ADHD in the Workplace

I didn't tell them [employer] that I had ADHD, because I personally don't feel like it's that big a deal. Don't get me wrong, it impacts on my life really badly sometimes but I don't feel it should affect my working life, although it really does. I just feel that if they knew that they wouldn't have given me a job.

Adolescents are usually employed in one of two forms of work: (1) part-time employment to financially support further education (e.g. weekend sales assistant); or (2) full-time employment for those leaving full-time education. In both cases people with ADHD are more likely to exhibit behaviour problems in the workplace, and are more likely to be disciplined or experience dismissal.

A large US study reported that, compared with controls, those with ADHD in childhood only (i.e. remitted by adulthood) and those experiencing persisting ADHD symptoms may be fired or disciplined at work, or quit work as a result of their own hostility. Those with persisting symptoms had more frequent work problems than controls and those whose symptoms remit (see Figure 1) [1].

percentage_of_jobs_graph.png

...you've got a lot of things going on and I'll maybe lose something or I'll say 'I'll do that in a second' and then I don't, but, yeah, that can be quite an issue sometimes.

Occupational impairment has become such a topic of concern that in 2008 the World Health Organisation led a large-scale international initiative to assess the prevalence and correlates of mental disorders and occupational problems [2]. Across the countries surveyed, ADHD was associated with a significant and costly impact on work with an estimated 143.8 million days of productivity lost each year. It is therefore in the interests of both employers and employees to address this problem.

How can we prevent these adverse occupational outcomes? Of course some young people with ADHD will find work that is less affected by, or even suited to, their characteristics such as work in creative or sports industries. The natural creativity of people with ADHD can be a great asset to many organisations; the downside is that all jobs include some aspect of less engaging work and it is rare that tedious and/or menial tasks can be completely avoided. Some people are employed in work that means they are able to delegate this aspect of their work to secretarial and/or administrative staff, but others are less fortunate. Nevertheless there is a responsibility for both employers and employees to recognise and understand the occupational problems faced by people with ADHD and make reasonable work adjustments that will maximise the potential of the employee. This is clearly a shared initiative.

Applying for Work

People with ADHD often avoid tedious tasks that may include completing forms and applications. Attention to detail is required to complete job applications effectively and without errors. It is often necessary to attach a personal statement and/or a comprehensive Curriculum Vitae to an application, and it may be helpful for parents or friends to look over application forms to ensure that they are completed correctly, concisely and are relevant to the job of interest. Aside from paper-based applications, young people often additionally interact with employment advisors (e.g. at Job Centres) and, as with job interviews, it is important to give the ‘right’ impression and communicate effectively [3].

People with ADHD often forget their appointments, double-book themselves, or turn up late. If they miss a job interview they may not be offered a second chance so it is important that they use a diary, and set alarms and reminders to prevent this from happening. It is natural to feel anxious during a job interview and anxiety exacerbates attentional problems, so arriving late or unprepared can add to the stress. Individuals can prepare for a job interview by finding out as much as possible about the job role and the organisation. They should seek information from family, friends, employment advisors, school career advisors and/or other sources of career advice (e.g. see Useful Resources) about this and get advice on how to conduct themselves in job interviews. A mock interview can be very helpful as this will prepare the young person for likely questions that may be posed and provides an opportunity to rehearse appropriate and constructive communication skills and behaviour.

Disclosure of ADHD Status

Job Centre

At some point between applying for a job and starting work, an individual may have to make a decision about whether to disclose their ADHD status and this can be a difficult choice. The concern is that this will be negatively regarded by employers and/or a source of stigma and discrimination.

People with ADHD are protected by disability discrimination laws [4,5] and during the recruitment process, the questions employers can ask about disability are limited and there must be a reason for asking. Thus disclosure about ADHD will often be a matter of personal choice. Advice can be sought at job centres.

Employers may be apprehensive about offering employment to someone they perceive as suffering with a serious and chronic condition [3] and may be unaware that, with minimal effort, a number of simple and practical accommodations can be made for ADHD employees. If the diagnosis is disclosed, this provides an opportunity for employers to work with employees to take appropriate steps to maximise the employee’s potential whilst minimising obstacles. In turn, this is likely to ensure a positive employment outcome for both parties.

Reasonable Adjustments

The Equality Act 2010 imposes a duty on employers to make reasonable adjustments to premises or working practices to help disabled job applicants and employees. An employer has a duty to make reasonable adjustments where it knows (or ought reasonably to know) that a person has a disability and there is a provision, criterion or practice (PCP), a physical feature or lack of auxiliary aids which place the disabled person at a substantial disadvantage compared to those who are not disabled. Failure to make reasonable adjustments amounts to unlawful disability discrimination.

