Editor's note: This text-based course is a transcript of the webinar, Time Blindness: A Critical Executive Function In Adults With ADHD, presented by Zara Harris, MSOT.
*Please also use the handout with this text course to supplement the material.
Learning Outcomes
- After this course, participants will be able to recognize and describe time blindness as it relates to adults with ADHD.
- After this course, participants will be able to distinguish the science behind "high time preference" and the connection with shorter life expectancy.
- After this course, participants will be able to apply the tools and strategies that help clients make time "real" and "manageable."
Introduction/Outline
That little click you heard was me turning on my timer. We’ll come back to that as we explore time blindness. Today, I want to take a deeper look at our current understanding of adult ADHD, the concept of time blindness, and a related term that might be new to some—high-time preference—which plays a significant role in this discussion.
Occupational therapy practitioners often see how these challenges manifest in daily life, sometimes in ways that clients struggle to articulate. I’ve worked with individuals constantly running late, not out of disregard for schedules but because their internal sense of time feels fragmented. Others describe an overwhelming sense of urgency when completing tasks, leading to last-minute bursts of effort. Then, some struggle to plan for the future because the present moment consumes all their attention.
The science behind these experiences is compelling. ADHD affects executive function, including how the brain perceives and organizes time. Time blindness isn’t just about being late—it’s about difficulty sensing the passage of time, estimating how long tasks will take, or pacing oneself effectively. On the other hand, high-time preference refers to prioritizing immediate rewards over long-term benefits. This can appear in financial decisions, health behaviors, or work habits, making it challenging to stick with delayed gratification.
Beyond the personal experience, there are social consequences. Relationships, employment, and daily responsibilities can all be impacted. Someone who struggles with time blindness might face frustration from loved ones or colleagues who misinterpret their behavior as careless or irresponsible. Occupational therapy practitioners play a key role in helping individuals develop strategies to work with, rather than against, their unique time perception.
That’s why intervention isn’t just about using planners or setting reminders—it’s about tailoring solutions that align with how an individual experiences time. For some, visual timers help externalize the passage of time. Others benefit from structured routines that anchor their day. Addressing time perception in occupational therapy isn’t just about productivity; it’s about fostering self-efficacy, reducing stress, and improving quality of life.
As we navigate this discussion, I invite you to reflect on how time perception influences our clients and ourselves. What strategies have you found effective? What challenges do you see in your practice? Let’s explore together how we can support individuals in managing time in a way that works for them.
ADHD in Adults
ADHD in adults is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity that significantly interferes with daily functioning and life achievements. It is not a minor condition, affecting an estimated 17 million people across all ages, genders, IQ levels, religions, and socioeconomic backgrounds in the United States alone. From my own experiences traveling and living overseas, I have seen ADHD present in every cultural group I’ve encountered. At one point, I even wondered if the Japanese might be an exception, given their highly structured education system, which often provides built-in scaffolding that supports individuals with ADHD remarkably well. However, that assumption quickly faded as I observed some of the most hyperactive individuals within this population, reinforcing the reality that ADHD is truly a global phenomenon.
For a long time, ADHD was believed to be a childhood condition that individuals would naturally outgrow. However, research now shows that approximately 75% of children with ADHD continue to experience significant symptoms into adulthood. The disorder is highly familial and genetic—it doesn’t simply vanish with age. Instead, individuals often develop strategies to function more effectively, sometimes masking their symptoms in ways that make it seem as though they have "grown out" of it. Over time, symptoms evolve—overt hyperactivity may diminish, but fidgeting, internal restlessness, and impulsivity often persist. Some individuals find ways to accommodate their challenges by choosing careers that align with their strengths, gravitating toward structured environments, or partnering with people who help them manage their executive functioning difficulties.
Despite these adaptations, adults with ADHD often face significant challenges in academic, professional, and social domains. They tend to have lower educational and career attainment compared to their neurotypical peers and are at higher risk for co-occurring psychiatric disorders. The risk of suicide is also increased in individuals with ADHD, underscoring the importance of early identification and appropriate intervention. ADHD rarely occurs in isolation—comorbid conditions such as anxiety, depression, sleep disorders, substance use disorders, and eating disorders are common, which is why accurate diagnosis is crucial. We can delve deeper into these comorbidities and their impact on occupational performance if you're interested.
Diagnosing ADHD is complex. There is no single medical, physical, or genetic test for it. Instead, a qualified mental health professional must conduct a thorough evaluation, gathering information from multiple sources, including clinical interviews, behavioral observations, and standardized assessments. In today’s era of online self-diagnosis, it might seem easy to label oneself with ADHD, but a true diagnosis requires expertise. The assessment process evaluates symptom severity, duration, and impairment across at least two life domains—such as work and home—not just in one setting. Additionally, it is critical to rule out other potential explanations for symptoms, such as anxiety, sleep deprivation, or even unmanaged stress, while also carefully assessing for comorbid conditions.
According to the DSM-5 and DSM-5-TR, ADHD is categorized into three distinct presentations: predominantly inattentive, predominantly hyperactive-impulsive, and combined presentation, with the latter being the most common. These classifications help guide treatment approaches, but in practice, symptoms often fluctuate based on an individual’s environment, demands, and coping mechanisms. As occupational therapy practitioners, understanding these variations allows us to tailor interventions that truly support an individual's daily ability to function and thrive.
Predominantly Inattentive Presentation
The predominantly inattentive presentation of ADHD is marked by significant challenges with attention and focus, often leading to difficulties in daily life. Individuals with this presentation may struggle to concentrate on details, frequently making careless mistakes in work or personal tasks. They might seem as though they are not listening when spoken to, not out of rudeness but because their minds easily drift. Following through on instructions can be particularly difficult, as retaining and sequencing information requires a level of sustained attention that does not come naturally.
Organizational skills tend to be a major challenge. Tasks that require extensive planning or prolonged mental effort—such as budgeting, report writing, or even scheduling appointments—are often avoided or left incomplete. This is not due to laziness but rather the sheer mental exhaustion of structuring complex tasks. Individuals with this presentation may frequently misplace important items, such as keys, phones, or documents, creating additional stress in their daily routines. External distractions, like background noise or movement, can quickly derail their focus, but just as often, their thoughts are the primary source of distraction, pulling them away from the task.
Forgetfulness is another hallmark of this presentation. Important dates, appointments, or daily responsibilities may be unintentionally overlooked. This can lead to frustration for the individual and those around them, particularly when deadlines or commitments are missed.
To be diagnosed with ADHD under the predominantly inattentive presentation, an adult must exhibit at least five of the nine symptoms outlined in the DSM-5. These symptoms must be persistent, impair daily functioning, and be present in multiple life domains, such as work, home, or social settings. Understanding this presentation is critical for developing effective occupational therapy strategies that support individuals' ability to manage their responsibilities, structure their environment, and create sustainable routines that work with their cognitive strengths rather than against them.
Predominantly Hyperactive/Impulsive Presentation
The predominantly hyperactive-impulsive presentation of ADHD is often more recognizable because its symptoms are outwardly visible, making it easier to diagnose. Individuals with this presentation tend to fidget, squirm, or have difficulty remaining seated in situations where stillness is expected. Restlessness is a defining feature—they may pace, tap their fingers, or shift in their seat constantly, often without realizing it. Engaging in activities quietly can be challenging, as they frequently display excessive movement or energy, even in settings where such behavior is socially inappropriate.
