AD/HD in Adults
Focusing on Adult ADHD in the Workplace
Approximately 2.5% of adults in the United States—nearly 6.1 million—have received a diagnosis of attention-deficit/hyperactivity disorder (ADHD) (American Psychiatric Association, 2013). Despite the fact that it was once thought of solely as a pediatric condition, it is now apparent that ADHD can and often does persist across the lifespan. Many of these individuals are gainfully employed, and increasing amounts of research are helping to shed more light on ways in which adult ADHD impacts occupational outcomes.
What is ADHD?
The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains the criteria psychiatrists and mental health experts use to diagnose mental illnesses, including ADHD (American Psychiatric Association, 2013). According to DSM-5, ADHD is a brain disorder that develops during early childhood. Symptoms generally fall into two broad categories:
Inattention: This includes, but is not limited to, such symptoms as having difficulty focusing on tasks that require sustained attention; overlooking important details in work, school activities, or other tasks; failing to follow through on instructions; and becoming easily distracted or displaying frequent forgetfulness in regards to completing daily activities.
Hyperactivity and impulsivity: This refers to symptoms like excessive fidgeting; having difficulty sitting still or standing for extended periods or time; struggling to wait one’s turn (such as while waiting in line); or often interrupting others in conversation or during activities.
Some individuals with ADHD have most of their symptoms in the inattention category, some have more in the hyperactivity and impulsivity category, and some display many symptoms from both categories. Individuals with symptoms only in the inattention category are sometimes referred to as having attention deficit disorder (ADD), although the proper DSM-5 diagnosis is termed ADHD, predominantly inattentive presentation. To receive a diagnosis of ADHD, individuals must experience difficulties in several environments, such as both at school/work and at home. Their symptoms must be severe enough to interfere with their ability to function well in activities such as maintaining good academic/job performance or establishing and keeping friendships.
Psychiatric interventions often include prescription of stimulant medications, which have demonstrated strong effectiveness (Volkow & Swanson, 2013). Psychotherapy also is typically involved and includes teaching patients ways to regulate their behaviors and impulses so that these clinical manifestations will interfere less with their daily responsibilities (Chandler, 2013). It is important to note that the term “adult ADHD” does not mean that the disorder began in adulthood. In fact, for ADHD to be diagnosed there must be evidence that the symptoms began no later than 12 years of age. But not every child with the disorder receives a diagnosis in childhood. Some individuals only learn of their diagnosis once they are grown—often following years of struggle throughout adolescence and adulthood. In general, ADHD is under recognized in adulthood, which further decreases the likelihood that people who have the disorder will receive appropriate treatment (McCarthy et al., 2009).
Some children with ADHD become better at managing their symptoms as they get older. For instance, with age and experience, people can develop strategies on their own to help them become more patient, less impulsive, or less hyperactive. But without proper diagnosis and treatment, many children with ADHD will continue to face difficulties into adolescence and adulthood, which can have significant implications on their occupational, social, and economic potential.
Compared to adults without ADHD, adults with ADHD are at risk for:
Decreased productivity on the job due to poor time management, difficulty multitasking, or distractibility (Asherson et al., 2012);
A decreased likelihood of completing high school, college, or postgraduate training (Biederman & Faraone, 2006; Klein et al., 2012);
Greater risk of unemployment, underemployment, or job loss (Fried et al., 2012; Asherson et al 2012);
An increased propensity toward frequently changing jobs, holding multiple positions simultaneously, or experiencing lower job satisfaction (Fried et al., 2012);
Occupational under-attainment relative to intellectual potential (Fried et al., 2012);
Productivity loss due to absenteeism, poor performance, disability, and/or worker’s compensation claims, with productivity loss from these causes recently estimated to range from approximately $88 to $141 billion annually (Doshi et al., 2012);
And an increased loss of household income. For instance, Biederman and Faraone (2006) reported an average loss of household income per person with ADHD of $8,900 to $15,400 per year, leading to an annual loss in household income of $67 to $116 billion.
