"Spoon Theory" as Applied to ADHD

"What's this about spoons?" I hear you say. Spoon Theory is an explanation initially developed by Christine Miserandino to describe the energy management required when living with a chronic illness, in her case, lupus. The explanation uses spoons as a metaphor for physical and mental resources. According to Spoon Theory, each activity a person does during a day "costs" a certain number of spoons. When you have a chronic illness, you start the day with a smaller number of spoons compared to the average person. Simple tasks, such as getting dressed or making breakfast, might use up one or two spoons, while more demanding activities like going to work or grocery shopping might cost more.

The idea is that once you've used up your spoons for the day, you have to rest and recuperate, and generally wait for the next day to receive your next spoon allocation. It's a way of explaining the need for careful energy management and the decision-making process that people with chronic illnesses often go through on a daily basis. Spoon Theory has been adopted to explain resource management in an array of chronic illnesses, mental illnesses, and even neurodiversity experiences such as ADHD and autism.

Fewer spoons and inefficient spoon use

In this blog post, I am going to present my modified version of Spoon Theory for ADHD, which has an explicit place for stimulant medication as a spoon moderator. In this context, "spoons" represent the mental and emotional resources needed to focus, stay organised, regulate emotions, and perform other tasks throughout the day.

Individuals with ADHD will generally find that they have fewer spoons to start with each day, and that tasks cost more spoons for them compared to neurotypical people, usually due to the extra effort required to perform a task that in a neurotypical person is easier, or even automatic. For instance, a task that might seem simple, like getting started on a work project, will likely require extra spoons for a person with ADHD due to difficulties with attention, motivation, and task initiation.

Stimulants as a spoons injection

In the context of ADHD and the Spoon Theory, stimulant medication can be thought of as a "spoons injection". It effectively increases the total number of spoons available. This is akin to how stimulant medication dramatically increases the amount of dopamine and norepinephrine available in the orbitofrontal cortex, increasing the overall capacity to focus, regulate emotions, and manage tasks.

At the same time, stimulant medication helps improve the allocation of these spoons throughout the day. For someone with ADHD, the unmedicated state might lead to rapid use of spoons during a working day, leaving them depleted for the late afternoon and evening. However, with medication, the allocation of spoons can be more evenly distributed. This improved self-control prevents rapid burnout and enables a more balanced utilisation of spoons throughout the day.

It's important to note that the effectiveness of stimulant medication varies from person to person, and not everyone with ADHD will experience the same degree of "spoons injection", especially if medication has not been optimised to the right formulation, dose, and for enough hours a day, which I see with a lot of my therapy clients. Also, stimulant medication doesn't resolve all the difficulties related to ADHD; there will still be tasks that require more spoons than others, and others that still seem impossible to start. However, it can be a significant help in managing daily tasks and maintaining energy levels, contributing to a more balanced and productive day, perhaps with some spoons left over in the evening to do something satisfying or useful instead of going into a coma on the couch.

In summary, this modified version of the Spoon Theory for ADHD illustrates the dual role of stimulant medication in both increasing the available mental and emotional resources (i.e., providing more "spoons") and enhancing the individual's ability to better allocate these resources throughout the day. It's a powerful metaphor to understand the tangible impact of ADHD and the potential benefits of stimulant medication. It really can be that effective!

• This ADDitude article The Antidote to ADHD Fatigue and Exhaustion? Stacking Habits (and Spoons) offers practical advice for spoon management

• Here is Christine Miserandino's account of how the Spoon Theory came to be

• Here is a more detailed model of Spoon Theory for people with ADHD and/or ADHD