October 22, 2018

Using Scrum to Help with Attention Deficit Hyperactivity Disorder (ADHD) - Part One

I first met Sally, and then later Francis her husband, at a local user group - Agile in Leeds, where Sally delivered a fantastic 10 minute talk on how she implemented Scrum to help Francis with ADHD. 

It blew my mind then and it still does now. Taking a framework which I have seen work multiple times and to use it in the most complex of all situations - Home life and Marriage. It changed their life and I'm not overplaying it. 

Enjoy the read!! 

Steve Trapps

Sally and Francis
Francis and Sally

 

I’m Sally Waters. I work as a computer programmer for Sky. 

Francis Waters is my husband. He used to be in a band, but now he’s aiming to become a paramedic. I often find him playing computer games, whittling, or shooting arrows in our back garden.

We met each other in music AS-level class when we were sixteen. We lost touch at the end of that year when Francis was kicked out for not getting high enough grades in his exams. Two years later, around the same time as I started a music degree at Cambridge, a young driver crashed into Francis while Francis was on a late-night walk. The car pushed him through a wall, shattering both legs below the knee. When I heard about this, I Facebook-messaged Francis to say how glad I was that he was still alive. Six months later, he asked me out. Six years later, I proposed, and we married in August 2018.

Francis has ADHD. Attention Deficit Hyperactivity Disorder is a disability which affects the executive functions. These are “a set of processes that all have to do with managing oneself and one's resources in order to achieve a goal.” They come from the frontal lobes of the brain, behind the forehead.

Executive functions include:

  • Inhibition of impulses
  • Shifting your thinking flexibly from one situation to another
  • Controlling emotions
  • Initiating a task
  • Planning
  • Self-monitoring

October is ADHD awareness month. I am very grateful to Steve Trapps and Scrum.org for giving us the opportunity to write a couple of posts about ‘Agile ADHD’ - that is, how we are using Scrum to manage Francis’s disorder.

This first part is about what it’s like to live with ADHD, what other coping strategies we’ve tried, how we started using Scrum and what effects it has had on our lives so far. In part two, we will go into more detail about the way we use Scrum at home to organise our lives.

(When not otherwise stated, the answers are written from Sally’s perspective.)

 

Francis, Can you explain what ADHD is and how it affects you?

Francis: I am always worried about not doing justice to ADHD. The perennial problem with my disorder is how manageable and puny it seems in the scale of other mental disorders. So my biggest fear here is understating my disability in the face of the stigma attached to it.

As I grew up, it seemed everyone had their own ideas on how to “handle” ADHD. Luckily, I came along one generation too late for the instructive clip around the ear. But even given that, there were harmful ideas floating around. I heard that ADHD is a myth, ADHD is an excuse for bad parenting, ADHD is an excuse to drug naughty children. When I was diagnosed we didn’t even know that ADHD carried through into adulthood, when now we realise that adulthood is when ADHD becomes a much larger problem.

So bearing that in mind I’ll try to explain a couple of the ways ADHD is disabling for adults.

Working memory: ADHD has been described as time-blindness. I am myopic to the future. A more generous description is that I live my life glued to the moment, like a Billy Connollypuppy. Practically, this means I cannot hold task-relevant information in mind while I do work. For example, you would not believe how many times I check the recipe book while cooking. Another example is how often I forget the point I was about to make while in mid-stream conversation. This (combined with my related distractibility) makes conversation with me a very rambling affair. A great example of this is the world-renowned comedian Billy Connolly, fellow ADHD sufferer, and his catchphrase “What was I talking about?”.

It’s like trying to plot a route on a map to somewhere far away, but every time I look away from the map my planned route disappears.

Russell Barkley

Motivation: Without being able to hold an end goal in mind, it is nigh on impossible to muster the energy to work towards it. What this practically means is I procrastinate a lot. Unfortunately, it’s not something I can just shake myself out of. I have managed to achieve some larger things, though. For instance, I have become highly proficient on the guitar. But that is only because I enjoyed picking up the guitar and making noise. A commitment to daily noisemaking + a decade and a half = accidental mastery.

There are a number of other disabling features of ADHD, including the cumulative psychological and social effects of being consistently impulsive and perceived as being lazy and rude. If you would like to know more about the difficulties of ADHD I recommend Professor Russell Barkley’s talks. He is a leading professor in this field and a magnificent speaker. He has the rare ability to hold the attention of an attention-deficit crowd. Here’s a short video of his to get you started.

 

Sally, What is it like living with someone with ADHD and how does it affect you?

It can be very hard. I’m a perfectionist, which means that to cope with frequent anxiety my instinct is to impose control. This means I would plan everything, down to each ten-minute block of my day. This led to lots of achievements, culminating in attending Cambridge university, but that environment just exacerbated my sense of shame at not being able to do even better.

Conducting the Orchestra
(I'm the one in the sparkly jacket, having just conducted a concert which caused me more stress than I can ever express)

 

In a way, this drew me to Francis in the first place. His approach to life was so different, so chilled-out and easy-going, that he provided the perfect escape from the pressures I was putting on myself. This worked well while we were long-distance, but once we started living together, I was confronted with the daily realities of ADHD.

Kitchen Mess

I explain in the talk I give about this that the main visible way I could tell I was living with ADHD was how messy the house was. It was very comforting to read the book Is it You, Me, or Adult ADD? because it validated what we were going through.

For instance, many partners feel as though they’re living with a child or teenager rather than a fellow adult. This can actually be fun – for instance (especially before he’s taken his medication), Francis is very bouncy and can get enthusiastic about little things (such as breakfast) that I would otherwise think of as a chore. But it’s not so good when the only thing Francis is motivated to do is to go to the supermarket at the very start of the day and buy loads of sugary snacks.

His impulses can be so strong that I find myself going along with his ideas about how to spend our time. This can be fine; we’ll end up having a relaxing evening, watching a film, ordering a take-away, and getting to bed very late. But in the long-term this pattern started to really clash with my perfectionism. I get very confused about the boundary between when I should loosen up and challenge my desire for control or when I need to exercise my autonomy. This often triggers my anxiety, and I get annoyed at myself for not being able to say no to him and stay focused on my own projects. You can see how this adds an extra element in managing the risk for resentment in our relationship.

The flip side is that when I suggest doing something, Francis is often reluctant if it’s not a task that provides some kind of instant gratification. This can be very annoying when it’s something that will benefit both of us, as it doesn’t feel fair that I have to work so hard to persuade him to agree to take his share of the work.

It’s difficult to see someone you love struggle to make very little progress. For instance, I remember us both crying our hearts out after a third driving instructor abruptly dropped Francis as a pupil because he missed a lesson with her. It didn’t matter that we paid for that lesson in full or that we explained that ADHD makes it very difficult for Francis to stay in control of his schedule. Given all these extra setbacks and disappointments, it’s not surprising that Francis, like many ADHD-sufferers, is extremely prone to addictions of every kind. When we first got together he was already a smoker and a committed alcoholic, drinking at least four beers a night (and, at the beginning, in denial that this was even a problem). He was completely adrift, and quite depressed because of it. In this situation it’s a constant effort for a partner not to sink into a similar state of learned helplessness; trying to change anything feels overwhelming.

Another aspect people rarely know about ADHD is that it affects emotional impulsivity – Francis can get panicked or irritated very quickly by an unexpected demand on him or a change of plan. Even before we found Scrum though, I’ve always been impressed by Francis’s willingness to acknowledge these problems and try to mitigate them. Honestly, I think in any relationship the self-awareness of both people in the couple is hugely important. And I am grateful we knew why we were having these problems - without the diagnosis, I would have felt as though I was going mad.

A small disclaimer: looking at our relationship just through the lens of ADHD gives a very dark and distorted view of it by focusing only on the worst parts. I want to make it clear that there are lots of great things about being married to Francis!

 

What had you already tried to do to manage ADHD?

Luckily, Francis was diagnosed at the age of seven (and, thankfully, his medic parents believed the facts rather than the anti-ADHD campaign started by the scientologists). Since then he’s been on stimulant medication to manage some of the symptoms, and this helps a lot.

However, while medication can temporarily reverse the dopamine-deficit in Francis’s brain, it isn’t enough to totally fix the problem. People with medicated ADHD still can’t really respond to long-term consequences, so they need the consequences for their actions brought closer, into their immediate environment.

I tried everything I knew to build the appropriate environment that would provide this for Francis. I even got him to try some of the perfectionistic planning methods I used, such as writing down every little thing he wanted to do that week. But although that really helped him (that was the week he organised his first gig), it wasn’t a sustainable process as it basically needed me to nag him constantly.

Having read a lot of self-help and hoarded a lot of productivity tools, I thought surely some of them would help. But after running through every single one I could think of, nothing stuck. They might help in the particular area we were targeting, such as keeping the kitchen clean, but everything else stayed just as messed up. Sooner or later, Francis would miss a few days, get discouraged, and stop.

 

How did you start using Scrum? Did you implement everything at once, or start slowly with one aspect then move onto the next? 

