Focusing on ADD in the Workplace

At the end of a counseling session last winter, the therapist handed Aaron a book and suggested he read it. Ive got this disorder myself, she told him. I recognize the symptoms in much that youve told me. This book might help explain a lot of what youre going through.

Before he read Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood (Touchstone Books, 1995), Aaron (who requested that his last name be withheld) knew that he had problemsprocrastination, disorganization, impulsivity, inattentiveness, lack of follow-through and talking out of turn. He had struggled with these issues for as long as he could remember, and they all had significantly impaired his personal and professional life.

Productivity problems at work, believes Aaron, 28, were balanced by bursts of energy.

I would procrastinate, procrastinate, procrastinate, he recalls. Then Id cram, cram, cram.

The stress was a tremendous and growing burden. But it was how he had lived his life. And he assumed it was something hed have to continue to live with.

He was wrong.

Aaron was diagnosed with attention deficit disorder (ADD), a brain disorder that is increasingly being recognized as a condition that affects adults nearly as much as it affects children. It is harder to diagnose the syndrome in adults because they typically do not exhibit the hyperactive trait found in children who have attention deficit/

hyperactivity disorder (AD/HD). But even without the hyperactivity, ADD can hinder an employees success in the workplace.

For that reason, HR professionals need to be aware of how the disorder manifests in the workplace. Educating yourself as well as your managers and employees, who may have ADD and not know it, about the symptoms could lead to accurate diagnosis and treatment, and therefore, higher productivity.

Recognizing ADD and AD/HD

ADD is a neurological syndrome whose classic defining triad of symptoms are impulsivity, distractibility and hyperactivity or excess energy, write Edward M. Hallowell and John J. Ratey, authors of Driven to Distraction. The disorder impairs the executive functions of the brain, such as organization, working memory and information assessment.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), published by the American Psychiatric Association, officially terms the disorder attention deficit/hyperactivity disorder. The terms ADD and AD/HD often are used interchangeably. First medically documented in children in 1902, the disorder is a neurological condition that affects an estimated 3 percent to 5 percent of school-age children and 2 percent to 4 percent of adults. It occurs in boys and girls at a 3:1 ratio, and in men and women at a 2:1 ratio, according to Children and Adults with Attention Deficit/

Hyperactivity Disorder, a Landover, Md., non-profit education, advocacy and support group.

Its most recognizable symptom in children is hyperactivityan inability to control ones physical actions. In both the classroom and at home, a child with the disorder is likely to talk out of turn and refuse to sit still. Constantly. With the help of a psychiatrist, the disorders symptoms can be greatly alleviated with drugs and, in some cases, psychotherapy. There is no cure. A missed diagnosis and lack of treatment, over the long term, can have disastrous personal and professional effects.

Until recently, though, most researchers believed that the disorder, which often appears to diminish during adolescence, disappeared fully by adulthood. Some kids really do grow out of it, says Timothy Wilens, associate professor of psychiatry at Harvard Medical School, but probably half will keep it, either the full diagnosis or two clicks short.

The hyperactivity so often associated with the disorder diminishes over time, leading scientists to believe that the brain caught up in adolescence, explains Stephen Faraone, associate professor of psychology at Harvard Medical School. Thats wrong. With the passage of time, symptoms tend to change. [There is] a diminution of hyperactivity and impulsivity, [but] not a diminution of inattentiveness. As adults, the same symptoms that showed up in childhood also appear, either in the same form or in a slightly different manifestation, in the workplace.

Some experts, to emphasize this point, choose to refer to the disorder simply as attention deficit disorder (ADD), especially when discussing adults.

Workplace Dilemma

Aaron has high energy levels. Before his diagnosis and treatment, he spoke loudly, often interrupting his co-workers, and forced himself and his point of view onto those around him. I didnt pick up clues that people werent into it, he recalls. Aaron was restless at his desk, unable to relax. His outward behavior reflected what happens in his headone after another, thoughts popped in and dropped out without a moments notice.

If Im trying to read something, my eyes keep scanning the same sentence 10 times, says Aaron, describing the disorders effects prior to treatment. [With] any activity, my mind is wandering all over the place.

Unable to stay focused, he procrastinated. He put off work that needed to get done, distracted by e-mail, voicemail and the Internet. Before the web, he says, I read magazines all day, hoping no one would notice.

Nevertheless, his work developing and programming web applications always got done on time. Because he was productive, Aaron believes, his supervisor and co-workers didnt realize that anything was wrong, leading him to ask, As long as youre getting the work done, why would anyone notice? If its not causing a problem, is it a problem?

It was for him. He obsessed over organizing his desk, knowing that the slightest thing out of place would be a distraction. He made lists of everything in an effort to remain in control of his work. In short, he countered the confusion his scattered thoughts caused by trying to keep his environment in order. Still, he struggled to finish work that he knew should require much less time, effort and frustration. At the end of the day, Aaron knew that he was not accomplishing nearly as much as he could.

It was more of an internal sense of my abilities rather than people around me thinking or saying I can do better, he says.

That sense of not living up to ones potential is what Wilens of Harvard calls a quality of life impairment. It is a common side effect of ADD, and, over a lifetime, half to three-quarters of all untreated adults will develop additional conditions. ADD doubles your risk for most disorders, like anxiety, conduct disorders, depression and substance abuse, he says.