Whether there is a breach of the duty to make adjustments will depend on whether a particular adjustment was 'reasonable' in the circumstances. This is an assessment which is very much fact-sensitive. Factors which may be taken into account by an Employment Tribunal when deciding what steps are reasonable for an employer to have taken include:

...the majority of the time I don't tell people because I don't feel they need to know. I feel it's none of their business. They've probably got things that they don't want to tell me; they might have a deficiency with their health or something. I don't want to know about it. I don't feel I should know about it, so I don't feel that I should tell them about my problems.

  • the extent to which the adjustment would have ameliorated the disadvantage;
  • the extent to which the adjustment was practicable;
  • the financial and other costs of making the adjustment, and the extent to which the step would have disrupted the employer’s activities;
  • the financial and other resources available to the employer;
  • the availability of external financial or other assistance; and
  • the nature of the employer’s activities and the size of the undertaking.

The duty to make reasonable adjustments applies to all employers, irrespective of their size and resources. However, what is reasonable in the circumstances may vary according to the size of the organisation, the nature of its activities and the resources available.

New employees working in large companies are usually referred to an Occupational Health service for assessment. Existing employees may also be referred for a needs assessment, advice and/or forward referral in the course of their employment. Hence, Occupational Health practitioners need to be aware of the needs of ADHD staff in order to recognise related problems and suggest what reasonable adjustments, if necessary, can be applied to support the individual. It is important that both employee and employer work together to establish what may be helpful and reasonable within the work context (see Box 1).

Box 1: Potential workplace adjustments for people with ADHD
Symptom Possible Adjustments

Attention and distractibility

Consider the working environment and how it presents an opportunity for distraction, e.g. move to a private office, quieter room or quieter positioning of work space (e.g. not facing a corridor). Use of telephone headphones. Consider a flexi-time arrangement. Introduce regular supervision meetings, mentoring, written instructions (in addition to verbal) and use of visual cues/reminders.

Impulsivity

Devise clear and detailed work plans. Set targets and break these down into goals and the smaller steps required to achieve them. Specify deadlines for goals and steps. Schedule these into a daily and weekly/monthly work plan. Add reminders to prompt self-monitoring and revision of outstanding tasks and establish a buddy/mentor to monitor progress.

Hyperactivity and restlessness

Allow productive movements at work by introducing regular structured breaks in long meetings, work plans that introduce change in tempo (e.g. tasks requiring intense concentration are interspersed with tasks involving movement) and shifts in topic.

Disorganisation, time management, and memory problems

Introduce a buddy system and/or regular supervision. Use electronic devices, beepers and alarms, reminders, structured agendas, note taking in designated book, diaries, calendars and colour coded filing systems. Delegate tedious tasks and introduce an incentives and reward system (including both immediate and longer term rewards).

Adjustments for employees with ADHD may include ensuring that their working environment has limited potential for distraction (e.g. by locating their desk in a quiet area of the office and away from corridors). In order to aid concentration, short breaks can be factored in to allow the individual to maintain a better ability to focus and concentrate. Mentoring systems or, in some cases, buddy systems with peers may be helpful for impulse control, organisation, planning and time-management. Regular meetings will assist the employee to develop achievable work plans and ensure targets are met within set deadlines. There should be regular and structured reviews to identify and address difficulties early on. Information that is given verbally in supervision sessions should be endorsed in written format, especially instructions. It is important that feedback is constructive and includes positive feedback and encouragement. Ironically, some people with ADHD can become hyperfocused, especially when completing incentivised work, in such cases it is important that the right balance is obtained in order to avoid burnout [3].

It is not the sole responsibility of the employer to take steps to enhance the functionality of their staff. There are a number of strategies that individuals with ADHD can use to counter the problems they face in the workplace. These include making work-plans, writing lists of tasks and instructions, using memory aids such as a diary to structure the day or alarms (on computers, phones, watches) as reminders for meetings; removing potentially distracting material from working space to reduce the likelihood they will go off-task, and asking for help and advice if they are struggling (specific techniques for improving organisation, time-management, attention, memory and impulse control skills can be found in Young and Bramham [6]). Effective employment will rely on good collaboration between employer and employee but, of course, this requires disclosure of their ADHD status.

