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
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
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
Goal orientation: Motivation or desire is clearly focused toward a
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
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,
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.
According to Nadeau, what are the six internal resilience factors common
to successful adults with ADD? Record the letter of the correct answer the .