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Trouble staying focused and paying attention are two familiar symptoms of attention deficit hyperactivity disorder (ADHD), a common health issue among children and teens.

When ADHD persists through early adulthood and on into middle age, it presents many of the same challenges it does in childhood: it’s hard to stay organized, start projects, stay on task, and meet deadlines. But now life is busier, and often expectations from work and family are even higher. Fortunately, there are lots of strategies that can help you navigate this time in your life.

Staying organized

Organizational tools are a must for people with adult ADHD. They’ll help you prioritize and track activities for each day or the coming weeks.

• Pick the right tools. Tools can include a pen and paper to make lists, or computer or smartphone apps to set appointment reminders, highlight important days on the calendar, mark deadlines, and keep lists and other information handy.
• Schedule updates. Set aside time each day to update your lists and schedules. Don’t let the task become a chore in itself; think of it like a routine task such as brushing your teeth, and do it daily so it becomes an established habit.
• Set a timer. And a word of caution: smartphones and computers can also turn into a distraction. If you have adult ADHD, you may find yourself spending hours looking at less useful apps or sites. If that’s a frequent trap for you, set a timer for each use or keep the phone off or in another room when you are trying to work.

Staying focused

Just being organized doesn’t mean your work will get done. But a few simple approaches can at least make it easier to do the work.

• Declutter your home and office. Give yourself an appealing work environment and keep important items easily accessible.
• Reduce distractions. This could mean changing your workstation so it doesn’t face a window, moving to a quieter space, or just silencing your smartphone and email alerts.
• Jot down ideas as they come to you. You may have an “aha” moment for one task while you’re in the middle of another. That’s okay; just write down that thought and get back to it later, after your more pressing work is finished.

Meeting deadlines

Deadlines pose two big challenges when you have adult ADHD. First, it’s hard to start a project, often because you want it to be perfect, or you’re intimidated by it so you put it off. Second, when you do start a project, it’s very easy to become distracted and leave the task unfinished.

How can you avoid these traps?

• Put off procrastinating. Put procrastination on your to-do list — like a chore — and fool yourself into actually starting your work.
• Deal with emails, phone calls, or other matters as soon as you can. That way there will be fewer things hanging over your head and overwhelming you later on.
• Be a clock watcher. Get a watch and get in the habit of using it. The more aware you are of time, the more likely you’ll be able to avoid spending too long on a task.
• Take one thing at a time. Multitasking is overrated for everyone — and it’s a nightmare for people with adult ADHD. Focus on completing one task, then move on to the next.
• Be realistic about your time. This can mean having to say no to new projects or other commitments.

Get more help

The ideas listed here can help you start coping with adult ADHD, but they may not be enough to help you overcome adult ADHD’s challenges.

Consider hiring an ADHD coach who can provide more strategies and give you additional tools to cope with your condition. Look for an ADHD coach who is a licensed mental health professional who specializes in treating ADHD, and may also have a certification in ADHD coaching from the ADHD Coaches Organization.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

It’s an unfortunate reality: all medicines can cause side effects. While there are a few tried-and-true ways to deal with drug side effects, here’s a less common option to consider: adding a second medication.

That’s the approach taken with valbenazine (Ingrezza), a drug approved for a condition called tardive dyskinesia that’s caused by certain medicines, most of which are for mental health. Let’s dive into what TD is, how this drug is advertised, and what else to consider if a medicine you take causes TD.

What is tardive dyskinesia?

Tardive dyskinesia (TD) is a condition marked by involuntary movements of the face or limbs, such as rapid eye blinking, grimacing, or pushing out the tongue. TD is caused by long-term use of certain drugs, many of which treat psychosis.

TD may be irreversible. Early recognition is key to improvement and preventing symptoms from getting worse. If you take antipsychotic medicines or other drugs that can cause TD, tell your prescribing health care provider right away about any worrisome symptoms.

A sidewalk sale, a cookout in the park, and a pitch

One ad for Ingrezza starts with a young man working with customers at a sidewalk sale. Though his mental health is much better, he says, now he’s suffering with TD, a condition “that can be caused by some mental health meds.” A spotlight shines on his hands as he fumbles and drops an instant camera he’s selling. He seems embarrassed and his customers look perplexed.

