The Adult ADHD Tool Kit

It was published by Routledge in August 2014; some sources give 2015. Around two hundred and ten pages. Its full title is The Adult ADHD Tool Kit: Using CBT to Facilitate Coping Inside and Out.

J. Russell Ramsay is a clinical psychologist, Anthony L. Rostain a psychiatrist. They are the founders of the Adult ADHD Treatment and Research Program at the University of Pennsylvania. When the book was published, Rostain was president of the American Professional Society of ADHD and Related Disorders (APSARD).

I could not reach a verified Turkish edition; I am writing with the English title.

Two books from the same team

It helps to think of this book together with Rethinking Adult ADHD, which Ramsay wrote in 2020. I reviewed that one on the site as well.

Both come out of the same clinical approach. Ramsay and Rostain also wrote an earlier handbook for clinicians that treats cognitive behavioral therapy in adult ADHD together with medical treatment. Tool Kit is that approach translated directly for the reader with ADHD.

Rethinking Adult ADHD asks the therapist the question of why: why do people not use the skills they know? Tool Kit puts the same question in the reader's hands and builds the answer through concrete tools.

The publisher's description states the book's starting point openly: adults with ADHD know what they should do but struggle to turn intention into action. The book aims not just to list coping strategies but to offer tactics for how to apply them in daily life.

The difference from the rest of the shelf is in this sentence. Most of the shelf explains what to do. This book tries to place the question of why what was explained is not being done inside every tool.

Starting with the to-do list

The table of contents I saw opens with the most basic tool: the to-do list. The chapter's name is a question: what do you need to do?

My first reaction was a sigh. Half of ADHD books begin with a to-do list, and I am someone who has written and abandoned dozens of those lists.

But the way the book handles this tool is part of a frame of thought. The list is set up as a starting point: taking tasks out of the head and making them visible outside. The following chapters move on to placing this list inside time.

It begins from the same place as the idea I described in the one-list rule article on the site: as the number of lists grows, none of them is trusted.

How you spend yourself

The second tool is the daily planner. The chapter's name has a play on words: instead of asking how you spend your time, it asks how you spend yourself.

I liked this frame. An hour that looks empty in the calendar does not mean I am in a state where I can really do something in that hour. Tiredness, transitions, the cost of jumping from one task to another do not show in the calendar but they are spent.

The difference between the to-do list and the planner seems like one of the book's basic ideas. The list says what to do. The planner says when to do it. In ADHD the gap between these two is the reason tasks stay on the list for years.

Choreography

The third chapter deals with time and task management, and the three verbs in its name stand out: defining, prioritizing and choreographing.

The word choreography stayed with me. To do a task it is not enough to know what it is; you need to know which step comes after which, where each movement starts and where it ends. A vaguely defined task, like "write the report," is less a task than a fog cloud for an ADHD brain.

A review of the book said the authors use metaphors and pop culture examples generously, and that this helps the ideas stick. That is a rare feature for a workbook and one of the reasons the book does not read like a dry manual.

Starting the plan, sustaining the plan

The following chapters are devoted to setting the plan in motion and sustaining it. The sustaining part comes in two chapters.

This proportion told me a lot. Three chapters for building a plan, three chapters for carrying it out.

In ADHD the hardest part usually begins after the plan is made. As someone who makes a wonderful weekly plan on Monday morning and has completely forgotten it two days later, I valued that the book set up this balance.

Here the ideas in Ramsay's other book become concrete: the moment of starting a task, the first discomfort, the slide into avoidance. When the moment a plan fails is read as a character flaw, a person drops the plan altogether. When it is read as a behavioral problem, you can ask what will change in the next attempt.

The rest of life

The second half of the book carries the tools to particular areas.

School and work. Coping with ADHD at university and in the workplace is handled in a single chapter. Putting the two under one roof makes sense; in both, the balance between the structure imposed from outside and the structure the person has to build themselves becomes the problem.

Relationships, family and health. In the publisher's description, physical health and well-being are also counted among the areas the book covers. How ADHD affects health, from missing appointments to irregular sleep, is a little-discussed subject; my article on health appointments on the site also came out of this gap.

Relationship with technology. The description separately mentions excessive technology use. For 2014 a forward-looking choice. But the technology landscape of 2014 was very different from today's; short-video platforms and endless feeds as they are now did not exist then. Reading this chapter I had to take the principles and adapt the examples to my own phone.

