Adults with ADHD often struggle not because they lack knowledge, but because the executive function system that bridges intention and action is unreliable without external support — and no app or reminder can fully substitute for that support. Human accountability, when intentionally designed, provides real-time relational scaffolding that the ADHD nervous system actually responds to. This session explores why human accountability works neurologically, what makes it different from reminder-based tools, and how to design accountability systems that are proactive rather than reactive. Attendees will leave with a practical design framework, concrete strategies for structuring accountability relationships, and evidence-based approaches they can apply immediately — whether they are coaches, clinicians, or adults with ADHD navigating their own support systems.