Proper treatment can lead to more effective employees.
by Kathy McKimmie

Attention-deficit/hyperactivity disorder, ADHD, is widely discussed as a childhood problem, but more than half of children affected will take it with them into adulthood, causing ongoing problems with jobs and relationships.

Adults may have known all of their lives that something was wrong, says Dr. David Parks, clinical psychologist with Parks Associates Psychological Services, Portage, yet were never diagnosed with ADHD as children. Now, workers having trouble keeping a job are seeking help voluntarily or occasionally because of a “last-chance agreement” with an employer where termination is imminent.

“With adults it shows up most often as some other presenting problem and the actual ADHD has been misdiagnosed for years,” Parks says. In the workplace the symptoms can show up as difficulty remembering and an inability to follow instructions of more than one step, difficulty planning, missing deadlines and chronic lateness.

As the ADHD name suggests, there are really two types of problems, inattentiveness and distraction, and hyperactivity — frequent fidgeting and bouncing of the leg, and blurting out responses at inappropriate times and interrupting. They can wreak havoc on a person's ability to perform a job or get along with managers or peers in a work situation.

On occasion employers have referred employees to Parks for evaluation after erratic performance on the job because they want to save a good employee. Employers are generally so relieved to know that it isn't a substance abuse problem that they are accommodating and cooperative in helping the employee work though the ADHD issues.

The longer individuals go without treatment the more accumulated debris of disasters pile up, Parks says, like firings, chronic underemployment, absenteeism, low self-esteem and lack of awareness about the needs of others. It gets tougher to treat after age 25, and many of his clients are just learning about their condition in their 30s and 40s.

At that point, targeted interventions are based on specific behaviors. Learning to write things down, including instructions given on the job (not typically an accepted norm in a blue-collar workplace) is helpful, as is physically moving a cubicle or a desk so the person is free of distractions. If the employer is willing, flexible hours are helpful so that chronically late employees can arrive at slightly different times.

Another strategy that has worked for both students and adults, says Parks, is to have two projects going on at the same time in two separate locations. When the individuals get agitated on one, they move to the other and start anew, being more productive than trying to work through something when they are stressed and frustrated.

Medications combined with therapy may be helpful, Parks said. “I can diagnose the nature and form of the problem, then physicians will prescribe what best fits.”

Dr. Samir Gupta is a psychiatrist at Porter-Starke Services, Valparaiso, which provides behavioral health-care services. After a diagnosis, medication-based or cognitive therapy is begun. “I think the best treatment is a combination of the two,” he says. Not taking prescribed medications, however, is a big problem in this group, with 65 percent non-compliant.

Some adult patients come in seeking help for anxiety over poor work performance or depression because of a lost job, and are found to have ADHD, Gupta explains. “They are hard workers putting in effort, but not getting the same result as their colleagues. They get poor reviews.”

Those who do stick to their treatment program will see improvement and continue to benefit, Gupta says. It will help them not only in their jobs, but in their family lives and relationships, where high divorce rates, extramarital affairs and addictions are prevalent. “They are very prone to impulsive decisions that give instant gratification.”

Gupta says there are free online screeners to self-test for ADHD, and you don't necessarily have to see a psychiatrist for treatment. “A lot of primary care physicians are becoming more comfortable treating this disorder.” He adds an interesting clue for employers and primary care physicians to consider: 70 to 80 percent of adults with ADHD are smokers.