These individuals sit next to you in a lecture hall, clicking their pens or tapping their feet to maintain focus. They may speak excessively, interrupt conversations, or blurt out answers before a question is fully asked. Waiting their turn—whether in conversations, lines, or structured activities—can be incredibly difficult. Many describe an internal sensation of being "on the go," as if driven by an internal motor that doesn’t allow them to fully relax.
Hyperactivity doesn’t always manifest as physical movement; in adults, it can also present as an intense inner restlessness or an inability to slow down mentally. Some individuals channel this energy into highly active lifestyles, constantly seeking stimulation through work, hobbies, or social interactions. Others may experience frustration when forced into sedentary roles, leading to career difficulties that require long periods of focused, uninterrupted work.
Like the inattentive presentation, a diagnosis of hyperactive-impulsive ADHD in adults requires at least five of the nine symptoms outlined in the DSM-5. These symptoms must be persistent, impair daily functioning, and be present across multiple life domains. Recognizing this presentation is essential for tailoring interventions that help individuals manage their energy effectively, whether through structured movement breaks, environmental modifications, or strategies to enhance impulse control in work and social settings.
Combined Presentation
The combined presentation of ADHD requires an individual to meet the diagnostic criteria for both inattentive and hyperactive-impulsive presentations, meaning they experience significant difficulties with attention, hyperactivity, and impulsivity. Once diagnosed, the DSM-5 categorizes symptom severity as mild, moderate, or severe, acknowledging that ADHD exists on a spectrum and affects individuals in different ways.
Realistically, the term "ADHD" is not the most accurate or helpful diagnostic label, particularly for adults. Many adults with ADHD are not overtly hyperactive in the way that young children might be—constantly running, climbing, or bouncing from one activity to the next. The majority of adults fall more into the inattentive category, yet the diagnostic term remains ADHD, regardless of whether hyperactivity is a dominant feature. The term ADD, which was once used to describe the inattentive type, is no longer recognized in official classifications.
Another common misconception is that ADHD is purely a disorder of attention. Many individuals with ADHD can focus intensely—sometimes to the point of hyperfixation—on topics or tasks that interest them. The real challenge lies in regulating their attention, particularly when they are expected to focus on something less stimulating or externally imposed. This aspect of ADHD makes the term "attention deficit" somewhat misleading. The issue isn’t a lack of attention but rather the difficulty in directing and sustaining it in ways that align with societal expectations.
As with all aspects of life, individuals with ADHD often develop their methods of adapting to their challenges. Much of our work as occupational therapy practitioners involves helping them refine these strategies, ensuring they can function successfully in their professional and personal lives. The degree to which someone thrives with ADHD often depends on how well their job, relationships, and environment align with their cognitive style.
One example that stands out in my experience is a couple I dedicated my research thesis to. The husband, a former bishop in the Church of South Africa in Johannesburg, was an extraordinary man with a clear hyperactive presentation of ADHD. I often wondered how he managed to navigate such a demanding role so effectively—until I met his wife. She was a physical education instructor who lived by structure and certainty. In her world, the ball was either in or out—no gray area existed. She played a crucial role in his success, ensuring he moved from point A to point B, locking the doors at night, and handling the practical details that his ADHD made difficult. Their dynamic exemplified how a well-matched partnership can be a natural support system for someone with ADHD.
Ultimately, ADHD is better understood as an executive function disorder rather than simply an attention disorder. It affects time management, organization, impulse control, and emotional regulation—areas beyond attention. Perhaps one day, the terminology will evolve to reflect this reality more accurately. Until then, understanding ADHD through the lens of executive function can help us provide more effective interventions and support for those living with it.
What Is Executive Function?
Executive function is governed by the prefrontal cortex, the brain area responsible for directing and regulating thoughts, emotions, and behaviors. It is the last part of the brain to fully mature, typically not reaching full development until around the age of 25. This delayed maturation is crucial in decision-making, impulse control, and long-term planning.
Rental car companies understand this well. If you're under 25 and need to rent a car, you’ll likely face significantly higher insurance costs. The industry recognizes that individuals with underdeveloped executive function are statistically more likely to take risks and get into accidents. This real-world example highlights how executive function—or the lack of it—directly impacts behavior and outcomes in everyday life.
When explaining executive function to those outside our field, I often use the analogy of a bandleader or an orchestra conductor. Imagine an orchestra with musicians playing different instruments—winds, horns, timpani—all following their own sheet music. Even if every musician is highly skilled, the performance would be chaotic without a conductor providing timing, direction, and coordination. The music might start and stop at the wrong moments, with instruments clashing instead of harmonizing. The conductor ensures synchronization, guiding the musicians to work together seamlessly.
This is precisely what the prefrontal cortex does in the brain. Each brain region and body system may function well independently, but without strong executive function, they lack coordination. For individuals with ADHD, both children and adults, this absence of an effective "conductor" results in disorganization, impulsivity, and difficulty regulating behavior. Thoughts may feel scattered, time management becomes a challenge, and self-regulation is impaired—not because of a lack of intelligence or capability but because the internal conductor struggles to keep everything in sync.
Understanding ADHD through the lens of executive function helps explain why these individuals often experience difficulties with organization, emotional regulation, and goal-directed behavior. It shifts the conversation from "Why can’t they just focus?" to "How can we help strengthen their executive functioning skills?" By applying strategies that support self-regulation, external structure, and cognitive flexibility, we can help individuals with ADHD navigate their daily lives more effectively.
What Is Time?
Time is an intriguing concept—one that dictates nearly every aspect of our lives. Whenever I think about time, I immediately picture the White Rabbit from Alice in Wonderland, frantically rushing around, exclaiming, “I’m late! I’m late! For a very important date! No time to say hello, goodbye! I’m late, I’m late, I’m late!” Whether from the original book or the animated adaptation, that image perfectly captures the urgency and pressure that time imposes on us.
Our daily existence is completely governed by time. You had to be here at 12, and you need to leave at 1. Everything we do is structured within this framework. And yet, what is time? It is, in many ways, an abstract construct. There is no grand, universal clock like Big Ben determining an absolute measure of time. Instead, time is a societal agreement, a system we have created to bring order to our lives. We celebrate those who manage time well and criticize those who do not. Few insults carry as much weight as calling someone "a waste of time."
However, time is not just a rigid structure but deeply cultural. Having lived in different parts of the world, I have experienced firsthand how perceptions of time vary across societies. In Argentina, for example, if you invite someone to dinner at 8:00 p.m., arriving at 10:00 p.m. would still be acceptable. The real courtesy lies in accepting the invitation, not adhering to the clock. Social expectations around time can be fluid, even extending to whom one brings to dinner—whether a spouse or, in some cases, a mistress.
These cultural differences remind us that time is not as fixed as we often assume. However, time follows a far more structured and unforgiving rhythm for those living and working in the United States. Our expectations around punctuality, productivity, and efficiency shape our daily responsibilities and our sense of personal worth. A person who is "good with time" is often seen as competent and reliable, whereas someone who struggles with time management may be unfairly perceived as careless or unmotivated.
Understanding the fluidity of time across cultures can be liberating, but within our societal framework, we must acknowledge the challenges that arise when an individual’s internal sense of time does not align with external expectations. This is especially relevant when discussing neurodivergent experiences, such as ADHD and time blindness, where the perception of time is altered, making traditional time management strategies less effective. Time, though intangible, holds immense power over how we function in the world. How do we navigate it in a way that works for us, rather than feeling like we’re constantly chasing after the White Rabbit?
How Long Does It Take?