I came across Scrum at my first day on the grad program at Sky. I had heard a little bit about Agile and read the manifesto so I could talk about it in interviews, but until that day I hadn’t realised exactly what Scrum is for: it helps people to manage an ongoing complex system together. It had the scope and flexibility to encompass the whole system and not just small parts of it. I could hardly wait to get home but I also couldn’t believe that I’d never learned about this in all my productivity trawls. How is Scrum still such a tech-industry secret?

The very first thing we did that night was to clear a small corner of our messy table. We used the post-it notes I had pinched from work to break down all the tasks involved for getting our cork-board mounted to the wall. It’s probably the most detailed break-down we’ve made of a task before or since, but we really didn’t want to fail at the first hurdle. 

Post-ITs

We had never got around to putting up that cork-board, and we had had it for three years. With everything in such clear steps and the new hope of this Scrum idea right in front of us, we had it up in three days. I had fun finding ribbon and things to make the different columns. Seeing it all ready to use, and knowing we had actually worked together to get something done, was galvanising.

 

 

Sally, how did you explain Scrum to Francis? Did you use the same terminology as per the Scrum Guide?

I did – probably more accurate terminology than I use for it now, actually, as it was on the same day that I had just been trained about it. I ran through a couple of fundamental concepts (I seem to remember writing a triangle diagram showing Scope, Time, and Money), but didn’t really bother going in depth on what a Scrum Master or Product Owner are supposed to do, as we are not trying to get any products out to market, so it’s a bit different.

 

Francis, after trying so many things were you sceptical about trying Scrum and if so, what made you try it?

Francis: I was very sceptical – but luckily, Sally was able to talk me into it. She was very excited about it.

Sally: I think maybe Francis could see that I wasn’t going to let this one go, and it might be easier to try it than to disappoint me!

 

Did you see results straight away, or did it take a few attempts to see the benefits?

We started to see results after a few weeks, maybe a couple of sprints in. It’s evolved so much; it was so basic at first. 

List of activities One of the first things we did with it was getting the housework sorted out into a ‘regulars’ system (where tickets repeat at certain intervals, like daily or weekly), and the house being cleaner was probably the first really noticeable impact.

Quitting smoking came soon after that. We used a daily ‘no smoking’ task which had an ever-increasing value – it was a multiplier on that day’s story-point score, so the first day it made the total 1.1 times more, then 1.2, up to a doubling of the day’s points. We kept that going as long as Francis needed an incentive, until he felt he was over the main addiction and could manage without it.

At the same time, things started moving with Francis’s career. First, he tried to get into the army as a trainee engineer, but you can’t actually join the army in the UK if you have ADHD (there’s a new rule where you have to be unmedicated and ‘symptom-free’ for three years before you can apply – but that’s not how a life-long brain disorder works…). Now he’s becoming a paramedic. There are still obstacles but Francis wouldn’t have felt capable of achieving it at all before this.

 

Has Scrum moved into other areas of your life? Didn't you plan your wedding using Scrum? How was that for you?

 

Wedding

Francis: It was stressful, though not nearly so stressful as it would have been had we attempted to do the wedding without Scrum. It would have been much more Sally-based work – as it was it was still about 70% Sally-work. But before Scrum I couldn’t have helped hardly at all (or only in the most token of ways). And there would have been a lot more nagging.

Sally: We use Scrum to cover all areas of our lives, so I would say yes!all parts of life

I actually ended up using Scrum in a wider setting during the week before the wedding to organise everyone who helped out. We had a board with each day’s tasks on and a daily meeting to make sure everyone knew what they could help with the next day.

 

What results are you seeing now?

In January 2018 we went on a month-long early honeymoon to Vietnam. The biggest trip we’d tried to organise before that was a four-day camping trip to Whitby.

During that trip, Francis quit drinking, and has been sober since (including on our wedding day).

We are finally redecorating the house (we’ve lived here four years) – so Francis has a repeating ticket for getting the wallpaper off while I’m at work. 

ScrumboardRecently, we gave our piano away so that there would be space next to the original board to expand. Now I have my own board and have a ‘mirror’ of the columns that Francis has, so that the day’s ‘Done’ tasks can funnel down the middle together. 

 

 

 

We’ve just met the Leeds Adult ADHD support group for the first time, and, having spent about two hours with the other members, we decided in short order to set up a YouTube channel together to share our experiences. As everyone has ADHD except me, I’m the manager. It’s a little like herding cats, but on the other hand, everyone is hyper-aware that it could go nowhere and so everyone is very willing to engage with my suggestions for ways of working (at the moment, we’ve had one meeting and I’ve set up a couple of Trello boards). What I find really exciting is that we may be able to teach more people about ‘Agile ADHD’ and how to use Scrum at home.

