Monday, 29 September 2014

How ADHD Affects Careers

It is well documented that ADHD in adult life can very much affect the individual and those around them, most often in  deliterious ways. In fact frequent changes of jobs, turbulence in the workplace, under achievement and getting fired more than average is part of the diagnosis from the case history for those not diagnosed from childhood or adolescence.

ADHD is typified in adult life by disorganisation and distraction, two rather unfortunate handicaps in the workplace. In the author's experience, sufferers are  under represented in middle or higher management, and totally absent from those who work in the main three professions, Law-Accounting-Medicine. For the latter cases it seems that the demands in academia are too high in terms of volume of work, attention to detail and precision in completing practical examples.

It is also very typical that the sufferers tackle some tasks with real skill and ability to deliver on task, while other tasks or situations are handled with below acceptable standard. This is related to a high level of motivation for the task and it seems the low stimulation of the brain is circumvented by a level of arousal followed by acceptable performance, or actually extremely good performance in that one task. Also there can be social or economic rewards which stimulate the person to arouse their brains and achieve results.

Some successful celebrities, sports stars and entrepreneurs come "out" as ADHD, with eithr childhood or adult or self diagnosis, and even claim that the highs in mental activity,  and actually getting bored with, or avoiding mundane tasks meant that they could perform in a role they loved, or that they avoided what they found dull and found a talent in their non-conformist life style and career. Over the last decade many comedians, including of course the late great Robin Williams, have admitted to BiPolar depressive or hypomanic disorders. It seems likely though that many comedians in particular actually suffer from ADHD and have found a life style of self stimulation, positive stress and social gratification which in effect 'self medicates'.
However for the majority of adult sufferers there is no great reward for having ADHD and its on-off nature, and not being able to get on or hold down a normal job.
Career Path
> Several career changes, or no real career building
> Lower Achievement than peers
> Changes Jobs More Often Than Average
> Is Disatisfied with Own Abillity, Or Wonders Why They Have Not Got Further
> Well above average dismissals or failed to get rehired after temp or probationary period
> Some major conflicts with line management, coworkers or company HR or higher management
> Have disciplinary action or written demands for approval
> Quits jobs due to stress, times of conflict, fear or being fired, boredom and lack of promotion
Work Place Conduct
> Is distractable
> Does not follow instructions or training
> Does not remember instructions, methods or procedures
> bad time keeping on arriving or leaving work or for meetings etc
> poor time/task management and prioritisation
> Difficulty with summarising information or events
> difficulty in communicating clearly, especially in e-mail
> finds they irritate managers
> fails to finish tasks completely
> Distracts others and is talkative or 'PM happy' ie internal text messages are frequent
> Gets irritable in meetings or training lectures when they are not leading or involved
> Impulsive, can take rash decisions or act on the first course of action they think of
> Sees tasks, challenges, and work relationships subjectively and has difficulty with objectivity
>  Is poor at having balanced discussions, resorts more to arguments or one sided approaches
> Can show anger or frustration over situations others would tackle.
> Becomes tired and lacks concentration at some points in the day
> gets bored and easily distracted from repititve tasks
> Lacks attention to detail and does not check work before it is submitted or completed
> Fails to perform as well on average as other similarly qualified coworkers
> Can be insolent and resentful of management asking them to do dull or demanding tasks
> Often feel disappointed with employers overlooking them for promotion, or paranoid about not getting a better deal at work
> Can be conflict averse due to fear of becoming angry or of loosing control of the sitation by becoming passive.
> Used to negative outcomes from some types of management discussions, learned inability, passivness
> low self esteem, or fragile 'bubble ego' or excessive modesty.
Positive Sides
> Has high energy and dedication to tasks they really like to do
> Can be very creative
> Can be positive socially , lively and interactive with coworkers
> Can be suited very well to some types of jobs having perhaps started in a company in another job
> Can think laterally in some circumstances, and present many different solutions or scenarios, and evaluate these for relevance, likelihood or applicability
> Can act with quick wits or actions when presented with a pressing challenge
Tackling Strategies
Most of the medical and psychiatric literature and web info in English refers to medication as being an important part of management, and is often vague on other techniques other than calling it "councelling" or "concentration techniques" without going into any real detail. Clinical trials are generally not conducted on such therapies or self help strategies, they would be complex, expensive and probably less conclusive than pharmaceutical trials, and that is one reason that there is less about them in the medical literature - they are less well documented and physicians and psychiatrists are wary of quoting them, and would rather grab for a known management of the disease by Ritalin and other preparations. Often then the social and psycho cognetal approaches are suggested as a nice to have secondry approach, with an aire of patronisation in some papers.
