What BLS needs to do differently for ADHD clients.

When my sister was being evaluated for ADHD, I was supposed to be waiting in the lobby. I was a kid; I had a chair. By the time her appointment ended, I had visited the receptionist’s plant about five times, organized the magazines on the side table into vertical stacks, and asked someone if the carpet pattern was on purpose. The clinician came out, looked at me, and added me to the appointment. We both walked out with a diagnosis. I never had my own intake.

I think about that story whenever I think about how bilateral stimulation lands for an ADHD client. The clinician didn’t need a questionnaire to read the room. They read the room. What they were seeing — a kid whose attentional control had drifted, then drifted again, then drifted again, with no underlying threat in the environment to explain it — is the same thing many therapists are working with when they bring BLS into a session with someone like me.

The cognitive load problem

Bilateral stimulation, on paper, is supposed to occupy the working memory in a way that loosens the grip of a target memory. That works well for clients whose working memory has slack. For clients whose working memory is the bottleneck — ADHD, post-concussion, chronic stress, dissociation — adding a tracking task can pull attention away from the work, not toward it. The client lands in the wrong place. They’re scanning for the ball. They’re wondering if they’re doing it right. The somatic data the protocol was supposed to surface goes quiet.

What a clinician can adjust in-session today

A few levers that tend to help, in order of how often I’ve seen them suggested by clinicians who work with ADHD populations:

1. Slow the pace. Closer to 0.5–0.8 Hz. The standard EMDR pacing band is tuned for neurotypical attentional control; ADHD clients often do better with a slower target and longer set durations rather than the other way around.
2. Add redundant modalities. Stereo audio panning and a tactile pulse (haptics) give the client three signals saying the same thing — left, right, left, right — so they don’t have to actively track any single one. If their visual attention slips, the audio and haptics carry them. Headphones make the audio panning effect immediate.
3. Shorter sets, more pauses. Don’t leave a distractible client tracking for 60+ seconds. Set durations in the 20–30 second range with grounding pauses in between hold more of the work in the room.
4. Hide what the client doesn’t need to see. Read-only client mode, distraction-free background, no menus or timers in the client view. Every UI element they can read becomes something they can think about instead of the work.
5. Name the difficulty up front. For me, the most helpful thing a clinician has ever said is “if your attention drifts, just come back when you can — there’s no wrong way to do this.” It dissolves the meta-anxiety about being a “bad client.”

What I’m building toward

Psy180’s current visual / stereo-audio / haptic stack supports every adjustment above. The next layer — attention-aware visuals that actively reduce cognitive load for distracted clients without breaking the bilateral mechanism — is what I’m exploring now, with input from clinicians who treat ADHD and neurodivergent clients. The principle: attention without taxing working memory. No firm ship date; the work is being done with clinicians, not on a quarterly calendar.

If you treat ADHD clients and want to weigh in on what would actually help, the feedback form is right there. I read it.