Let’s take a moment to think about time in practical terms. How long does it take for water to boil before adding pasta? How long does it take to get to class or fill a bathtub? Most of us develop an intuitive sense of these things. We don’t routinely overfill the bathtub or let a pot boil dry before adding the pasta because, through experience, we’ve learned to anticipate the passage of time and adjust our actions accordingly.
For many people, this awareness of time feels almost automatic. It’s not something consciously calculated—it’s just known. However, this isn’t an ability we are born with; rather, it’s a skill that develops as we grow older. Through experience and repetition, we refine our internal clock, allowing us to plan our actions with relative accuracy. This intuitive time sense enables us to navigate daily life effectively, from estimating how long it will take to get ready in the morning to pacing ourselves during a long workday.
But what happens when this internal clock is unreliable? For individuals with ADHD or other executive function challenges, gauging time accurately can be incredibly difficult. Tasks that seem simple—like estimating how long it will take to send an email or complete a short errand—can suddenly stretch much longer than expected or, conversely, be rushed through with the assumption that there’s more time than there is. This disconnect between perceived and actual time is at the core of time blindness, which can significantly impact productivity, punctuality, and daily functioning.
For those who take our sense of time for granted, it can be hard to imagine what it feels like to lack that intuitive clock. However, by understanding that this skill is learned rather than inherent, we can better appreciate why some individuals struggle with time-related tasks and how interventions can help them develop more effective time-management strategies.
What Is Time Blindness?
Time blindness is the inability to perceive and measure time accurately. Individuals who experience time blindness lack the internal clock that most people develop, making it difficult to judge the passage of time or estimate how long tasks will take. This difficulty often leads to planning, punctuality, and overall time management challenges.
For most people, an intuitive sense of time develops through repeated experiences—waiting for a traffic light to change, knowing how long it takes to brew coffee, or estimating the duration of a meeting. However, for those with time blindness, these estimations are unreliable. Five minutes may feel like thirty, or vice versa, leading to an ongoing struggle with keeping schedules and following through on commitments.
Time blindness is commonly observed in individuals with neurodevelopmental disorders, particularly ADHD, but it can also be present in other conditions affecting executive function, such as traumatic brain injuries, autism, and certain mood disorders. Without an intuitive sense of time, individuals may struggle to regulate their daily routines, frequently underestimating or overestimating how much time they need for tasks. This can result in chronic lateness, missed deadlines, and frustration from others who misinterpret these struggles as irresponsibility or lack of effort.
One of the biggest challenges for those with time blindness is the disconnect between intention and execution. Someone might fully intend to leave the house on time but become absorbed in a task, unaware that an hour has passed instead of the five minutes they thought. Conversely, they may overcompensate, arriving far too early because they can’t accurately gauge how long their commute will take.
This is where occupational therapy interventions can play a crucial role. Strategies like externalizing time through visual timers, setting structured routines, and using alarms or reminders can help bridge the gap between perceived and actual time. By creating external structures that support time awareness, individuals with time blindness can develop more effective ways to manage their daily responsibilities and reduce the stress that often accompanies their difficulties with time perception.
Symptoms
Individuals with time blindness frequently lose track of time due to distractions, often describing a disconnection from how others seem to predict and measure time so naturally. Many feel they lack an internal clock, making it difficult to pace themselves throughout the day. This inevitably leads to poor time management—falling behind on responsibilities, missing deadlines, or running late. When ADHD is accompanied by impulsivity, the challenge becomes even greater, as decisions are often made at the moment without an awareness of how they will affect future commitments.
Boredom is another significant factor. Many individuals with time blindness describe feeling easily disengaged, which can lead to time slipping away unnoticed. This often results in excessive time spent on unplanned activities—scrolling through a phone, hyper-fixating on a single task, or zoning out completely—while important tasks remain unfinished. Transitions are also a major challenge. Shifting from one task to another, particularly from an engaging activity to a necessary but less stimulating one, can be difficult. For example, someone might be deeply focused at their desk and fail to realize that it's time to start dinner much later than planned. Procrastination becomes a natural byproduct of these struggles, with tasks continually pushed back until they become urgent, leading to cycles of last-minute stress and frustration.
One particular moment from my research in the UK on adults with ADHD in the workplace stands out as a powerful example of time blindness. I interviewed a man in his mid-30s, a father of two who worked as a long-distance truck driver. He had switched jobs frequently but found that truck driving allowed him to work independently while managing his social interactions on his terms. He was exceptionally well-informed, spending hours listening to talk radio while driving, and could hold in-depth discussions on politics, philosophy, and global events. Like many individuals with ADHD, he was engaging, intelligent, and energetic.
During our conversation, I asked about his employment history, as my research focused on job patterns among adults with ADHD. To help him recall a timeline, I posed a simple question: “Who were you working for on 9/11?”—a moment most people remember vividly. He paused for a moment, then responded, “Ah, September… Now, does September come before or after August?”
That moment truly highlighted the nature of time blindness. This was a highly capable, articulate man with an impressive ability to retain and analyze complex information, yet he still struggled to sequence basic time concepts well into his 30s. This interaction underscored how profound time blindness can be—it’s not just about lateness or disorganization but about a fundamental difficulty in perceiving, processing, and structuring time. For individuals with ADHD and other executive function disorders, time does not flow in a predictable, linear manner. Instead, it can feel fragmented, inconsistent, and difficult to grasp, making traditional time management strategies frustratingly ineffective. Recognizing this helps shift the conversation from simply expecting better planning skills to developing adaptive strategies that work with, rather than against, an individual’s unique time experience.
Time Management (TM)
Time management is critical in nearly every aspect of life—whether in the workplace, at home, or as a student. It is the system by which we organize, prioritize, and complete tasks efficiently. For most people, time management is a skill that evolves, shaped by personal experience and the external structures that guide us during childhood and adolescence.
However, these external structures diminish as we age, and the responsibility for managing time independently increases. This transition can be particularly challenging for individuals who struggle with executive function. A clear example of this is seen in students who excel in high school under the structured guidance of teachers and parents but then struggle in college when those supports are removed. Without a parent managing their schedule, reminding them about assignments, or ensuring they complete daily responsibilities like laundry and meals, many students find themselves overwhelmed and unsure of how to structure their time effectively.
This shift can be especially difficult for individuals with ADHD or time blindness. Without built-in structures, they often struggle to regulate their schedules, keep up with deadlines, and balance multiple responsibilities. This can lead to academic difficulties, missed obligations, and increased stress. Many describe a feeling of constantly playing catch-up, where deadlines seem to appear out of nowhere because time wasn’t tracked accurately. Small, manageable tasks can pile up until they become overwhelming, further reinforcing patterns of procrastination and last-minute scrambling.
Workplaces and higher education environments tend to assume that individuals already possess strong time management skills. Deadlines are set with the expectation that employees or students will pace themselves accordingly. Yet, for those with executive function challenges, this assumption fails to account for how difficult it can be to break large tasks into smaller steps, estimate how long something will take, or even recognize when time is slipping away.
This is why externalizing time—using planners, visual timers, alarms, or structured routines—can make a significant difference for individuals who struggle with time management. Strategies that provide clear, external markers of time help bridge the gap between perception and reality, reducing the cognitive load required to track time internally. By recognizing the challenges associated with time management in ADHD and time blindness, we can create strategies that support individuals in developing sustainable routines that work with their brains rather than against them.
Children Live in the "Now"
Children are not born with a sense of time. They exist entirely in the present, fully absorbed in whatever they are doing at any given moment, without much awareness of the past or the future. This is why young children, particularly those with ADHD, often struggle with cause-and-effect reasoning. They may not naturally reflect on past experiences to guide their current choices, making traditional parenting strategies that rely on consequences less effective. A child may repeatedly touch a hot stove or forget to bring their homework, not because they don’t care or aren’t intelligent, but because the connection between past actions and future outcomes hasn’t yet solidified in their cognitive development.
