulation, impulsivity, and distress-tolerance skills – such as crisis survival and self-soothing – that can be adapted for adults with ADHD.) 

  
  

• Pan, M. R., Dong, M., Zhang, S. Y., Liu, L., Li, H. M., Wang, Y. F., & Qian, Q. J. (2024). One-year follow-up of the effectiveness and mediators of cognitive behavioural therapy among adults with attention-deficit/hyperactivity disorder: Secondary outcomes of a randomised controlled trial. BMC Psychiatry, 24(1), 207. https://doi.org/10.1186/s12888-024-05673-8 
  (Group-based CBT for adults with ADHD with one-year follow-up, identifying mechanisms such as improved time management and more structured routines as key mediators of sustained benefit.) 

  
  

• Safren, S. A., Sprich, S., Perlman, C. A., & Otto, M. W. (2017). Mastering your adult ADHD: A cognitive-behavioral treatment program (2nd ed.). Oxford University Press. 
  (Manualised CBT protocol for adult ADHD organised into modules on time management, prioritisation, organisation, and reducing procrastination, with extensive practical exercises.) 

  
  

• Solanto, M. V. (2011). Cognitive-behavioral therapy for adult ADHD: Targeting executive dysfunction. Guilford Press. 
  (Describes a CBT programme explicitly aimed at training executive functions – breaking tasks down, estimating time, structuring activities, and self-monitoring – supporting the idea that initiation can be improved through learnable skills.)