Handing things outward

This was the heading I expected least in the table of contents: outsourcing, data management and materials management.

Reading the heading I felt relief. Most ADHD books try to teach the reader to do everything on their own. Handing a task to someone else, taking a system from outside, using the support of an app or a person is also a legitimate part of coping.

The data and materials management headings seem to cover a wide area, from piles of paper at home to digital files. This part is more practical and less striking; it suits being used like a reference section.

Problems and medical issues

The last chapter brings problem management and medical issues together.

That medical issues sit inside the book, under the same roof as the coping tools, is in line with the approach the team has defended for years: therapy and medical treatment are parts of the same plan. Having a psychiatrist on the team also makes it easier to set up this balance. The medication decision is always made with a physician; a workbook cannot replace that decision.

The evidence behind the book

There are randomized studies showing that cognitive behavioral therapy is effective in adult ADHD. The best known is the 2010 study by Safren and colleagues in JAMA: in adults whose symptoms continued despite medication, cognitive behavioral therapy gave better results than the group receiving relaxation and educational support. The group-based metacognitive program by Solanto and colleagues was likewise tested in a randomized study.

The tools in Tool Kit overlap largely with the components used in these studies: planning, prioritizing, procrastination and working with thought patterns.

But a distinction has to be made. Knowing that a program run with a therapist is effective does not mean that the same content will have the same effect when read alone from a book. I have not seen a study testing the use of this book alone. I explained this distinction in more detail in the article on cognitive behavioral therapy on the site.

Next to Safren's workbook

On the site I also reviewed the workbook Mastering Your Adult ADHD by Safren and colleagues. The two are often mentioned in the same sentence, so I want to say the difference.

Safren's book is the client volume of a tested protocol. The modules move in a set order, with weekly sessions and homework. Behind it is a randomized study that tested that protocol itself. Its strength is exactly that it is narrow and measured.

Tool Kit covers a wider area. Alongside planning and time management it opens separate chapters for areas of life such as work, school, relationships, health, technology and outsourcing. Its language is also more conversational. In return, it does not claim to be a protocol tested as a whole.

If you have to choose between the two: Safren if you will work with a therapist or in a highly structured way. Tool Kit if you are stuck in a particular area of life and want to adapt the tools to your own life. The two do not exclude each other; I used parts of both.

The question that comes before the tools

The emphasis on cognitive behavioral therapy in the book's subtitle means the tools always come with a question about thinking. Writing a list is easy. Noticing what you tell yourself to avoid looking at the list is harder.

For me this was the book's real contribution. Having bought dozens of planners over the years, I had an abundance of tools. What was missing was catching the sentence going through my head at the very moment I needed to open the planner.

Where I found it lacking

Women and hormonal periods. In the table of contents I saw there is no heading devoted to this subject. In 2014 this area was not yet discussed as much as it is today.

Emotions. I could not see a separate heading on subjects like emotional regulation and rejection sensitivity. The part devoted to emotion management in Ramsay's 2020 book is also short. For this area you need to look at other sources.

The difficulty of using it alone. The shared irony of cognitive behavioral therapy workbooks applies here too. It asks a reader with ADHD to use tools regularly and to build a system. The book is aware of this and tries to make application easier, but however well a book is designed, it cannot fully give the outside structure a weekly appointment provides.

Age. A twelve-year-old book. The basic tools do not age. The technology chapter and some examples have aged.

How to use it

I do not see it as a book to be read from beginning to end.

It makes sense to read the first chapters, that is, the list, the planner and the time management part, in order, because everything after is built on them. After each chapter, stop for a week and really use that tool, and look at what held before moving on to the next chapter.

The work, relationships, technology and outsourcing chapters are like reference sections to be opened when needed.

If possible, work through it with a therapist, if not, with an accountability partner. At the very least, return to the book on a fixed day of the week at a fixed hour.

For whom

For adults who say the sentence "I know what I need to do but I can't do it."

A good book for someone who has been diagnosed, has understood what ADHD is, has left the period of emotional digesting somewhat behind and now wants to do something concrete.

Early for someone who has just been diagnosed and is still in the period of shame or grief. First a book that helps to understand the picture, then this.

And a short note: for someone who read Rethinking Adult ADHD and thought "these ideas are lovely but what will I be left with," this book is a good continuation. The order works the other way round too.