The authors have yet to examine or translate the French literature because they take a very different approach to ADHD, and although they tacitly accept hyperactivity and attention deficiency exist, they take a strucutred approach to improving concentration in particular for sufferers at school. In this way they exclude the mass over diagnosis, by virtually denying it is a disease in some quarters, and thus picking up low motivation, lazy and distractable students and those with social background related problems in this approach AND giving some benefit to the ADHD sufferers.  Many in France also see diet as important and recommend a change to a healthier diet and avoidance of high sugar foods, and highly refined carbohydrates and hihgly processed foods with many chemical additives.
So in our group, and over the history of moderating the group as it has evolved and reformed itself over 5 years, we have collated many anonymised comments or histories on how individuals tackled their challenges in working life, and what non medical help was sought or offered.
1) Moving where the work is, or down sizing to meet lower income expectations - two related strategies which overcame the issues or swapping jobs or being fired and then often acepting a lower anticipated long term income and down sizing , or indeed being  disabled out the workforce in a couple of our current group ( far more prominent in our first incarnations when earlier members were younger and more volatile in nature)
We have had very few women in our group after the first younger participants fell away, so it is hard to judge if women are more likely to drop out by getting married or cohabiting with a man who creates most of the income.
The latter is a rather sad indictment of not seeking help, and not self fullfilling, however it is compensated by
2) FInding work which really interests or rewards
This was often lower paid but sometimes it has involved moving into sales or a more sociable job, where creativity and personability is rated higher than precision, analysis, summation, calmness and focus on repetitive tasks over time.   So the most typical example is sales, where an economic and often social reward seems to stimulate the sufferer who then can be very turned-on in the sales call, while being able to be distracted or on 'low cycle' between sales calls. Sales people are known for their varied abilities in administration anyway.
One long term member of the group has done stand up comedy, and has in fact been paid and invited to other venues.
Others have moved into care work with handicapped people or the elderly, which is a big career sector for the semi skilled locally here.
3) FInding work which is Better Structured
For those in our current group of more mature sufferers, average age around mid 30s, this was also a marked career tendency in those which had been able to follow a more stable career and shift jobs less often, and end up with the better wages of the group.
This was often in industry, or in administration within industry, and it may strike the reader that this would seem the type of repetitive, dull work which ADHD sufferers should avoid.
The key difference is that these jobs offered a high degree of structure and business or quality processes. One described their job in technical admin' as having 'hand  rails' and small intermediate goals which maeant than when they felt low on concentration, they had at least the next stage to complete, and when they were a little hyper, they could come down off the high and have a natural process to follow. Several agreed, and this has also been the councellors past experience with other more successful members. Often these jobs had a degree of variaability, each type of task having its own proceduralk systems,. These were most often in larger companies, where of course they have the need to reduce human error by having systems which can be taught and which integrate to other functions in their value= and admin= chains.
4) Better structuring work and goals themselves
This was a more cross the board opinion, which showed the benefit of group therapy and discussion, because it mannifests itself in many different ways. These days people often use personal mobile devices, and the work PC or laptop to help in particular with
>Having a to-do list on the computer
> Prioritising tasks and goals from this list (s)
Breaking down the task into sub components with notes on the computer
Describing the task in their own words or cut and pasting from instructions or asking coworkers by email for help and pasting in the best answers
> Scheduling the Task
> Holding a calendar with alarms. Making those alarms or other pre/alarms such that they make meetings, or start to finish off tasks with enough time to do this before the appointment time or due date
> Building small systems in software or with colleagues, or even wihtin a department which help them deliver and integrate their work to others.
Some without daily use of laptops, simply wrote post it notes, or had a small diary at hand. Others took an approach of using other people to help them organise their day and remember appointments, and this for a couple of entrepreneurs was tantamount to having a cheap PA in missusing young office staff or spouses who worked in their small business.
5) Self Knowledge
Leading on from the last point in 4, because particulary now the group dynamic is older, the younger members have nearly all fallen away completely, then there is a large amount of using self knowledge to make decisions about what type of work, tasks and motivations they have in general, and how these may vary through a working day.