Working Relationships

The interpersonal and social relationship problems experienced by children with ADHD have been well documented (see Module 6). As they grow up and move into the world of work interpersonal difficulties often present in the workplace with peers and/or line management. The emotional volatility of young people with ADHD may hamper the development of functional work relationships as they have a ‘short fuse’. They become easily frustrated and irritated when things don’t work out and they are prone to emotional outbursts. As in school (see Module 4), they may also experience anxiety about their performance as they are aware of their perceived weaknesses compared to peers.

Young people seek full-time employment after completing their education and many seek parttime employment during their studies. Whilst ADHD should not limit career choices, there is no doubt that young people with ADHD are disadvantaged by the condition from the initial application process through to maintaining employment and longer-term career progression. ADHD employees may be perceived as being unreliable, inefficient and temperamental and it is not commonly recognised that they have a disability for which reasonable adjustments can be made. This need not be an onerous task, rather it is a matter of understanding the condition and making reasonable adjustments to improve functionality. In the longer-term this will keep individuals gainfully and productively employed.

Key Points from Module 5

Box 2: Key points from Module 5 - ADHD and Employment
  • Occupational problems are common for young people who are more likely to be disciplined or dismissed.
  • Costs to employers are high due to loss of productivity.
  • Application and interview processes are challenging for those with ADHD who may find it difficult to complete forms accurately and/or to engage appropriately in interview.
  • Some individuals are successful in obtaining work in which their ADHD characteristics can be harnessed in a positive way (e.g. sports or creative industries); others may manage their problems through delegation of routine and tedious tasks to administrative staff.
  • Those with ADHD are protected within disability discrimination laws, although disclosure is a matter of personal choice.
  • If disclosed, a number of reasonable adjustments can be made to improve performance.

References

[1] Barkley, R.A., Murphy, K.R., & Fischer, M. (2007). ADHD in adults: What the science says. New York: The Guilford Press.

[2] de Graaf, R., Kessler, R.C., Fayyad, J., ten Have, M., Alonso, J., Angermeyer, M., et al. (2008). The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Journal of Occupational and Environmental Medicine, 65(12), 835–842.

[3] Adamou, M., Arif, M., Asherson, P, Aw, T., Bolea, B., Coghill, D., Gudjonsson, G., Halmoy, A., Hodgkins, P., Muller, U., Pitts, M., Trakoli, A., Williams, N., & Young, S. (2013). Consensus statement: Occupational issues of adults with ADHD. BMC Psychiatry, 13(1), 59, dx.doi.org/10.1186/1471- 244X-13-59

[4] Great Britain, Parliament. Disability Discrimination Act 2005. London: HMSO. www.legislation.gov.uk/ukpga/2005/13/contents

[5] Great Britain, Parliament. Equality Act 2010. London: HMSO. www.legislation.gov.uk/ukpga/2010/15/contents

[6] Young, S., & Bramham, J. (2012). Cognitive Behavioural Therapy for ADHD Adolescents and Adults: A Psychological Guide to Practice, Second Edition. Chichester: John Wiley & Sons.

Further Reading and Useful Resources

National Institute for Clinical Excellence. (2009). Attention deficit hyperactivity disorder:Diagnosis and management of ADHD in children, young people and adults. NICE clinical guideline 72. London.

Young, S., Murphy, C.M., & Coghill, D. (2011). Avoiding the 'twilight zone': Guidance and recommendations on ADHD and the transition between child and adult services. BMC Psychiatry. 11:174, dx.doi.org/10.1186/1471-244X-11-174

Young, S. (2013). The 'RAPID' cognitive behavioral therapy program for inattentive children: preliminary findings. Journal of Attention Disorders, 17(6), 519-526.

Young, S., Fitzgerald, M., & Postma, M.J. (2013). ADHD: making the invisible visible An Expert White Paper on attention-deficit hyperactivity disorder (ADHD): policy solutions to address the societal impact, costs and long term outcomes, in support of affected individuals, www.europeanbraincouncil.org/pdfs/ADHD%20White%20Paper_15Apr13.pdf

Citizens Advice: www.adviceguide.org.uk/index/your_money/employment.htm

ADHD Support Group:
www.adders.org/info78.htm
aadduk.org/living-with-adhd/workplace-issues

Government websites:

www.legislation.gov.uk

www.direct.gov.uk/en/Employment/index.htm

nextstep.direct.gov.uk/PLANNINGYOURCAREER/Pages/default.aspx

www.direct.gov.uk/en/DisabledPeople/Employmentsupport/LookingForWork/DG_4000219

www.adviceguide.org.uk/england/work_e/employment_advice_in_bslv2.htm