As individuals mature, they typically develop the ability to integrate past experiences and future planning into their present decision-making. This skill—understanding how past actions led to specific outcomes and using that knowledge to anticipate future consequences—becomes fundamental to responsible decision-making. Most people learn to delay gratification, plan ahead, and adjust their actions based on what they have previously experienced. However, for those with ADHD or time blindness, this developmental progression is often disrupted. Their difficulty in perceiving time makes it harder to recognize patterns, recall past mistakes at the moment, or effectively plan for future responsibilities.
This impairment can create challenges in various aspects of life. In school, a student with ADHD may genuinely intend to start a project early but continuously put it off because the deadline doesn’t feel real until it’s imminent. Employees might struggle with pacing themselves at work, either procrastinating or hyperfocusing on one aspect of a task while losing track of other priorities. In personal life, relationships can be strained when a person repeatedly forgets appointments, misjudges time commitments, or fails to follow through on responsibilities—not out of neglect, but because time doesn’t register as it does for others.
Understanding time blindness as a neurological difference rather than a personal failing allows for more effective interventions. Strategies such as externalizing time through calendars, alarms, and structured routines can provide the scaffolding to bridge the gap between intention and execution. By recognizing that time perception is not a given but a skill that can be supported, we can help individuals with ADHD navigate their personal, academic, and professional lives more successfully.
Choice Behavior
This concept may or may not be familiar to you, but in everyday life, we constantly make trade-offs, weighing the potential consequences of our choices. These decisions often center around well-being and long-term goals—saving money instead of spending it, choosing healthy food over junk food, or studying for an exam rather than watching TV. The ability to prioritize long-term rewards over immediate gratification is a cognitive skill that develops as the brain matures. However, due to its impact on executive function, ADHD is associated with high-time preference compared to same-age peers, making it more challenging to delay gratification and plan for the future.
High-time preference refers to a tendency to prioritize immediate rewards over future benefits, whereas low-time preference—which typically strengthens with age—allows individuals to make choices with their future well-being in mind. ADHD is linked to a developmental lag in this progression, making it harder for individuals to weigh long-term consequences effectively. This difficulty is not due to a lack of intelligence or willpower but rather a difference in how the brain processes time and rewards.
A classic example of this concept comes from the famous marshmallow experiment, in which children were given the choice between eating one marshmallow immediately or waiting to receive three later. The experiment captured their struggle with delayed gratification—some children turned away from the marshmallow, squeezing their hands into fists to resist, while others gave in and ate it right away. While the study has been debated regarding its long-term predictive power, it still illustrates the fundamental challenge of delaying immediate rewards for greater future benefits.
As adults, most of us make decisions that prioritize long-term benefits when future consequences are both significant and probable enough. We invest in retirement, maintain relationships, and pursue education or career growth with the understanding that these efforts will pay off in the future. However, the ability to do so varies widely among individuals. Psychologist Russell Barkley has pointed out that time preference varies as broadly as human height—some people naturally have a strong ability to delay gratification, while others struggle with it, regardless of intelligence or motivation.
For individuals with ADHD, this challenge manifests in daily life. A person might fully understand the importance of paying bills on time, but the reward of a night out with friends feels more immediate and tangible than the distant penalty of a late fee. Likewise, the long-term benefits of exercise or healthy eating may not carry enough weight at the moment compared to the instant pleasure of comfort food or sedentary activity.
Recognizing that time preference is neurologically influenced rather than simply a matter of willpower allows for more effective interventions. By externalizing rewards, setting structured incentives, and breaking larger goals into smaller, more immediate milestones, individuals with ADHD can bridge the gap between present actions and future outcomes, making long-term success more attainable.
Delayed Gratification
Lower Time Preference
Delayed gratification is a key factor in long-term success. Individuals with a lower time preference—the ability to prioritize future rewards over immediate gratification—tend to make choices that support their long-term well-being. They are more likely to save money, build stable careers, and maintain healthier lifestyles. Research also suggests that those with a lower time preference are less likely to engage in dishonest, impulsive, or aggressive behaviors. In many ways, the ability to delay gratification aligns with what we commonly associate with success—careful planning, long-term goal setting, and thoughtful decision-making.
Higher Time Preference
On the other hand, individuals with a higher time preference—like the child who eats the marshmallow in the classic experiment—prioritize immediate rewards over future benefits, often to their detriment. This tendency affects nearly every aspect of daily life, from nutrition and sleep to substance use, relationships, finances, employment, and overall health. Someone with a high time preference might struggle to save money because spending provides an immediate reward. They might stay up late watching TV even though they have an important meeting the next morning. They may engage in impulsive behaviors in friendships or intimate relationships without considering the long-term impact.
For individuals with ADHD, high time preference often makes maintaining long-term stability particularly challenging. The ability to consistently make choices that benefit one’s future requires strong executive function, particularly in areas such as impulse control, planning, and self-regulation—precisely where ADHD presents the greatest difficulties.
Someone with a higher time preference is far more likely to prioritize immediate gratification over long-term benefits. They are the ones who eat the marshmallow, not just one piece of chocolate but the entire box, or say, “I’ll just have one more drink,” even when they know they’ll regret it later. They may skip exercising because it’s raining outside, putting off important responsibilities. After all, the immediate discomfort outweighs the distant reward, or they spend impulsively despite knowing they should save.
This tendency creates significant challenges in everyday life, affecting nearly every domain—health, finances, relationships, work, and overall well-being. High-time preference can result in impulsive spending, poor dietary choices, difficulty maintaining routines, and struggles with commitment. Tasks that require long-term effort and delayed gratification—like saving for retirement, maintaining a fitness regimen, or pursuing higher education—may feel overwhelming or not urgent enough to take priority.
For individuals with ADHD, these challenges are compounded by deficits in executive function, making long-term planning, impulse control, and self-regulation even more difficult. They may genuinely intend to make better choices but struggle to bridge the gap between intention and action. The future often feels too abstract, making immediate rewards far more compelling.
Recognizing this pattern helps shift the conversation from blaming individuals for poor self-control to understanding the neurological factors at play. Instead of relying on willpower alone, effective strategies involve externalizing accountability—using reminders, structuring environments to reduce temptations, and breaking long-term goals into smaller, more immediate rewards. By creating systems that support decision-making rather than relying on internal time management, we can help individuals with ADHD and high-time preferences develop habits that lead to better long-term outcomes.
Why Is This Important?
So why does this matter? The impact of ADHD symptoms—particularly disinhibition and lower conscientiousness—goes far beyond daily struggles with organization or focus. Research has shown that these traits are linked to a significantly shorter life expectancy. Disinhibition, which is closely tied to high-time preference, leads individuals to make impulsive choices that can have serious long-term consequences. This isn’t just about forgetting deadlines or struggling with time management—it’s about decisions that affect health, safety, and overall well-being.
Individuals with ADHD, who often exhibit high-time preference, have been shown to have a significantly lower life expectancy. This isn’t a minor concern—it is a major public health issue. No matter which area of occupational therapy you work in, you will encounter clients affected by these challenges. ADHD influences more than just attention; it impacts impulse control, risk assessment, and long-term planning, all of which are critical for maintaining health and safety over a lifetime.
