ADHD Workplace Interventions: Strategies for Adult Success

ADHD and Its Symptoms in Adults

Robinson and McNamara (n.d.) report that Attention Deficit Hyperactivity Disorder (ADHD) has only recently been recognized as persisting into the adulthood of many people. Public awareness began to develop when the New England Journal of Medicine published a research article on the subject. Robinson and McNamara note that the difference between child and adult ADHD lies not in the symptoms themselves but in how those symptoms manifest. Symptoms for both groups are largely the same: lack of attention to detail, difficulty sustaining attention, apparent failure to listen, difficulty following through with instructions, difficulty with organization, failure to keep up with task-associated materials, distractibility, and forgetfulness. Teachers and parents often manage some of these challenges for children, whereas adults are expected to function with much greater — if not total — independence. While children with ADHD may fail to complete assignments, daydream in class, and misplace school materials, resulting in low grades, the same behaviors in adults carry far more serious consequences (Robinson and McNamara, n.d.).

The National Resource Center on ADHD lists the following symptoms and problems associated with ADHD:

(1) Poor attention and excessive distractibility; (2) physical restlessness or hyperactivity; (3) excessive impulsivity — saying or doing things without thinking; (4) excessive and chronic procrastination; (5) difficulty getting started on tasks; (6) difficulty completing tasks; (7) frequently losing things; (8) poor organization, planning, and time management skills; (9) excessive forgetfulness; (10) workers start many tasks but complete few; (11) workers frequently leave their work area; (12) affected workers distract others with restlessness or hyperactivity; (13) workers disrupt meetings or offend colleagues with impulsive verbal outbursts; (14) workers have trouble getting started on and completing tasks and projects; (15) workers are disorganized — misplacing tools, planning poorly, and managing time ineffectively; and (16) workers unintentionally neglect tasks and assignments (Robinson, 2009).

Robinson and McNamara offer a helpful illustrative example:

"Consider the hypothetical case of Ted. Ted was hired by an advertising agency primarily because of the brilliant creativity he demonstrated in his portfolio and in several hypothetical projects assigned as part of the interview process. In meetings with management and clients, Ted tends to shift frequently between ideas — whether in presentations or while attempting to listen to client needs or management desires. He is rapidly developing a reputation as a 'big picture' person with lots of ideas, energy, and enthusiasm. He gets projects off to great starts but fails to follow them through to completion. He often appears for client presentations unprepared or lacking necessary materials or information. Consequently, his client responsibilities are continually being reduced. In all likelihood, management is considering letting him go. More importantly, Ted is likely to be unaware of his potential ADD diagnosis. According to Dendy (1995), 'Individuals who are extremely bright or who have ADD/Inattentive/Without Hyperactivity are more likely to reach adolescence or adulthood without a diagnosis'" (Robinson and McNamara, n.d., citing Dendy, 1995).

Murphy (1995) reports that some of the more common emotional correlates of adult ADHD are low self-esteem, avoidance and anxiety, and depression. Approximately 80% of the adult population at one university medical center's ADD Adult Clinic admitted to having low self-esteem. Murphy also noted that because of the behavioral manifestations of ADD in adults — including impulsivity, interrupting, forgetfulness, inattentiveness, temper, and mood swings — others tend to view these individuals as rude, insensitive, irresponsible, or obnoxious (Murphy, 1995, cited in Robinson and McNamara, n.d.). As a result, some adults with ADHD come to associate social interactions with embarrassment, disappointment, criticism, or failure. When faced with future opportunities for social interaction, they often prefer to stay on the sidelines. Murphy further notes that some individuals have experienced failure so many times that they no longer attempt work or school.

Robinson (2009) states that drug therapy for ADHD has scarcely been researched. However, the National Resource Center on ADHD (NRC, 2004) suggests that drug therapy serves to level "the neurobiological playing field" so that adults can learn and develop coping skills. Psychostimulants are the primary pharmaceutical intervention for ADHD and include methylphenidate and amphetamines. Pemoline is a third, less frequently prescribed psychostimulant due to rare instances of severe liver damage. Secondary pharmaceutical interventions have been found to be less effective and carry greater health-related risks. These include atomoxetine, tricyclic antidepressants (desipramine and nortriptyline), monoamine oxidase inhibitors (MAOIs), bupropion, venlafaxine, antihypertensives (clonidine and guanfacine), and modafinil, a wake-promoting agent (Robinson, 2009). Antidepressants are sometimes prescribed, although there is no documentation on their efficacy in treating ADHD specifically.

Robinson (2009) emphasizes that drug therapy "should not be considered as the only treatment." When medication is used, it should be administered under medical supervision and only as part of a comprehensive treatment program. Such a program should include a careful diagnostic evaluation; education about ADD and associated learning problems; practical suggestions for restructuring one's life and managing one's moods; counseling, coaching, or psychotherapy; and family or couples therapy as needed.

Vocational Counseling for Adults with ADHD

A persistent question in the field is where vocational counseling ends and personal counseling begins (Robinson, 2009). This is because ADHD permeates adult patients' lives, and a primary life role of adults is that of worker. Ideally, the crucial intervention period is when clients are exploring vocational opportunities. Counselors can assist clients with ADHD in identifying occupations and work settings that complement the behavioral tendencies associated with ADHD (Robinson, 2009).