Why? At least in part because symptoms such as procrastination, inattentiveness and an inability to stay on task frequently lead to failurefailure to attend to details, to meet deadlines, to finish projectswhich, over time, can become a pattern, an expectation and an impairment.

If you run around with an IQ of 140 but cant execute anything, and you are selling ice cream on the corner, I would consider that impairing, Wilens says. A less extreme case: A bright young web developer who, beyond his control and despite his potential, cant perform at his maximum.

Impairment is relative to your expectations, he says.

Treating AD/HD
Recognizing he had the symptoms described in Driven to Distraction, Aaron made an appointment with a psychiatrist. After discussing his symptoms and his therapists recommendations, the doctor prescribed Concerta, a time-release form of the stimulant methylphenidate, better known in its short-acting form as Ritalin.

Stimulant medications, most researchers will agree, are the most effective treatment for properly diagnosed AD/HD. Its been 50 years now, and we know that stimulants are safe and effective, says Alan Zametkin, senior staff physician at the National Institutes of Health in Bethesda, Md.

The most commonly prescribed stimulants are methylphenidate and dextroamphetamine (better known as Dexedrine), each of which comes in a variety of forms and dosage sizes. Anti-depressants, especially the older tricyclics such as Norpramin, have proved effective in some cases and often are prescribed if stimulants dont work, as are a variety of other medications. Like the disorder itself, for which there is no definitive diagnostic test, there are no predictors of the proper medication. What works well for one person might not work at all for someone else.

Why do we have a variable response? Because the brain is a highly complex organ, Zametkin states. It is safe to say that the disorder affects different people in different parts of the brain.

Those diagnosed with ADD often try several different medicines, at different strengths and on different schedules, before they find something that works. This process can take months.

Aaron was lucky. From an initial 18-milligram dose of Concerta, he quickly moved up to 54 milligrams a day. He has stayed there ever since.

Wow, this is perfect, he told himself. Ive arrived.

Helping Employees Cope

However, medication is not a cure-all for the symptoms of ADD. Most people have a 50 percent reduction in symptoms on medication, notes Stephen Safren, a researcher at Massachusetts General Hospital and assistant professor of psychology at Harvard Medical School. The other half must be addressed by learning new habits to eradicate lifelong patterns of procrastination, distraction and impulsivity.

This is especially true in the workplace. While those with ADD can be extremely energetic, intelligent and creative, they easily get bogged down in the small details. Papers pile up instead of being put away, mail and phone messages disappear, and appointments are missed. What should be the days simplest tasks become a frustrating mass of incompletes as ADDers attempt to navigate their day without a mental map and compass.

People with ADD rarely function well without structure, says Kathleen Nadeau, author of ADD in the Workplace: Choices, Changes, and Challenges (Brunner/Mazel Trade, 1997). To create structure, Nadeau recommends that employees with ADD discuss with their supervisors ways to increase their efficiency. Working memory for those with ADD is notoriously bad, says Nadeau. Managers should know that as much information as possible should be given in writing. And when thats not possible, have [employees with ADD] walk around with a pad of paper or a tape recorder.

People like Aaron often function better with, and frequently require, external structure like deadlines. I will tell people when I expect to have something in even if they dont give me a deadline, Aaron says. Brief weekly meetings to discuss priorities, short-interval goals during long-term projects and checklists for daily tasks also work well. Those with ADD function well with small increases in structure, says Nadeau.

Why go through the effort? Lynda Katz, president of Landmark College in Putney, Vt., an acclaimed school for students with learning disabilities and ADD, recommends that employers look beyond the state of an employees desk and remind themselves why they hired that employee in the first place. Who are you hiring? Someone very meticulous or someone very creative? Maybe you have to sacrifice one thing to get another, Katz says. [For employees with ADD] youve got to provide support for them in the details.

Aaron was fortunate that his job could afford some flexibility. While there are six hours during each day (core hours) when he must be at his desk, Aaron decides whether he will come in early or work late. One day out of the week he telecommutes. And he can work extra hours to make up days that he decides to take off. Arrangements like this are precisely what Nadeau recommends: A lot of people with ADD resist habits, so arrange their schedule so that it rotates. Allow them to vary the routine part of the week.

It is certainly common sense to provide ways for an employee to function fully; it is also the law. Under the Americans with Disabilities Act, employers are required to provide reasonable accommodations for impaired yet otherwise qualified employees, and many people with ADD and AD/HD are protected under the law.

But as lawyer Pat Latham says, With ADD, most accommodations are minor, and most employers are happy to provide them. Even when employers cant offer flexible schedules, providing an empty office and/or a white noise machine can reduce distraction, while personal digital assistants (PDAs) and speech-to-text software can help an ADD employee stay organized. Latham, co-author of Succeeding in the Workplace (JKL Communications, 1994) and an expert on the ADA and employment law, continues, Its important to try and get across that a few accommodations will accomplish a great deal.

Aaron still procrastinates. Part of him doesnt want to give up the rush of deadline pressure. But with the medication and a flexible schedule he has more control over his behavior. He feels he can choose to work rather than force himself to do it.

I can work better with long-term deadlines, and theres less of an effort to stay focused, Aaron says. I was excited to find a way to fix [my problems]. The excitement hasn't worn off.

Matthew F. McMillen, a freelance writer based in Washington, D.C., has written about his own experience with AD/HD for The Washington Post .