Russell Barkley’s research, published in 2004, estimated a reduction in life expectancy of 11 to 13 years for individuals with ADHD. While this was based on a predictive model, the implications are staggering. This reduction is greater than the combined effects of heart disease, high blood pressure, and many forms of cancer. The primary reasons for this shortened lifespan are behavioral risks—such as higher rates of accidents, substance use, poor diet, inconsistent healthcare, and engagement in risky behaviors—many of which stem from difficulties with executive function and impulse control.
This research underscores the urgency of addressing ADHD not just as a matter of academic or workplace performance but as a life-threatening condition that demands targeted intervention. As occupational therapists, we are in a position to help individuals with ADHD develop skills that promote long-term health, safety, and well-being. Strategies such as externalizing executive function demands through structured routines, using environmental modifications to reduce risk, and providing coaching in decision-making can make a profound difference. By understanding the broader implications of ADHD and time preference, we can improve daily functioning and overall life expectancy for those we serve.
Newsworthy
I am truly excited to share a groundbreaking study published in January 2025 in The British Journal of Psychiatry, which analyzed data from over 30,000 adults diagnosed with ADHD in the UK. This matched cohort study revealed that men with ADHD had a life expectancy reduction ranging from 4.5 to 9 years, while women faced an even greater reduction of 6.5 to 11 years compared to those without the condition.
These findings underscore the critical need for targeted interventions to support individuals with ADHD in managing health risks and improving long-term outcomes. I highly recommend reading the full study for those interested in exploring this topic further. Additionally, Dr. Russell Barkley, a prominent figure in ADHD research, has extensively discussed the long-term impacts of ADHD on health and life expectancy. His insights provide a compelling perspective on the urgency of addressing these risks.
Understanding the profound implications of ADHD on life expectancy emphasizes the importance of comprehensive support systems and effective interventions. As occupational therapy practitioners, we play a vital role in helping individuals with ADHD develop strategies that promote long-term health, safety, and well-being.
Role of Occupational Therapy
This is why I am so passionate about raising awareness of ADHD in adults—not just among occupational therapy practitioners working in mental health, pediatrics, or schools, but across all areas of practice. The implications of ADHD extend far beyond childhood or traditional psychiatric settings.
For example, if you are a hand therapist, consider how a patient lost their fingers—was it due to an impulsive action? If you work with individuals recovering from car accidents, could impulsivity or time blindness have contributed to their situation? In cardiology, are patients failing to take their medications consistently? Could these behaviors be linked to high time preference and executive function deficits? I believe in many cases, the answer is yes.
So where do we fit in as occupational therapy practitioners? It is not within our scope to diagnose ADHD, but it is absolutely within our practice to recognize red flags, ask the right questions, and encourage individuals to seek evaluation. If you want to explore more on how to approach this, I highly recommend the CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) organization. CHADD is a national organization dedicated to ADHD education and advocacy, and everything on their site is grounded in scientific research. Given the amount of misinformation about ADHD online, this is a trusted, evidence-based resource. They also provide excellent handouts and materials that can help guide clients toward proper diagnosis and support.
As occupational therapy practitioners, we have a responsibility to be educated about ADHD in all its forms, not just its pediatric presentation. Many of you may be familiar with the Brief Behavior Rating Inventory of Executive Function (BRIEF), a valuable tool used in various areas of OT practice. It can be particularly helpful in assessing and explaining executive function challenges to clients. Understanding and integrating these concepts into our work can make a profound difference in the lives of individuals with ADHD, helping them build strategies to improve their long-term outcomes.
Understanding Time Blindness For Better Interventions
As occupational therapy practitioners, understanding time blindness is essential because it allows us to design more effective interventions tailored to our clients' unique challenges. I greatly respect our physical therapy colleagues, but their traditional approach to prescribing exercises—such as “Do 28 push-ups” or “Complete 30 squats every day”—often assumes a level of internal time awareness and self-discipline that individuals with ADHD may struggle with. Without external structure, built-in accountability, and immediate reinforcement, someone with time blindness or high time preference is unlikely to sustain that goal-directed activity.
This is where we, as OTPs, can step in. We have the ability to reframe goals in ways that align with how individuals with ADHD engage with tasks. Instead of relying on abstract, long-term motivation, we can incorporate intermediate rewards and structure tasks to be more engaging and manageable. This could mean gamifying exercise routines, integrating movement into daily activities, or linking tasks to external cues that make them more tangible. We increase the likelihood of sustained follow-through by designing interventions that work with a client’s natural tendencies rather than against them.
Additionally, we can help clients establish accountability structures—whether checking in with a friend, using visual trackers, or incorporating technology like reminder apps to reinforce consistency. This aligns with a core principle in occupational therapy: intervention at the point of performance. Change happens not just through good intentions, but in the context of real-life routines, habits, and environmental demands.
The real challenge is implementing these strategies to fit each client’s needs, strengths, and environment. This is where our role becomes crucial in helping individuals with ADHD improve their daily functioning, build sustainable habits, and ultimately, enhance their long-term success. By recognizing and addressing time blindness within our interventions, we can create meaningful, practical solutions that make a lasting difference.
How Does Time Blindness Affect Occupational Performance?
So, how does time blindness affect occupational performance? It shows up in a variety of ways that disrupt daily life. Our clients often misjudge how long it takes to complete a task or get somewhere, leading to chronic lateness. They miss important deadlines, put off necessary but mundane responsibilities—like paying bills—and struggle with procrastination, which can cause serious financial or professional consequences. Organization is another major challenge, whether at work, home, or school. Clutter, misplaced items, and unfinished projects often accumulate, making it even harder to stay on top of daily demands.
Task completion can be particularly difficult. Individuals with time blindness may start something with good intentions but lose track of time or get distracted before finishing. Transitions from one task to another are another common struggle. The mental shift required to stop one activity and start another—especially if the second task is less engaging—can be overwhelming. This leads to a pattern where tasks are abandoned halfway through, or new ones are started impulsively without completing previous commitments.
A perfect example comes from my bishop friend in Johannesburg. Locking up the house at night was an important security measure in that environment. But on his way to the door, he might notice a postcard that had just dropped through the letterbox. Oh, I better deal with that! And just like that, he would be off on another task, leaving the door unlocked. It wasn’t a conscious choice—it was simply how his attention was redirected at the moment.
Many of us can relate to this type of distraction in transitions on some level. You set out to do one thing, but along the way, something else captures your attention, and suddenly, you find yourself on an entirely different track without completing the original task. For individuals with ADHD and time blindness, this isn’t just an occasional frustration—it’s a daily occurrence that can impact safety, productivity, and well-being.
As occupational therapy practitioners, recognizing these patterns allows us to create interventions that accommodate these challenges. Rather than relying on willpower or internal time awareness, we can implement external strategies—visual reminders, structured routines, and accountability systems—to support clients in improving task completion, organization, and transitions. By understanding how time blindness affects occupational performance, we can help individuals build more sustainable strategies to navigate daily life effectively.
Personal and Emotional Repercussions
But never underestimate the emotional repercussions of this. When intentions and actions don’t align, it creates a deep sense of inadequacy. They genuinely want to be on time, finish tasks, and follow through, but time blindness gets in the way. Over time, they begin to feel like they are constantly disappointing others.
Being labeled as lazy is particularly painful. It dismisses their effort and turns a neurological challenge into a moral failing. The frustration, guilt, and shame build up, making it even harder to stay motivated. The personal and emotional toll of this executive function delay is significant and should never be underestimated.
