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Attention deficit hyperactivity disorder (ADHD) | Insight

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is considered a form of neurodiversity, along with other conditions such as autism, dyslexia, dyspraxia and dyscalculia.

Neurodiversity refers to different ways the brain can work and interpret information. Those with ADHD can feel restless and lack concentration.

ADHD is thought to be caused by a complex mix of environmental and genetic factors, but is a strongly hereditary condition. It is present from childhood, but an increasing number of adults are now being diagnosed with ADHD for the first time.

It affects around 3-5% of children and around 2% of adults in the UK. The condition is usually diagnosed between three and seven years of age, but can be identified later in childhood — or even in adulthood.

Simple strategies can help those affected thrive in the workplace, and those with ADHD can also bring many strengths to an organisation.

Key takeaways

ADHD affects around 2% of the adult population
People with ADHD can be restless, lack concentration and be impulsive
There is no cure, however it can be managed with appropriate treatment
Treatment for adults usually involves medicine or psychological therapies
Workplace supports/adjustments need not be expensive or complicated, talk to your employee to find out what they think will assist them at work
ADHD may be seen as a disability under the 2010 Equality Act
Occupational health can provide you with further bespoke guidance to help with individuals’ case management; in certain circumstances this may include the recommendation for a referral to a specialist service for bespoke workplace advice

Condition overview

Those living with ADHD can experience a variety of challenges, which can affect their home life and work life.

Symptoms often improve as people get older, but many still experience problems throughout their lives. People with ADHD can also have sleep or anxiety issues.

The cause of the condition is unknown, however it has been found to run in families — and has been associated with premature birth or low birth weight.

Symptoms and signs

There is no definitive list of adult ADHD symptoms, and it can present differently to the way it does in children. For example, hyperactivity tends to decrease in adults, while inattentiveness tends to get worse as the pressure of adult life increases. Also, adult symptoms of ADHD tend to be far more subtle than childhood symptoms.

ADHD has three core symptoms which affect people to different degrees:

Inattention

Difficulties with concentration, short term and working memory.
Difficulties with planning and getting started (activation).
Difficulty with organisation and losing things.
Easily distracted by small things which others wouldn’t notice.

Impulsiveness

Acting or speaking on the spur of the moment without thinking through the consequences.
Difficulty controlling emotions.

Hyperactivity

Adults with ADHD are usually much less active than children with ADHD, but may still have symptoms such as restlessness and the need to tap or fidget.
Some people are diagnosed with Attention Deficit Disorder, without hyperactivity. This is particularly the case for girls and women.

Co-existent sleep issues can have knock-on consequences for getting up and out to work in the morning.

Some (but by no means all) people with ADHD, also develop mental health difficulties, such as anxiety and depression.

Strengths associated with ADHD include:

Ability to ‘hyper focus’ on things of Interest
Willingness to take risks
Spontaneous and flexible
Good in a crisis
Creative ideas – “thinking outside the box”
Relentless energy
Often optimistic
Motivated by short-term deadlines – working in sprints rather than marathons
Good eye for detail

Treatment

There is no cure for ADHD, but medicines and therapies such as CBT have been shown to help.

Coaching can help a person understand their condition better and identify strategies to help them.

Medication can help people with ADHD to concentrate, be less impulsive, feel calmer, and learn new skills.

ADHD and work

Ask your employee which adjustments they feel may help them at work. These will depend on the nature and severity of their difficulties, along with the nature of their job.

Depending on their role, undertake a safety risk assessment and make any required highlighted adjustments. For example, if your employee is finding it hard to focus on safety critical/business tasks, restriction from these might be necessary until the situation has improved. Occupational health can offer bespoke case advice.

A diagnosis of ADHD may require the employee to notify the DVLA if ‘’there is a risk it could affect the person’s driving’’. Advice from a GP, specialist or occupational health may be necessary to clarify.

These issues might slow output, and could have further implications for driving.

Job features which can fit well with ADHD include:

Roles which match an individual’s interests and skills, boredom and low interest will make focus much more difficult
Structured work day
Opportunities for movement
Stimulation, allowing reaction to incoming demands
Regular and fairly immediate feedback

Job features which may be more challenging include:

Long periods working in isolation
Monotonous and repetitive tasks without variation
Need for high levels of concentration to manage risk (e.g. industrial safety monitoring, long distance driving)

Reasonable adjustments

There are a number of measures employers and employees can take to help people with ADHD, and these can be broadly split into three categories:

Modifications to the work environment

Visual prompts such as wall charts for routines, checklists, reminder notes
Larger computer screens so everything is visible (reducing burden on memory)
Visible clocks, with use of alarms and timers
Reducing distractions, allowing headphones or earplugs, if needed
Opportunities to work flexibly, including from home

Modifications to working practices

Offer increased supervision, check-ins and feedback — giving constructive feedback
Break tasks down into clear, manageable steps
Give instructions and meeting notes in writing, rather than verbally
Allow regular movement / stretching breaks, including during long meetings
Try working in short bursts (see the Pomodoro Technique)
Allow employees to delegate unsuitable work, where appropriate

Technological modifications

Apps can be useful for people with ADHD, but they need to be chosen wisely not to add an extra burden on memory.

Potentially useful apps might include:

To-do list / scheduling apps
Reading or writing aids, if needed
Blockers to eliminate distractions from social media / smart phones
White noise / ambient noise apps
Note-taking apps

People with ADHD may benefit from sessions with a work coach, to help develop their organisation and time-management skills. Access to Work funding can sometimes be used to fund this.

As above, mental health issues such as anxiety and depression can co-exist for those with ADHD, so be alert to this and signpost your employee where necessary.