At the lower end of productivity and wealth, there were as mentioned the medically disabled, who in fact probably dont have the strongest symptoms amongst the older dynamic (a reverse of the early incarnation demographics!!) They have learned that they do not function well in working life and have chosen to seek medical help, and indeed to some extent you can see this as fraudulent when they start to reach out for other conditions like having a bad back, or social angst to then boost up their chances of getting invalidity benefits.
Also at the lower end there were a few and have been before, who work in practical work, like mechanics or gardening, and are mostly not fully qualified. They know they are not very productive compared to some, but their employers often pay them a lot less, or allow them to work part time, or give them more interesting tasks to do. They have a longer term relationship with the employer, while actually in only a few cases over the years whcih have come to light, has the employee discussed or had a case worker discuss their diagnosis, or reduced capacity without knowing it was ADHD. The work place then had been altered for their needs to some extent, or their sphere was tailored to them. 
Further up the listings of income and success have been some academics and journalists, who have thrived on creativity and not been tied down to doing tasks they do not like.
Then as mentioned there was a group of admin and techno/crats, who had chosen to some extent consciously to follow a more structured career, often down sizing from other jobs, but just as often happening to find a niche were they could perform and actually acheive more..
Above this there have been few managers, but a good few high earning sales personnel, some of whom tried and did not do well at sales management or in other functions. Also there have been a number of self employed people who are relatively successful, self actualising a lot, on varied incomes. They come to the group most often due to their spouses asking, or because in fact they have difficulty with romantic relationships, or in a couple of cases because they could not retain staff or had conflict with staff they felt they could not resolve easily because of lack of assertiveness
6) Alternative Self Selected Tackling Strategies or Qausi Medication
The most common of these in the first two years of the group, was substance of abuse. It is usually difficult for drugs and alcohol (which we always categorise as a drug too) to be seen as anything than exaverbating ADHD or leading to a false diagnosis of the condition in the first place. However some sufferers use the "upper/downer/make-it-go-awayer" approach to self medicating. This can take the form of once substance of abuse in one category, usually either narcotic or barbituate /amphetamine and we include alchohol as a narcotic in this fashion most often, if it is not being used to self release from inhibitions. Some however in the earlier days, amongst younger adults, used an interesting course of using the uppers for the desired effect in the morning, before going out, or before what ever event or situation was anticipated (sometimes criminal of course) While then using the downers, such as cannabis, to relax, counter act the amphetimines,  or come down from the hyperactivity of the disease perhaps itself. For ethical reasons we cannot discuss any positive effect of this, and indeed we will not take this any further here, other than pointing out that it happens and some people actually consciously use drugs of abuse to try to tackle everyday life and the symptoms of ADHD.
As the group evolved, and also due to another local initiative to involve all people with psychological diagnosii to participate in sport, more and more members reported positive effects of sport and physical activity. Some noted that longer bouts of even activity seemed to be more beneficial to concentration and in changing training pattern from short burst intensity sessions over to longer sessions they found that they had improved both concentration and how they tackle situations. THis is one area which is amenable to clinical trials, single blind at least.  Numerous studies have linked exercise to improved cognitive abilities and even effects on the number of nerve cells in the brain. It is something which the group recommends new members, and older members who are less active are also encouraged to just go out for long gentle walks etc. Cycling, running and xc skiing are the predominant 'endurance' sports here incidentally. A small minority had participated in marial arts, or had even in two members become very proficient and they felt that the concentration and means of training up to the levels of skill, stregnth and  concentration were quite probably very therapeutic for themselves.Lateral studies between ADHD sufferers and their level of activity, and type of activity could be conducted with potentially conclusive or indicative results, while longdituninal studies on individuals starting on a new course would also be indicative as to any benefit from low technique sports, longer duration sessions or concentration sports like martial arts and XC skiing.

Meditation was a far less commonly noted therapy, and was part of the marital artists repertoire. Hypnotherapy has been reported, with no detail or value discussed. A few had sought quasi qaulified help or alternative therapies, without any notable success, but a good feeling about having done it.
Very few over the last five years had self selected concentration exercises, and there was no real conclusion from them or those who had been through them after referral.More on that below.
Diet has been an issue for several, especially those with children who have begun to show signs of possible ADD /ADHD, and it is often discussed in the group without any conclusive nature, but that many feel the benefit of a healthier 'whole food' diet with fish and omega 3 supplements. There are some internet sources who claim that in fact (some?) ADHD is caused by lactose metabolism defects and a dairy free diet can totally alleviate the symptoms in children especially. This has not been clinically trialled in adults at least, the non dairy, non sugar diet has been trialled in children with indicitative results (but the diagnoses of the entry groups has in the larger studies come into question for over-diagnosis, thus either diluting the effects or actually beingn the contributory sub group of those with a lactose metablism problem displaying some signs of ADHD) Lactose free diets have  been tried by pastt and present group members with some reporting positive effects.