Social Implications
The social implications of time blindness are significant. When someone is constantly late, others don’t always see it as a struggle with time perception—they take it personally. Friends, family, and colleagues may feel slighted, interpreting chronic lateness as a sign of disrespect or indifference. Over time, these misunderstandings can strain relationships.
In professional settings, the impact is just as serious. Being late to meetings, missing deadlines, or struggling to manage schedules can quickly lead to the reputation of being unreliable or a poor manager. These perceptions can affect job performance, career growth, and workplace relationships. In some cases, people find it outright insulting—If this mattered to you, you’d be on time. They don’t see the underlying executive function challenges; they only see the repeated behavior.
These social consequences make time blindness more than just a logistical issue—it’s relational. It affects trust, credibility, and how others perceive an individual’s intentions.
In The Workplace
Eventually, people will start to see you as unreliable in the workplace. The ramifications of this are significant. The research I conducted with adults with ADHD, focusing on employment patterns, confirmed that adults with ADHD change jobs far more frequently than those without the condition. But the most striking finding was that the number one reason people with ADHD were fired was poor timekeeping.
This study took place in the UK, where labor laws make it harder to fire employees compared to the U.S. That makes the finding even more compelling—if job loss due to timekeeping issues is happening at a high rate in the UK, where employment protections are stronger, the impact is likely even more pronounced in countries with more flexible termination policies.
Timekeeping is something employers can measure, record, and document as legitimate grounds for dismissal. So, it’s not surprising that chronic lateness or missed deadlines would be a primary reason for job loss. It’s a concrete issue with clear evidence, unlike other workplace challenges that might be more subjective.
This reinforces the need for practical interventions. Time blindness isn’t just an inconvenience—it has real consequences for job security, career advancement, and financial stability. Addressing it isn’t just about improving productivity; it’s about ensuring long-term employability and reducing the risks of being seen as unreliable in professional settings.
What To Do?
The first step in addressing time blindness is understanding that it is a component of executive function. This is where the conductor of the orchestra analogy becomes so useful. People with ADHD have all the necessary skills—they are intelligent, capable, and have functioning “instruments” in their brains. Their violins, timpani, and horns work just fine. The issue isn’t their ability; they lack a strong conductor to keep everything in sync. Their brain struggles to regulate the timing, coordination, and transitions necessary for effective time management.
Once we establish this understanding, the most important takeaway from this entire discussion is this: Time blindness and ADHD explain why these difficulties occur, but they are not an excuse. Individuals with ADHD are not at fault for struggling with time, but they do have a responsibility to develop compensatory strategies. This distinction is crucial—understanding the challenge is step one, but learning to work around it is what leads to success.
The key, then, is to teach strategies that make time real. Time is an abstract, amorphous concept—more so for some people than others. For those with time blindness, traditional time awareness doesn’t develop naturally, so externalizing time is necessary. This is where tools like clocks, timers, visual schedules, and alarms become essential. These external structures serve as the “conductor” that the brain lacks, providing clear, tangible cues to help regulate tasks, transitions, and deadlines.
The goal isn’t just to make someone more punctual—it’s to equip them with systems that allow them to function successfully in daily life. By helping individuals with ADHD recognize time blindness as a challenge they can work with rather than fight against, we empower them to take control of their routines, responsibilities, and long-term success.
Analog Vs. Digital
I strongly encourage people to use analog clocks rather than digital ones. It’s increasingly common for children to grow up without ever learning how to read an analog clock because they can quickly glance at a digital display on a stove, microwave, phone, or smartwatch. They may be able to say, "It's 7:30," but they lack a real sense of time progression because they’ve never had to visualize it.
So first, check that they actually know how to read an analog clock. If they don’t, teaching them can make a real difference in their time awareness.
Why is an analog clock so important? Here’s the key: most of the time, when we look at a clock, we don’t need to know the exact time down to the minute. What we need to know is whether we’re running late or still have time. If I need to be somewhere at 11:30 and I glance at an analog clock, I immediately see that I have one minute left. If I need to be somewhere at noon, I can instantly recognize that I have half an hour. An analog clock gives a clear, visual representation of time present, time past, and time future all at once.
With a digital clock, this awareness isn’t automatic. If the clock says 7:30 and I need to be somewhere at 7:45, my brain has to calculate the difference: Okay, 45 minus 30… that’s 15 minutes. For individuals with time blindness, that extra cognitive step—doing the math to figure out how much time remains—is often skipped entirely. Without a strong internal clock, they don’t naturally feel the time passing, which makes estimating it even harder.
This is why analog clocks are so much more effective. They make time visual. You don’t just know the time—you see it moving. The position of the hands gives a direct, intuitive sense of how much time has passed and how much remains. If someone already has a digital watch, most models allow you to switch to an analog display. I keep mine set to analog at all times.
For individuals with ADHD and time blindness, externalizing time is crucial, and analog clocks are one of the best tools to help bridge the gap between intention and action. If you’re working with someone struggling with time perception, start by making sure they’re using a clock that shows the time in a way their brain can process more effectively.
Clocks in Every Room
Clocks in every room. This is one of the simplest yet most effective strategies for individuals with time blindness. They need to see time everywhere—in the kitchen, bedroom, office, bathroom, and even near the front door. Time must be externalized to keep it constantly within their awareness.
Talk to them about their clocks. Where are they? How often do they look at them? Can they actually tell time accurately? Make sure they’re using clocks in a way that supports their time perception. Most importantly, those clocks should be analog. A collection of digital clocks won’t be nearly as effective because they require that extra mental calculation. Analog clocks provide a constant, visual representation of time passing, helping the brain see it instead of processing it numerically.
Beyond clocks in every room, encourage them to wear a watch. Not a phone. Phones get left behind, buried in bags, or serve as distractions when picked up. A watch, especially an analog one, keeps time visible at all times. It eliminates the excuse of “I didn’t check the time” because it’s always on their wrist.
Making time unavoidable is one of the most effective ways to improve awareness and accountability for individuals with ADHD and time blindness. It’s a small change, but it can make a big impact.
Wear a Watch
Wear a watch—one that is attached to them at all times. Time needs to be on them, not just around them. Phones are unreliable for time awareness because they get left on desks, buried in bags, or forgotten in another room. I know I’m guilty of this myself—the button I press most on my Apple Watch is the one that pings my phone! It’s not always in my pocket, and for many people, that’s the case too.
Maybe some individuals keep their phones on them at all times, but even then, checking the time often leads to distraction. They glance at the clock and suddenly find themselves scrolling through notifications, answering a text, or opening an app. The time-checking moment is lost in the sea of digital noise.
This is why wearing a watch—an actual, dedicated timepiece—is so important. A watch keeps time visible, accessible, and free from distractions. If possible, encourage them to wear an analog watch. It reinforces the ability to see time moving rather than just reading a number.
For individuals with ADHD and time blindness, externalizing time isn’t just about having clocks—it’s about ensuring that time is always within reach. Wearing a watch eliminates the barrier of having to look for time. It’s there on them, helping to keep them grounded in the present and aware of what’s next.
Use a Timer
And then, timers. Use countdown timers, count-up timers—whatever works best for the task at hand. Timers make time real by externalizing it so that individuals with time blindness can see and feel.
Often, a timer alone isn’t enough. You need both a clock and a timer working together. Just like my situation right now—I have a clock telling me how much total time I have left, but I also have a timer counting down. The issue with countdown timers is that once they hit zero, they don’t track how much time has passed since zero. This is where a clock becomes essential—it tells you how long you’ve gone over time, which can be just as important.