Loss of Productivity
In the United States specifically, data from the U.S. National Comorbidity Survey Replication (Kessler et al., 2006) suggest that adult ADHD is associated with more than 120 million lost workdays of productivity per year, at a human capital value of $19.5 billion.
Occupational problems do not appear to be isolated to the United States. In one of the largest surveys of working and nonworking adults in 10 countries, including the United States, Mexico, and several European nations, researchers found that adult ADHD was associated with 143.8 million lost workdays of productivity each year (de Graff et al., 2008). Across all countries, employees with ADHD experienced an average excess of 8.4 days out of role (the number of days in which an individual was completely unable to carry out work and normal activities), 21.7 days of decreased work quantity (days in which the individual was able to carry out work and normal activities but had to cut down on the amount performed), and 13.6 days of decreased work quality per year, in comparison to workers without ADHD.
More insight into the economic impact of ADHD in the United States workplace.
Tips for Employers
Research indicates that there are highly effective approaches to helping employees with ADHD, including medication, psychotherapy, and simple accommodations. These approaches can help ensure employees stay on-task, minimize distractions, and become better poised to succeed in the workplace.
Perhaps the most obvious contributor to poor productivity among adults with ADHD is the lack of proper diagnosis and treatment. The number of adults estimated to have ADHD is far greater than the number of individuals actually receiving help—a paltry 10% (Kessler et al., 2005). Recent data (Dakwar et al., 2014) from a survey of more than 34,000 Americans found that the probability of an individual with ADHD seeking treatment at any point in his or her lifetime was only 55% and that those who sought treatment often did not seek treatment until adulthood.
Employers can help address this need by promoting health insurance coverage and employee assistance programs that make access to mental health services easy and affordable. Research indicates that medication and psychotherapy are highly effective in helping adult patients with self-regulation, organization, task completion, and symptom reduction (Chandler, 2013; Volkow & Swanson, 2013). Because ADHD often appears in families, employees with ADHD may be more likely to have children with the disorder. This too underscores the importance of access to mental health services.
Furthermore, employers and colleagues should heed these famous words from entrepreneur Henry Ford: “Whether you think you can or think you can’t—you’re right.” Individuals with ADHD may have endured a lifetime of criticism for being perceived as lazy or unmotivated, but for most people, those descriptors simply do not apply. Most workers with ADHD want to succeed, but disparaging attitudes can create a self-fulfilling prophecy in which people feel destined to fail. Employee education can be helpful in dispelling misperceptions that individuals with ADHD are sloppy or incompetent, which contribute to stigma and poor self-esteem. Positive reinforcement from supervisors about their employee’s talents and value to the company can go a long way in building confidence, which may translate to better productivity and greater success for the individual—and for the company as a whole.
Occupational accommodations can be highly effective in keeping workers on-task and engaged (Children and Adults with Attention-Deficit/Hyperactivity Disorder, 2003). For instance, employees with ADHD may benefit from more structured environments, such as regular check-ins from supervisors on the status of assignments to ensure time management is efficient and effective. Allowing employees to wear headphones while working can help reduce distractions from noises and conversations taking place around them. Seating or office arrangements that minimize distractions, such as moving desks away from windows or noisy doorways, can be helpful. And encouraging intermittent breaks can help reduce restlessness.
Finally, while medication is often tremendously helpful, individuals with ADHD still have to adopt their own particular learning and working style in order to prevent their symptoms from decreasing productivity. Employers can help them accomplish this by utilizing the Job Accommodation Network as a resource for additional ideas for workplace modifications. Simple strategies, such as helping people divide larger tasks into smaller, more manageable assignments and providing them with a checklist of current responsibilities, can empower employees by giving them the tools they need to succeed. Having ADHD does not mean having to give up on career goals and aspirations, and employers play an important role in creating a work environment that helps emphasize employees’ individual strengths rather than their unique challenges.
Visit the American Psychiatric Association's (APA) Help with ADHD page to learn about symptoms, risk factors and treatment options. You can also find answers to your questions written by leading psychiatrists, read stories from people living with ADHD and links to additional resources. View the latest ADHD posts on APA's blog.
CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) is the nation's leading non-profit organization serving individuals with ADHD and their families. Their website includes information for both parents seeking information on behalf of their children and adults looking for support dealing with their ADHD.
The Job Accommodation Network is a federally funded resource center for employees, employers and others. They offer consultation, resources, and information on job accommodations.
Economic Impact of ADHD in the United States: A study published in the Journal of the American Academy of Child and Adolescent Psychiatry found a substantial economic impact of attention deficit/hyperactivity disorder (ADHD) in the United States.
Emily A. Kuhl, Ph.D., owner and operator of Right Brain/Left Brain, LLC, is a consultant to the Center for Workplace Mental Health and a medical writer and editor in the Washington, D.C., area.
Adler, L. A. (2008). Epidemiology, impairments, and differential diagnosis in adult ADHD: Introduction. CNS Spectrums, 13(8, Suppl 12), 4–5. Retrieved from http://www.cnsspectrums.com/aspx/article_pf.aspx?articleid=1703
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Asherson, P., Akehurst, R., Kooij, J. J., Huss, M., Beusterien, K., Sasané. R., . . . Hodgkins, P. (2012). Under diagnosis of adult ADHD: Cultural influences and societal burden. Journal of Attention Disorders, 16(5 Suppl), 20S–38S. doi: 10.1177/1087054711435360
Biederman, J., & Faraone, S. V. (2006). The effects of attention-deficit/hyperactivity disorder on employment and household income. Medscape General Medicine, 8(3):12.
Chandler, M. L. (2013). Psychotherapy for adult attention deficit/hyperactivity disorder: A comparison with cognitive behaviour therapy. Journal of Psychiatric and Mental Health Nursing, 20(9), 814–820. doi: 10.1111/jpm.12023
Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2003). Succeeding in the workplace.
Dakwar, E., Levin, F. R., Olfson, M., Wang, S., Kerridge, B., & Blanco, C. (2014). First treatment contact for ADHD: Predictors of and gender differences in treatment seeking. Psychiatric Services, 65(12), 1465–1473. doi: 10.1176/appi.ps.201300298
de Graaf, R., Kessler, R. C., Fayyad, J., Ten Have, M., Alonso, J., Angermeyer, M., . . . Posada-Villa, J. (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. Occupational and Environmental Medicine, 65(12), 835–842. doi: 10.1136/oem.2007.038448
Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., . . . Neumann, P. J. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 990– 1002. doi: 10.1016/j.jaac.2012.07.008
Fried, R., Surman, C., Hammerness, P., Petty, C., Faraone, S., Hyder, L., . . . Biederman, J. (2012). A controlled study of a simulated workplace laboratory for adults with attention deficit hyperactivity disorder. Psychiatry Research, 200(2–3), 949–956. doi: 10.1016/j.psychres.2012.04.020
Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., . . . Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723.
Kessler, R. C., Adler, L., Ames, M., Barkley, R. A., Birnbaum, H., Greenberg, P., . . . Ustün, T. B. (2005). The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. Journal of Occupational and Environmental Medicine, 47(6), 565–572.
Klein, R. G., Mannuzza, S., Olazagasti, M. A., Roizen, E., Hutchison, J. A., Lashua, E. C., & Castellanos, F. X. (2012). Clinical and functional outcome of childhood attentiondeficit/hyperactivity disorder 33 years later. Archives of General Psychiatry, 69(12), 1295–1303. doi: 10.1001/archgenpsychiatry.2012.271
McCarthy, S., Asherson, P., Coghill, D., Hollis, C., Murray, M., Potts, L., . . . Wong, I. C. (2009). Attention-deficit hyperactivity disorder: Treatment discontinuation in adolescents and young adults. British Journal of Psychiatry, 194(3), 273–277. doi: 10.1192/bjp.bp.107.045245
Volkow, N. D., & Swanson, J. M. (2013). Clinical practice: Adult attention deficit-hyperactivity disorder. New England Journal of Medicine, 369(20), 1935–1944. doi: 10.1056/NEJMcp1212625