The authors opinion is this:
> generally healthier eating and lifestyle can help alleviate the signs and symptoms of ADHD, and there may be a molecular explanation for this directly interacting with the disease mechanism, or just a more general effect on the brain as is now documented scientifically.
>Specific diets may reveal that ADHD like symptoms are casued by intolerances, and this can lead to misdiagnosis of course. We moderate our group in an ethical manner, and we therefore allow the topic of lactose free diet be aired without provoking it ourselves or particularly antagonising it. We moderate this to a short term try-and-see due to the potential loss of calcium and protein intake some people with traditional or less healthy diets may encounter. We say that if they feel benefit, they should go quickly to their GP for dietary advice
> Also specific sports or types of freetime activity should be studied to reveal positive effects on the actual disease, or general  "lifting" effects.
>  Concentration exercises have been studied clinically, with we feel inconclusive results on balance, and an issue in compliance and once again, pre screening for correct diagnosis. Also they are nealy all from younger age groups, so the nature of the exercises may not be so applicable or effective in adults. Perhaps studies published in french, where the opposite is sometimes true, that ADHD is not diagnoses but considered a concentration deficiency which can be 'taught out' of pupils,  have not been considered by us yet. We express a keen interest in this area and hope to be able to have some kind of path to go on at some point in time, and to be able to present intersting exercises mediated via books or web sites, or even Apps of course now, which have proven effect and are enjoyable or really worth the effort.
7) Courses, Therapies , The Help Group Itsef
Outside Norway, where we hold this group in native language, in english speaking western countries there has been a big focius since the 1980s on assertiveness training for managers, and for staff who are seen to perhaps need help in making assertions and taking action.  This was absent completely from comments taken now or earlier, apart from the course leaders who had been on these courses (both non norwegian by coincidence and fortuity) . However over the years a notable large minority had either been referred to a psychologist by their employer, or to family councelling, or as the most common prior to any diagnosis, over to Anger Management
Anger management courses through out the western world are no doubt made up of a high proportion of ADHD sufferers, and those others with post traumatic stress from childhood or adult exposure to violence. Some of course have ADHD and been exposed to trauma or caused traumatiic situations which exacerbate their poor lives.
There seems to be a lot of common ground though, and the councellors are taking this as a conclusion, that there should be a public or private offering of anger managment and for the less peppery of temperament, assertiveness training based on anger mangement techniques. One councellor currently teaches  and leads alternatives-to-violence courses for sufferers and health professionals. That is why they arre involved with the ADHD group, and they are suprised that the passivitiy or learned helplessness is very aa-kin to the type of feelings their other sufferers have, who are often probably ADHD and sometimes have had a diagnosis, or go on after a recommendation from ATV to seek diagnosis.
The self help group over the last five years as mentioned has evolved from being populated by mainly young adults with disturbed lifestyles, mostly having had the diagnosis in their teenage years, to being a far more mature group, and this is not perhaps purely coincidence. Younger sufferers were also seemngly more heavily affected, and less able or willing to contribute constructively. Many came with partners, parents or some kind of guardian figure. Now we have a group of older who come voluntarily, the majority having adult diagnosis while some have not yet had the diagnosis and wanted to share their stories or hear from others to decide if they should seek professinal help. Some feel it is a but of an insult to either bare the label, or even a stigma, while others feel frustrated that they did not get earlier diagnosis, often having had brushes with the medical profession around the edges but not on the cause. Most feel that mediication alone is not the answer in the bigger picture, several have stopped or refused ritalin, and discussion on mediaction forms a confidential part of our process, where we remind everyone that it must be voluntarily discussed or presented and it stays in the room, with off line discussions being avoided due to the risk of stigmatisation from outside.
Experiencs with the symptoms of the disease, most often the deliterrrious effects, experiences with the health profession, often frustrating, experiences with medication, very mixed, and then the experiences of how people tackle working life, romance, relationships, partenthood, crisis in life and so on and so on, form the rich content of our self help group. In our last quality evaluation , which was audited unofficially so far by the district psychological services, members  expressed overwhelmingly that they felt both emotional support from attendance, and also practical benefits in relation to self awareness and tackling strategies, as well as where they may like to go to look for further professional help or alternative techniques.