A particularly valuable tool for individuals with ADHD is the Time Timer. You may already be familiar with it—it’s one of the most useful tools for this population. That’s the one in the top right, with the red section that shrinks as time passes. Instead of relying on numbers alone, it visually represents time disappearing, making it much easier to understand time passing at a glance.
For individuals who struggle with time perception, these external supports are game-changers. Combining clocks, timers, and visual countdown tools helps bridge the gap between intention and execution, giving them a much-needed sense of control over time.
Managing Time/Write It Down
Teach your clients this simple rule for managing time: Do it now or write it down. There’s no in-between. If a task isn’t completed immediately, it must be externalized—preferably in writing—because relying on memory alone is a losing battle for those with time blindness.
Why writing? Because writing engages motor memory. Think about how many times you’ve made a shopping list in the kitchen only to leave it behind on the table. Yet, when you arrive at the store, you somehow remember most of what was on the list. Why? Because the act of writing it down locked it in through motor memory. This same principle applies to managing time and tasks—if they write it down, they’re far more likely to remember and follow through.
Motor memory is fundamental to so many aspects of our daily lives. I know I’m speaking to the converted here—OTs understand this better than anyone—but it’s worth reinforcing for our clients. Writing down an appointment, a deadline, or a to-do list can make an enormous difference in helping individuals with ADHD externalize time and bridge the gap between intention and execution.
Phones/Watches/Tablets/Computer
Phones, watches, tablets, computers—we all have them. But do we use them effectively? Many time management tools require apps; while some are free and others are paid, they all require new learning. That’s the key factor—whether the tool exists, but whether the individual is prepared to invest the time and effort into learning how to use it properly.
So, how do we approach this? First, encourage your clients to research before investing in a new app. A simple way to start is by checking out a YouTube tutorial on how the app works. There’s no sense in spending time and money on something they won’t fully engage with. The second consideration is whether they will realistically dedicate the necessary learning time to make it work. A tool is only useful if it gets used—having multiple time management apps sitting unused on a phone is no different than owning a treadmill that never gets turned on.
I’ve read countless articles listing apps that can help with time management. While many of them are well-designed, their effectiveness depends entirely on the individual’s ability to integrate them into daily life. This is where occupational therapy practitioners can step in. We can help our clients trial different tools, determine what best fits their habits and routines, and support them in learning how to apply them effectively.
The goal isn’t just to introduce technology but to ensure that it works for the client. If an app isn’t intuitive or requires too many steps, it may not be the best fit. Instead, we need to help individuals find functional, sustainable solutions—whether that’s a simple calendar reminder, an external alarm, or a highly structured planning app. The key is selecting tools that match the client’s level of engagement and ability to integrate them into real-life habits.
Daily Calendar
A daily calendar is essential. If digital works for someone, great—but are they using it? Digital tools are effective for some people, especially when synced across devices. If that’s the case, ensure their calendar is connected to their phone, watch, and computer so that if one device is lost, their schedule isn’t lost with it. One of the biggest advantages of digital calendars is the ability to set multiple alarms and reminders—these should be used frequently and strategically.
However, for many individuals, a paper calendar is often preferable. It engages motor memory, which reinforces the information. But the calendar must be functional—visually appealing, easy to navigate, and include daily, weekly, and monthly pages. The ability to quickly flip between a monthly and weekly view is crucial for tracking upcoming deadlines while still managing daily tasks.
Certain habits must be firmly established if a client uses a paper calendar. First, the calendar must be with them at all times. How will they move it from work to home? Where will they keep it? Discuss a system that ensures it’s always accessible.
Second, if it’s not written down, it doesn’t exist. This habit must be engraved into their system. Plans, commitments, appointments—everything must go into the calendar. Encourage them to write things down immediately instead of relying on memory.
Third, they must estimate time accurately and block it in the schedule—including time for transitions. It’s not enough to write down “Dentist at 2:30.” If they don’t account for the fact that they need to leave at 2:00 to get there on time, they will run late.
A useful exercise is to review past calendar entries together—if they used a paper calendar, they can go back and see how accurately they estimated time. Did they allow enough time for transitions? Did they schedule too much in one day? Helping clients reflect on this can improve their ability to plan effectively.
Walking through this process with your clients—choosing the right calendar type, establishing habits, and refining time estimation—can make a huge difference in how successfully they manage their schedules. Whether digital or paper, the goal is to externalize time and create a reliable system on which they can depend.
Family Calendar
I always encourage the families I work with to have a large family calendar in a central location—usually the kitchen. It should be somewhere highly visible, where everyone can see it. This becomes the command center for the household, listing everyone’s events—mom, dad, the kids, soccer games, basketball games, doctor’s appointments, work meetings—everything.
And the rule is simple: If it isn’t on the calendar, it doesn’t exist.
When someone schedules a new appointment, they can immediately see if there’s a conflict. There will be no more double-booking or forgotten commitments. A shared calendar creates accountability for the whole family, reducing stress and last-minute scrambling.
For individuals with ADHD, externalizing time and commitments in this way can be a game-changer. Instead of relying on memory or fragmented reminders, they have a single, reliable system that keeps everyone on the same page.
Analyze Chronic Lateness
If you can help your clients analyze their chronic lateness, they can start to identify patterns. What do they constantly miss? Are it appointments? Work meetings? Social events? School drop-offs? Which part of the process is tripping them up?
- Are they underestimating how long things take?
- Are they struggling with transitions?
- Are they losing track of time while doing something else?
- Are they forgetting to check their calendar or reminders?
Once you pinpoint the problem areas, you can work with them to create strategies that directly address those challenges.
The motto they need to learn is simple: On time, all the time.
Of course, we all strive for this, but for those with time blindness, it requires structured support. By helping them understand where their struggles lie, we can help them develop systems that make punctuality possible—not just occasionally, but consistently.
Better Planning
Help your client find a planner that works for them. This isn’t a one-size-fits-all situation—some people thrive with a digital planner synced across devices, while others need a paper planner they can physically write in. The key is finding a system they will use.
Once they have a planner, the next step is designing a routine. A planner is useless if it sits unopened on a desk. Build habits around checking and updating it—morning planning, midday check-ins, and evening reviews. Instill the importance of writing things down immediately and using it for transitions.
A truly effective planner should include everything—not just appointments but daily transitions like commuting, meal prep, and especially bedtime and sleep. Individuals with time blindness often struggle with sleep schedules, either staying up too late or underestimating how much time they need to wind down. Encouraging them to schedule sleep as part of their routine reinforces the importance of rest in time management.
The goal is to make planning a habit, not just an occasional tool. Integrating it into their daily routine and ensuring it includes all aspects of life, you help your client create a structure that supports on-time, all-the-time living.
Avoidance/Denial/Procrastination
Discuss with your client what’s causing the procrastination. It’s easy to assume it’s just a lack of motivation, but there’s always something deeper at play. Ask them:
- Is it that you don’t feel like doing it?
- Is it overwhelming because you don’t know where to start?
- Are you waiting for the pressure of a deadline to kick in?
- Does the task feel boring, tedious, or unimportant?
- Are you afraid of failure or not doing it perfectly?
Once you pinpoint why they’re procrastinating, you can help them develop strategies to work through it.
Organizing the Environment
You can help them to organize their environment. Are they the sort of people who can work in chaos? Or are they the sort that have to have a really clean desk before they can start anything?
Clutter
Help them to understand the difference between clutter and how much they can handle. Different people can handle different amounts.
Filing Systems
Filing systems should be visual, intuitive, and engaging. Use color-coding to make it fun and easy to navigate. Many people with ADHD struggle with traditional filing methods because they don’t naturally categorize things in a structured way. Instead of relying on labels alone, assign colors to different categories—bills in one color, medical documents in another, work papers in a third. This way, they can visually see where something belongs without overthinking it.
Some individuals need to be taught how to file—how to sort through piles of papers, what to keep, what to discard, and how to create a system that works for them. Bills, in particular, can pile up when there isn’t a clear system, leading to missed payments and unnecessary stress.
There are countless resources available for those looking for guidance. One of the all-time classic books on organization (which I’m sure you’re familiar with) can still be found in various formats—print, audiobook, YouTube summaries, and even courses. Encouraging your clients to explore these resources can help reinforce the strategies they need to create a filing system that sticks.
Ultimately, the goal is to make the organization effortless—not a constant battle. A good system works with the brain, not against it.
7 Habits of Highly Effective People
Everybody should be familiar with Covey's work.
- Read the book
- Listen to the book
- Take the course
- See the YouTube clips
Teach How to Self-Advocate
A crucial part of the therapy puzzle is teaching clients how to self-advocate. Many individuals with ADHD or time blindness hesitate to ask for help because they fear judgment or feel they should be able to handle things on their own. However, learning to communicate their needs openly can make a significant difference in how they are perceived and supported.
Help your clients understand that when they ask for help, people are more likely to be understanding and supportive. Rather than making excuses or apologizing repeatedly, they can proactively explain their challenges and request assistance in a way that encourages collaboration.
For example, instead of saying, “Sorry I’m late again,” they might say:
"I struggle with time blindness, and I’m working on strategies to improve it. A quick reminder would be helpful if you notice me getting off track."
A colleague who has been asked to help is far less likely to criticize than someone who sees the same issues happening repeatedly without context. When people understand that it’s not about carelessness or lack of effort, they are often more willing to provide support rather than frustration.
Encouraging self-advocacy empowers clients to take ownership of their challenges while creating a more supportive environment in both personal and professional settings. We help them foster better relationships, improve accountability, and reduce unnecessary stress by equipping them with the confidence and language to express their needs.
Takeaway Messages
So, we’ve covered a lot, but the takeaway message is critical. ADHD, due to its deficiencies in executive function, is associated with an incredibly high time preference compared to same-age peers. Combined with time blindness, this explains much of the daily decision-making struggles faced by individuals with ADHD. The cumulative adverse effects of these decision-making patterns ripple across nearly every major area of life—leading to missed deadlines, financial instability, relationship difficulties, and, ultimately, poorer health outcomes and increased risk of accidents.
This is why occupational therapy, regardless of the setting, must recognize and address ADHD in adults. Time blindness and high-time preference are not just quirks—they are significant barriers to success, independence, and well-being. Every OTP should consider:
- Is ADHD a factor in why this person is sitting across from me in therapy?
- How has their time perception impacted their daily life and occupational performance?
- What strategies can I introduce to help them become more aware of and manage these challenges?
If ADHD is part of the picture, we can make a real impact—not just in helping them function daily but potentially changing the long-term trajectory of their health and well-being. By making time visible, supporting executive function, and helping them develop practical strategies, we can empower individuals with ADHD to gain more control over their time, decisions, and lives.
Resources
I’ve already mentioned several resources, and I believe they’re on your references list. One of the most important is the new research out of the UK on ADHD and life expectancy. I strongly encourage you to check it out, as it highlights the long-term health risks associated with executive function deficits.
I also highly recommend watching the YouTube clip by Russell Barkley, one of the leading experts in ADHD research. Though he’s now retired, he continues to share insights through YouTube, explaining the relevance of groundbreaking studies in a way that is both accessible and practical. His work is invaluable for understanding the real-world implications of ADHD, time blindness, and executive function deficits.
Other YouTube clips, articles, and research studies on time blindness and ADHD are available. One resource I just added to the references is an excellent article written by a Canadian OT for Attention magazine, which provides a well-rounded discussion on time blindness from an OT perspective. I highly recommend checking it out.
Just a quick note—I’ll be at AOTA this year, so if you’re attending, let’s connect! If you’d like to reach out, I’m heading to the UK tomorrow, so it may take me a little while to respond, but I’d love to continue the conversation. Safe travels and I hope you find these resources helpful!
Summary
Exam Poll
1)According to the presentation, how many adults in the United States are affected by ADHD?
2)Which of the following is NOT a primary characteristic of Time Blindness?
3)What does "High Time Preference" in individuals with ADHD typically result in?
4)What is the most common reason adults with ADHD are fired from their jobs, according to the presentation?
5)What is a key habit for effectively using a calendar to manage time?
Questions and Answers
Is there a relationship between childhood trauma and ADHD?
Yes, there is an association, though childhood trauma does not cause ADHD. Children who experience trauma often exhibit symptoms that resemble ADHD, such as impulsivity, difficulty focusing, and emotional dysregulation. However, this does not mean they have the genetic basis for ADHD. In areas with high trauma exposure, ADHD-like symptoms may be more prevalent, but the two conditions are distinct.
Is OCD commonly seen with ADHD?
Yes, OCD is often a comorbid condition with ADHD. It also frequently co-occurs with autism. While I didn’t include a specific slide on comorbidities, we could add a handout to the course with more details on the most common co-occurring conditions.
Could differences in ADHD between men and women be related to puberty?
I haven’t seen any research directly linking ADHD symptoms to puberty differences between males and females. While puberty is an important developmental period, most ADHD research has focused on executive function, time blindness, and social-emotional challenges rather than hormonal changes.
Is there a link between juvenile incarceration and ADHD or time blindness?
Yes, there is a significant connection between ADHD and involvement in the criminal justice system. I initially became interested in this issue while working with a psychiatrist specializing in prison populations. Research in the UK has shown that addressing ADHD early can help reduce crime rates. Many individuals with ADHD struggle with impulsivity, trouble following rules, and difficulties in school, which can lead to dropping out, associating with negative peer influences, and legal issues. The high prevalence of ADHD in prison populations highlights the importance of proper diagnosis and support.
Can ADHD symptoms worsen after a traumatic brain injury (TBI)?
Yes, absolutely. A TBI can significantly impact executive functioning, particularly if the prefrontal cortex is affected. Many symptoms of ADHD, such as difficulties with organization, impulse control, and time management, are related to prefrontal cortex function. When this area of the brain is injured, existing ADHD symptoms can become more severe, or new executive function challenges can emerge. This is also seen in other neurological conditions, such as dementia, which affect the same brain regions.
Is there a correlation between dyslexia and ADHD?
Yes, there is a strong correlation. About 80% of children diagnosed with ADHD have at least one other comorbid condition, which could include dyslexia, anxiety disorders, dyscalculia, or developmental coordination disorder (DCD). Additionally, 60% of children with ADHD have two or more comorbidities. If a child has dyslexia, it’s important to also screen for ADHD, as treating one condition without addressing the other may limit the effectiveness of interventions.
Are there tools or devices to help with time blindness and distraction in ADHD?
Yes, there are several options. Many people with ADHD benefit from wearable devices, such as smartwatches with vibrating alarms that provide discreet reminders. These can be set to buzz at intervals to help with time management and staying on task. Other options include visual timers, scheduling apps, and physical prompts like sticky notes or reminder boards. Having multiple types of visual and physical prompts can be very helpful for individuals struggling with time perception.
References
See additional handout.
Citation
Harris, Z. (2025). Time blindness: A critical executive function in adults with ADHD. OccupationalTherapy.com, Article 5789. Available at www.occupationaltherapy.com