Next we see a young woman at a cookout in a park. The mysterious spotlight is trained on her face as she blinks and grimaces involuntarily. Her voiceover explains that she feels like her involuntary movements are “always in the spotlight.”

Later these two happily interact with others, their movement problems much improved. A voiceover tells us Ingrezza is the #1 treatment for adults with TD. The dose — “always one pill, once a day” — can improve unwanted movements in seven out of 10 people. And people taking Ingrezza can stay on most mental health meds.

That’s the pitch. The downsides come next.

What are the side effects of this drug to control a side effect?

As required by the FDA, the ad lists common and serious side effects of Ingrezza, including

• sleepiness (the most common side effect)
• depression, suicidal thoughts, or actions
• heart rhythm problems
• allergic reactions, which can be life-threatening
• fevers, stiff muscles, or problems thinking, which may be life threatening
• abnormal movements.

That’s right, one possible side effect is abnormal movements — a symptom this drug is supposed to treat!

What the ad gets right

The ad

• appropriately highlights TD as a troubling yet treatable condition that can cause stress and embarrassment and affect a person’s ability to function
• emphasizes once-daily dosing, presumably because the recommended frequency of a competitor’s drug for TD is twice daily
• shares clinical studies that support effectiveness claims
• covers many of the most common and serious side effects.

What else should you know?

Unfortunately, the ad skims over — or entirely skips — some important details. Below are a few examples.

Which medicines cause TD?

We never learn which medicines can cause TD (especially when used long-term), which seems vital to know. Many, but not all, are used to help treat certain mental health disorders, such as schizophrenia or bipolar disorder. Here are some of the most common.

Mental health medicines:

• haloperidol (Haldol)
• fluphenazine (Prolixin)
• risperidone (Risperdal)
• olanzapine (Zyprexa).

Other types of medicines:

• metoclopramide (Reglan), which may be prescribed for nausea, hiccups, and a stomach problem called gastroparesis
• prochlorperazine (Compazine, Compro), most often prescribed for severe nausea, migraine headaches, or vertigo.

Also, the ad never explains that TD may be irreversible regardless of treatment. Because improvement is most likely if caught early, it’s important for people taking these medicines to check in with their health provider if they notice TD symptoms described above — especially if symptoms are growing worse.

What about effectiveness and cost?

Seven in 10 people reported that their symptoms improved, according to the ad. How much improvement? That wasn’t shared. But here’s what I found in a key study:

• Among 202 study participants with TD, only 24% reported having minimal or no symptoms of TD after six weeks of treatment with Ingrezza.
• Up to 67% of study subjects reported smaller improvements in symptoms.

What happens after six weeks? A few small follow-up studies suggest that some people who continue taking Ingrezza may improve further over time.

And the cost? That’s also never mentioned in the ad. It’s about $8,700 a month. No details on the financial assistance program, or who qualifies for free treatment, are provided.

Are there other ways to manage TD?

Well, yes. But the ad doesn’t mention those either. Three approaches to discuss with your healthcare provider are:

• Avoid drugs known to cause TD when other options are available.
• If you need to take these medicines, it’s safest to use the lowest effective dose for the shortest time possible. For example, limiting metoclopramide to less than three months lowers risk for TD.
• If you notice TD symptoms, ask about lowering the dose or stopping the offending drug right away. This may successfully reverse, or reduce, the symptoms.

If you have TD, you and your health care provider can consider several options:

• whether other drug treatments for TD not mentioned in the ad, such as deutetrabenazine (Austedo) or tetrabenazine (Xenazine), might cost less or minimize bothersome side effects
• botulinum toxin injections (Botox), which can relax the muscle contractions causing involuntary movements
• deep brain stimulation, which involves electrical stimulation to certain areas of the brain to interrupt nerve signals to abnormally contracting muscles.

The bottom line

The idea of treating a drug’s side effect with another drug may not be appealing. Certainly, it makes sense to try other options first.

But sometimes there are no better options. It’s always worth asking whether a treatment is worse than the disease. But TD is one situation in which all options — including a drug treatment for another drug’s side effects — are well worth considering.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD