An old video I shot 5 years ago just showed up in my Facebook feed, that made me smile ear-to-ear. My husband, Dermot, hides behind a pillar and then pops out to the delight and happy squeals of my, then 14-month-old. It's all very adorable. Partly, because what's cuter than a toddler laughing? But partly because peek-a-boo is one of those things that's only amusing until you're about 2.

After the age of 2 (or so), someone hiding behind a pillar or a cloth napkin loses its appeal. Play peek-a-boo with a 3-year-old, and his brain says: I saw you go back there- I know you are there- why are you pretending this is fun or exciting?

The reason for this shift? Something psychologists call Object Permanence.

Object permanence is the understanding that just because you can't see or hear or touch or otherwise perceive something doesn't mean it ceases to exist. So, peekaboo to a 1-year-old is endlessly entertaining because the thing you hide DOES cease to exist and then--peek-a-boo! It spontaneously reappears. But a 4-year-old? He's onto your tricks and knows you're just hiding.

Object Permanence and ADHD

What does this have to do with ADHD?

Well, The ADHD brain doesn't do object permanence well. Not that your ADHD brain is going to get excited by a game of peek-a-boo. But over time, as objects and people stop presenting themselves (i.e., you don't see someone for a while, or you put your meds in the drawer rather than on the counter), they stop existing.

I often talk about this as the fishbowl brain. Anything in your fishbowl at any given moment will be very present, very active in your mind. But once it is plucked from your fishbowl and placed somewhere else? It's gone. Really gone.

That's why, when your well-meaning partner takes your meds off the kitchen counter and puts them in a drawer, you don't take your pills for a week. It's why once that reminder counter of the unread messages disappears, you forget to reply to a text. And it's why when someone moves away, it's so hard to stay in touch.

All those things: the medication, the text message, even the friend- they've all been plucked out of your fishbowl, and they no longer exist.

You don't love your friend any less, you don't not WANT to reply, and you still need your meds. But if they're not part of your awareness, then your brain can't act on them.

So, if your brain doesn't retain cues unless they are omnipresent, then how do you handle partners that like clean and tidy spaces or friends that move away, or dental appointments that need to be scheduled 6 months in advance? How do you make sure your brain can act on those things even after they have disappeared?

The Strategic Cue System

In order to remember the thing you need to remember, you need to set up cues— things that reminder your brain of the right thing at the right time. But we all know that phone reminders have limited usefulness, so this can’t be just any cue- it needs to be a strategic cue.

What’s a strategic cue, you say? I’m so glad you asked. A strategic cue is always 3 things:

1. Automatic: You don’t want to have to work for your cue. Once you set it up, it should happen without your effort. (ie: an automatic reminder on your phone)

2. Obvious: This is not the time for metaphor or clever tricks. Strategic cues stare you in the face. The second your brain sees it, it knows exactly what it should do. (ie: Alexa telling you at 6 pm tonight: Call Nana)

3. Timely: Reminders to do things at times you can’t possibly do them are a setup for feeling bad about yourself. Time your reminders for times/ places where you can act on them immediately (ie: put your pills by the bathroom sink with a cup for water)

Tips for Creating Strategic Cues for all the items, people, appointments and messages in your life:

Not all the things you need to remember in your life and the same and so the system of cues can’t be exactly the same either. Here are some tips on creating strategic cues for all the “things” of your life:

Items:

Things that you need to remind yourself of (pills, keys, your calendar, etc.) are best strategically placed in full view. But you can't just put them anywhere or else they start to blend into the scenery. You want to think a few things through to maximize their impact:

• Choose only your most essential items to regularly leave out: Your brain will start to blend all the things into the landscape if it sees them out repeatedly. Chose those essential items and put the others away. (This may ease the struggle with partners, roommates, and others sharing your space)

• Place essential items on clean surfaces. A pill bottle becomes one more thing in a sea of clutter when placed on a crowded table.

• Find one spot. Keep your essential items in one, visible location, and let it live there- don't move it around.

• If you struggle to keep it in one spot- try labeling the spot. It'll cue the brain that that thing lives there.

• Chose a spot where you can act on the item. Pills that need to be taken with water are best beside a sink; keys are great by the garage door.

Appointments:

Appointments are best kept in a digital device with reminders. To assure yourself that they will pop out at you at the right time, you want to be thoughtful about how you put then in

• If using iCal, Outlook, or Google Calendar- use both appointment reminders- one for when you schedule your week (or if you’re not yet planning your week then the night before) and the second 5 minutes before you need to leave for the appointment

• Screenless devices like Alexa or Google Home are great ways of setting up reminders because they will tell you what to do, and when, rather than just chime.

• For essential appointments- try using a different alarm sound (a particularly jarring one) so that you don't just swipe it away like all the others.

People:

We can't just perch people on our kitchen table to remind us to attend to them. And alarms in our phones start to lose their impact when they begin chiming for things that aren’t essential. So what to do?

• Try setting a recurring appointment for semi-regular calls/ visits

• Tie the activity to something else that happens with the same frequency: Call your mother every Tuesday while making Taco dinner. Visit your grandmother every Sunday before you go to the grocery store.

• Schedule the next call/ visit during the last call/visit.Want to be sure you see your old college roommate once every 6 months? While you are with her, plan your next visit, put it in your calendar, and start setting up the travel arrangements.

• Be honest- tell people that you aren't great about staying in touch despite your best intentions and your love for them. Invite them to "bug" you if they want to.

Emails/Text Messages

Emails and texts deserve a system in and of themselves. But some basic tips for making sure they don’t fall by the wayside:

• Mark emails unread until they are dealt with

• Use your Important/ starred categories for emails that need to be dealt with but haven't been yet.

• Only touch it once- respond to emails and texts the minute you open them whenever possible.

• Don't open a text unless you're able to respond.

• If you do open a text and can't respond- immediately add a reminder- Siri/ Alexa or just a phone reminder to reply.

• Schedule email time into your day. Schedule 30-60 minutes in your day (I recommend right after lunch or at the end of your day- not during your prime time) to address emails and let them go the rest of your day. This email "appointment" will help you attend to them as needed but not get too distracted throughout your day.

What ways does your brain trip up on object permanence? What are your favorite techniques for cueing yourself?

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