Because ADHD manifests differently in each individual, vocational counselors must carefully assess each person's weaknesses and strengths and help them identify the options most closely aligned with their particular manifestations of ADHD. Adults with ADHD are capable and competent workers — ADHD is a treatable mental health condition. However, the complexity of ADHD and its differential expression among individuals makes accurate diagnosis a critical first step in successful treatment.

Harpin (2005) reports that approximately 60% of individuals who had ADHD symptoms in childhood continue to experience difficulties as adults. Adults with ADHD are more likely to be dismissed from employment and have often tried a number of jobs before finding one at which they can succeed. They are frequently self-employed, and many find it necessary to choose specific types of work because adults with ADHD "experience more interpersonal difficulties with employers and colleagues" (Harpin, 2005). Additional workplace problems include lateness, absenteeism, excessive errors, and an inability to accomplish expected workloads. At home, relationship difficulties and breakups are more common. Adults with persistent ADHD symptoms who have not received medication also face an increased risk of drug and substance abuse. Furthermore, due to the genetic component of ADHD, adults with the condition are more likely to have children who also have ADHD, which adds further stress to their lives. Comorbid disorders are also common — for example, oppositional defiant disorder (ODD) and conduct disorder coexist in approximately 30% of cases.

Workplace Interventions and Non-Pharmacological Strategies

Ramsay (2010) reports that individuals whose formal education ends after high school tend to view the workplace as a refuge from the classroom and a means of establishing their adult identity. Individuals with ADHD in particular seek jobs that allow them to use their skills and aptitudes without overemphasizing academic skills that may represent relative weaknesses. Young adults with ADHD who attend college and pursue graduate or professional education typically aim to establish a professional position in the workplace.

Ramsay (2010) notes that regardless of one's occupational path — whether in conventional employment, self-employment, or stay-at-home parenting — the ability to function in a work setting is an inescapable feature of adult life. This requires relatively independent functioning in terms of organization, time management, planning, prioritizing, following through on tasks, and other self-management skills. Although the academic demands of school can be very stressful for individuals with ADHD, the workplace presents similar, and in some ways greater, challenges.

Because adults in the workplace are expected to function independently with little supervision, ineffective self-management and organizational strategies can create problems with potentially serious consequences. Students with academic difficulties may access tutoring, benefit from an interesting course, form a positive connection with a teacher, or participate in extracurricular activities — each of which can foster confidence and competence. Even during extreme educational difficulties, students with ADHD can take some comfort knowing that, if they persist, they will eventually reach the end of the semester and start fresh. Workers with ADHD do not have comparable safety nets. The consequences of workplace impairment can be particularly damaging. While adults can choose to leave an unsatisfactory job, doing so carries costs such as loss of seniority, a cycle of being stuck in entry-level positions, and disruption in other aspects of life such as loss of health care coverage and relocation costs (Ramsay, 2010).

Workers with ADHD also lack the support services available to students, and they face the added responsibility of organizing and managing personal affairs, including supporting their families. As Ramsay (2010) observes, "workplace impairments stemming from adult ADHD have significant ripple effects." Despite a growing body of research documenting underperformance at work among adults with ADHD, there is still limited empirical guidance on approaches for helping these adults choose occupations or improve their workplace performance. Interventions are, however, being actively researched.

Cognitive behavioral therapy (CBT) is reported to work well for managing ADHD symptoms in adults. A CBT program for adult ADHD typically addresses five key components:

(1) Neurocognitive skills — for example, learning strategies to improve attention control, memory, impulse control, and planning; (2) Problem solving — for example, developing skilled thinking, problem identification, consequential thinking, conflict management, and decision-making; (3) Emotional control — for example, managing feelings of anger and anxiety; (4) Social skills — for example, recognizing others' thoughts and feelings, practicing empathy, and developing negotiation and conflict resolution skills; and (5) Critical reasoning — for example, evaluating options and developing effective behavioral skills (ADHD and You, 2013).

Works Cited

Antshel, K. M., Hargrave, T. M., Simonescu, M., Kaul, P., Hendricks, K., & Faraone, S. V. (2011). Advances in understanding and treating ADHD. BMC Medicine, 9, 72.

Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder in the Workplace. (2013). All One Health. Retrieved from

Emilsson, B., Gudjonsson, G., Sigurdsson, J. F., et al. (2011). Cognitive behaviour therapy in medication-treated adults with ADHD and persistent symptoms: A randomized controlled trial. BMC Psychiatry, 11, 1–10.

Harpin, V. A. (2005). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Archives of Disease in Childhood, 90(Suppl. 1), i2–i7.

Kubik, J. A. (2010). Efficacy of ADHD coaching for adults with ADHD. Journal of Attention Disorders, 13(5), 442–453.

Murphy, K. (2005). Psychosocial treatments for ADHD in teens and adults: A practice-friendly review. Journal of Clinical Psychology, 61(5), 607–619.

National Resource Center on AD/HD. (2003). What We Know #18: Coaching for adults with AD/HD. Children and Adults with Attention Deficit Hyperactivity Disorder.

National Resource Center on AD/HD. (2007). What We Know #4: Educational rights for children with AD/HD in public schools. National Resource Center on AD/HD.

Pliszka, S., & AACAP Work Group on Quality Issues. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7), 894–921.

Ramsay, R. J. (2010). Nonmedication treatments for adults with ADHD: Evaluating impact on functioning and well-being. American Psychological Association.

Robinson, C. R. (2009). Helping adults with ADHD succeed in the workplace. Professional Counseling Digest. American Counseling Association.

Subcommittee on Attention Deficit Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention deficit hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007–1022.