 

Has using Scrum changed your relationship with each other? 

Sally: I think it’s difficult to judge from the inside. It feels a bit more equal – we can actually share many types of work which we couldn’t before. I’d say we’re both a bit more hopeful for the future.

Francis: Our relationship feels a bit more secure. There’s a little more autonomy.

 

Do you see any of the Scrum Values (Courage, Commitment, Openness, Respect & Focus) present in your relationship more than prior to using Scrum?

Francis: I’ll honestly say this is literally the first time I’ve encountered those. We never consciously applied them. I tend to be a little resentful of systems which make careful monitoring of these, and other randomly selectable nouns (e.g. passion, clarity, responsibility etc.), a part of their functioning. The implication being that by not externally noting and paying credence to them I am somehow failing to value my values to the best of my ability. It feels like a wasteful expenditure of my precious, fleeting motivation to spend time actively aiming for vagaries which I would tend to pursue by default anyway. Except focus of course, no need to torture myself by attributing moral value to something I struggle so greatly with.

Sally: This question sparked quite a debate between us actually, as I love framing my actions in terms of values. I had forgotten these were the Scrum ones though. I’d say that at least the value of commitment is more present in our relationship now, because Francis can commit to doing things with a bit more confidence that he’ll actually do it. However, I’d say maybe our relationship requires a bit less courage than before using Scrum, as I think it took more bravery to believe that we would make it long-term as a couple with no evidence that our life-style could ever be less chaotic.

 

Francis, what aspects of Scrum "clicked" with you? After trying various things in the past, what was it that made this time different?

Francis: It’s difficult to ignore. It’s colourful and tactile. It’s like a multi tool, it’s all-in-one - it’s the list of all the things that need doing, the breakdown of those things, the thing I’m doing right now, all long and short-term projects on one plane of existence.

 

Francis, what would you say is the best bit of Scrum that works the best for you with ADHD?

Francis: It remembers what’s coming next and I can’t distort it – e.g. if it was just a list on paper of tasks I’m going to do today, you can lose the list, do something that’s not on the list, forget to add something to it, and get stuck with a half-done list that you have to do the next day. There are lots of ways that Scrum is resistant to being derailed, provided you keep on with the actual scrums (and the planning and retro etc.). Earning points incentivises me to add things to the board, whereas a list loses all its value as soon as it’s been used.

 

Has using Scrum caused any arguments / conflict between you two? If so, what aspects of Scrum caused it?

Francis: I think only minor ones about the functioning of the agile board itself when implementing certain changes - for instance how valuable certain bonuses are.

Sally: It has maybe brought a few tensions into the light about our different goals or ways of working. But I think these arguments are healthy as the only reason we hadn’t had them before was because there was no way for us to work together at all.

 

Francis, how do you feel now that your life is being controlled by a framework?

Francis: I was always resistant to control. I had, perhaps defensively, learned to over-value my impulsivity and saw structure as the device of schools and prisons. Through persistent effort and boundless patience, Sally was eventually able to make me see that structure offers more freedom, rather than less. Or at least that structure is the means by which we exchange short-term freedom for long-term freedom.

 

What was the feeling like when you saw that Scrum was working for you?

Sally: Relief and joy and hope. I’m so happy that there’s a way I can genuinely help Francis to manage his disability. I’m so grateful I no longer have to choose between watching helplessly as Francis fails to manage life’s demands or resenting having to rescue him. I feel more involved in his goals without feeling sucked in to having to help him avoid last-minute crises. And I am still so excited for seeing him succeed in his larger goals like being a paramedic. I can’t wait to see if this system could be taught to other people with limited executive functioning to change their lives as well.

Francis: The feeling is not finished being felt.

The Scrum system works gradually better as time goes by. When we go a few days without doing daily scrums, we describe it as being on ‘yellow alert’ or ‘red alert’. The old familiar feelings of being out of control and panicking about all the things that I ought to be doing get more acute and I’m more driven to procrastination as a way of dealing with this. 

Before, I felt like I was lost in a stormy ocean on a raft. Now I feel like I’m still on a raft, but it’s a slightly calmer ocean, I know vaguely where I am, and I have a paddle.

 

What would you like to ask of our readers? How can they follow your progress?

If you were us, how would you go about spreading the idea of Agile ADHD? How could we test it to prove whether it works for others?

We are also launching a YouTube channel with other adults with ADHD. Are there any topics you would particularly be interested in watching?

If anyone would like to get in contact with us:

 

Next Time we'll discuss....

  • Details of How Scrum was implemented in Francis and Sally's life.

 

Interested in learning more about Scrum - Professional Scrum Master course in Leeds, UK - November 2018