Approximately 4 percent of adults in the United States have attention deficit hyperactivity disorder (ADHD), yet less than 20 percent of those have been diagnosed or treated. What does this mean for employers and HR professionals?
Belynda L. Gauthier is a longtime HR professional and board president of CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), the national nonprofit organization for children and adults with ADHD. She said the condition can have a significant influence on employees' productivity and an even greater influence on how those employees are perceived. "Although many adults with ADHD have very successful careers, others struggle with a variety of challenges, including poor communication skills, distractibility, poor memory, time management issues, lack of interpersonal skills, procrastination, hyperactivity and difficulty managing complex projects."
Gauthier acknowledged that we all can have difficulty sitting still, paying attention or controlling impulsive behavior. "For some people, however, the problems are so pervasive and persistent that they interfere with every aspect of their life: home, academic, social and work."
She pointed out that ADHD symptoms, if not efficiently managed and accommodated, can create challenges for teams. For employees with ADHD, she explained, "their disorganization, their challenges with planning and managing work, and their poor estimation of the time required to accomplish certain tasks all lead to submitting work at the last minute. When working in a team, this can create havoc, as other members may have to scramble at the last minute to complete their tasks because of the late completion of assignments."
CHADD's CEO, Bob Cattoi, noted that employers may incur larger expenses due to lost productivity, absenteeism and increased health care costs. "People with untreated ADHD face a number of issues in the workplace. They may include interpersonal conflict, tardiness, high absenteeism, high error rate, inability to change and lack of dependability. Consequences for these behaviors could include reprimands, suspensions, demotions, loss of pay and termination. Individuals with untreated ADHD have higher rates of unemployment and frequent job changes, and often are overlooked for higher-paying positions.
"However, there are many successful, high-level workers with ADHD, including many professionals in law and medicine. Individuals with ADHD also bring a unique skill set to the table. Many individuals with ADHD are creative, bring out-of-the-box thinking, may take strategic risks and can be hyperfocused. There are many successful CEOs with exactly these skills."
Colleen McManus, SHRM-SCP, an HR executive and consultant based in Arizona, has worked extensively with ADHD issues over the course of her career. "One of the things I have frequently encountered is that many people feel they know about it, perhaps based on their own personal or family experiences, but they lack a true awareness of the range of ADHD symptoms and current treatments and possible accommodations.
"An example of old-school thinking occurred with a manager who came to me following an employee's disclosure that she had ADHD. This manager said, 'I suppose I'll have to provide her with a private office and treat her with kid gloves now.'
"I explained that before we assumed anything, we needed to engage in the interactive process with that employee to identify how, if at all, her ability to perform the essential functions of her job was impacted by her ADHD. I said we would base our actions and decisions on the medical guidance of the employee's health care provider, just as we would if the employee required surgery or physical therapy. This simple comparison seemed to take some of the mystery out of the issue for this manager and give him a road map for how we would move forward to address it."
According to Gauthier, there's also ignorance about whether ADHD is something to be accommodated. "The question I am most asked by those who have ADHD is whether they should reveal their diagnosis to their employer. Many of these individuals have told me that they attempted to request assistance from their HR office, only to find that many HR professionals believe that ADHD is not sufficiently debilitating to warrant accommodations."
Michael O'Brien, an employment law attorney in Salt Lake City, said failing to consider accommodations for employees with ADHD is "a big mistake and creates serious liability risks." He continued, "ADHD can be a disability covered by the Americans with Disabilities Act or similar state law, and it also might be a serious health condition triggering Family and Medical Leave Act rights. Often, it is better for an employer to engage the employee and offer reasonable help than to risk a violation of law."
The good news, Cattoi said, is that nearly all symptoms of ADHD may be alleviated with proper treatment and accommodations, enabling employees to perform their job at an optimum level. Adults with treated ADHD often have simple aids at work, such as a quiet workspace or white-noise earphones to reduce distractions; calendars and notes to keep track of deadlines; work tasks that are divided into smaller, manageable sizes; short breaks; timers to stay on task; and, for those with hyperactivity, intermittent breaks to get up and do other tasks.
Gauthier shared an example of a young man whose job was in a warehouse facility separate from the main offices. Every morning he clocked in at the main building, received his instructions for the day from his supervisor and then left for the other worksite.
Within a few weeks his manager wanted to terminate him for frequently failing to complete the tasks he was verbally assigned. Instead, Gauthier worked with the supervisor to develop a daily checklist that included all the day's assignments, along with spaces to add the tasks to be addressed on that particular day. The employee picked this up when he clocked in each morning, checked off the items as he completed them, and turned the sheet in to the supervisor when he clocked out at the end of each day.
He never missed another assignment. According to Gauthier, "He proved to be such a good employee that he moved up the ladder several times. And the use of a similar checklist spread to other employees, some of whom needed or wanted the reminders, whether they had ADHD or not."
McManus described accommodations she's helped make for individuals with ADHD, including a quieter work area; more time for completing work; a second-check system for peer review of more-detailed work; altered work hours to better accommodate peak periods of focus and attention; and directions, instructions and training materials put in writing for ease of future reference.
She noted, however, that it's important to be realistic about what can and cannot be done to accommodate ADHD in the workplace. "For example, I have worked with public-safety agencies for many years, and many public-safety functions cannot provide a quiet work environment or allow more time to focus or respond, an alternate work schedule, or detailed written instructions in every instance, particularly in the event of an emergency."
Advice for HR
HR professionals should encourage a workplace in which employees are comfortable discussing their challenges and asking for appropriate assistance or accommodations. They should educate themselves on invisible disabilities, including behavioral and learning disabilities, and consult resources such as CHADD and JAN, the Job Accommodation Network.
Gauthier advised HR professionals to note that ADHD frequently occurs alongside other conditions. "Should an employee request an accommodation for dyslexia, for example, keep in mind that the employee might also benefit from accommodations usually put in place for an individual with ADHD."
Individuals who have ADHD can be excellent and even inspired employees when placed in the right job with the correct structures in place. McManus recommended being very clear about performance expectations at the outset and frequently checking in with the employee to reinforce understanding and growth. "With an issue like ADHD, communication and understanding in the interactive process are essential if we are to find the best fit for the employee with ADHD so that [the worker] can be productive and successful."