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10 CEUs Treating Locking In & Blocking Out: ADD Adults

Section 23
How Adult ADD Impacts Workplace Functioning

Question 23 | Answer Booklet | Table of Contents | ADD CEU Courses
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

Although work life dominates the waking hours of most adults, remarkably little attention has been focused on workplace functioning, and few clinicians give workplace functioning high priority when formulating a treatment plan. More often, therapists relegate workplace concerns to career counselors and/or attention deficit hyperactivity disorder coaches. One study of adults who had learning or attentional problems (Blalock & Johnson) reported that adults who have ADHD (and learning disabilities [LDs]) were rarely able to find a professional trained in both career and cognitive issues associated with ADHD and learning disabilities. Instead, the career consultants they found had little or no training in those areas, and those who conducted cognitive assessments had no training that allowed them to apply their findings to careers. The ADHD-affected adults needed guidance to implement the recommendations of the reports but were unable to locate professionals who could integrate career assessments and neuropsychological assessments. One man poignantly remarked that he had spent a lifetime looking for someone who could help him find a suitable career direction and learn to function well on the job. A central goal of this article is to encourage clinicians who treat the adult who has ADHD to become that "someone"—a professional who provides integrated, comprehensive career-focused services from a neuropsychological perspective.

Beyond the ability to integrate the findings of neurocognitive assessments and career evaluations, there is a strong need for professionals who can help adults who have ADHD deal with the multiple emotional challenges typically associated with ADHD that affect workplace performance. The majority of adults whose ADHD has been untreated into adulthood carry significant emotional baggage from repeated failures, underachievement, broken relationships, family conflict, and never-completed college degrees. What is more, most adults who have ADHD have comorbid conditions including depression, anxiety, bipolar disorder, and substance abuse, that must also be addressed if treatment is to be successful. When considering all of these factors, it becomes increasingly clear that a therapist trained in both psychotherapy and neurocognitive assessment is uniquely qualified to provide the best services for adults who have ADHD and struggle with workplace challenges.

How Adult ADHD Affects Workplace Performance
As children progress from childhood through adolescence and into adulthood, hyperactivity tends to decrease while problems with inattention and distractibility remain. In addition, a larger and perhaps more challenging set of ADHD-related symptoms move to the foreground—a complex set of cognitive abilities clustered under the term executive functions. For adults who have ADHD, these problems with executive functioning have a direct effect on workplace performance. Poor time management skills result in chronic lateness and missed deadlines; organizational problems lead to cluttered desks, misplaced paperwork, and difficulty in scheduling and prioritizing tasks. Difficulties with self-regulation and need for structure often make it difficult for the adult who has ADHD to work well independently and to complete complex, multistep tasks. The adult who seeks consultation regarding ADHD is likely to report that life’s demands feel overwhelming and that daily life feels out of control.

High-Functioning Adults Who Have ADHD
Although some mental health professionals question the validity of an ADHD diagnosis for someone who has a high IQ and advanced education, in reality the incidence of ADHD among such individuals is significant. ADHD in these adults frequently results in significant disability—for example, a physician may be unable to pass medical boards despite repeated trials; an attorney may lose her position because of inadequate focus and efficiency; a doctoral candidate may be unable to complete his degree because of an inability to organize and complete the dissertation; or an accountant may repeatedly lose jobs because of problems with time management and organization and because of low motivation. Many such adults, by virtue of their high IQ, supportive environment, and less severe ADHD, are able to function well in elementary school, and sometimes through high school and college. However, when academic or professional demands surpass their ability to compensate for ADHD challenges, ADHD becomes a significant barrier to further success. It is often at this point that such individuals seek professional assistance. Often, many such adults are misdiagnosed by mental health professionals, who assume that an ADHD diagnosis is not appropriate for adults who have a history of past achievement. The concept of an ADHD "disability" among high-functioning adults remains controversial, but some experts have begun to write about this important issue. Garber, a pioneer in the study of high achievement among adults who have learning disabilities (Garber, Ginsberg, & Reiff; Reiff, Garber, & Ginsberg), writes, "Today, there is a developing literature on those with LD and/or ADHD who have exhibited almost incredible resilience throughout their lives to overcome major hurdles to adjustment, finding avenues to notable achievement" (Garber). Awareness of ADHD in high-functioning adults is especially important for the clinician in private practice because this population, because of financial ability and good health insurance, is overrepresented among those who seek private consultations regarding the workplace. In my experience, many such adults seek diagnosis or assistance only to be told that an ADHD diagnosis is inconsistent with their level of achievement.

Underfunctioning Adults Who Have ADHD
In a private practice setting, underfunctioning adults who have ADHD are most often in their early twenties, referred for consultation by parents who have the financial ability to pay for their unemployed or underemployed son or daughter who has ADHD. Some older underfunctioning adults may be referred by a spouse. However, most underfunctioning adults who have untreated ADHD never seek professional help because of lack of awareness, lack of health insurance, and/or financial constraints.

Factors Common to Successful Adults Who Have ADHD
Some adults who have ADHD, without benefit of intervention, have managed to reach high levels of achievement. If our goal, as clinicians, is to help other adults become successful, we should begin by understanding the factors that high achieving adults who have ADHD have in common. Garber refers to the shared traits of these successful adults as "resilience factors," which he divides into "internal" or personal factors and "external" or environmental factors.

Internal Resilience Factors:
Control: Successful adults focus on how to gain and maintain control of their life.
Desire: Motivation may be positive, or negative (such as need to prove someone wrong).
Goal orientation: Motivation or desire is clearly focused toward a particular goal.
Reframing: The disability is reframed to recognize strengths.
Persistence: There is a willingness to put forth extraordinary effort to achieve the desired goal.
Learned creativity: Strategies and techniques are used to enhance performance.

External Resilience Factors
Goodness of fit: Successful adults find the right niche—a job or career that calls on their strengths.
Supportive social environment: Encouraging, helpful people who appreciate their strengths and are tolerant.
Mentors: Someone is in a supportive role of teaching and guidance.
Support services: These are people hired to perform needed services.

Garber’s Resilience Factors
The clinician needs to educate the client that ADHD is a highly treatable condition, that success in life and in one’s career is quite possible when one has ADHD. Educating the client about Garber’s resilience factors provides an opening to the work that is to begin.
Reframing: The therapist should first help the clients to reframe their views of themselves and their life circumstances so that they can address challenges with a positive and constructive approach.
Desire and persistence: Although "desire" may exist (e.g., "I wish that my dreams would come true"), learned helplessness that often develops through years of frustration and failure prevents most adults who have ADHD from translating desire into motivation and persistence. For this reason, a transition from demoralization to optimism is the first and primary task of psychotherapy.
Goal orientation: As the client’s pattern of learned helplessness recedes, replaced by realistic optimism and armed with strategies to begin to mitigate the negative effects of ADHD, the therapist and client can begin to develop clear, realistic goals. Establishing goals that are a good match for the client’s strengths and weaknesses, personality, temperament, values, and interests is the central focus of the career assessment process.
- Nadeau, Kathleen G.; Career Choices and Workplace Challenges for Individual with ADHD; Journal of Clinical Psychology; May 2005; Vol. 61 Issue 5, p549

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Personal Reflection Exercise #9
The preceding section contained information about how adult ADD impacts workplace functioning.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 23
According to Nadeau, what are the six internal resilience factors common to successful adults with ADD? Record the letter of the correct answer the Answer Booklet.

 
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