Literature Review Chapter: Interventions That Improve the Workplace

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¶ … Interventions that Improve the Workplace Behavior of Adults with ADHD

ADHD & the Symptoms of ADHD

The work of Robinson and McNamara (nd) reports that Attention Deficit Hyperactive Disorder has only been recognized recently as persisting into the adulthood of many people. It is reported that public awareness began to develop "when the New England Journal of Medicine published a research article." (nd, p.3) Robinson and McNamara report that differences between child and adult ADHD is not within the "symptoms themselves but in the manifestations of such symptoms. Symptoms for both are much the same: lack of attention to details, difficulty sustaining attention, apparent failure to listen, difficulty in following through with instructions, difficulty with organization, failing to "keep up" with task-associated materials, distractibility, and/or forgetfulness. Teachers and parents often take care of some of these problems for children. Adults are expected to be able to function with much greater, if not total, independence." (Robinson and McNamara, nd, p.4) While children with ADHD fail to complete assignments and daydream in class losing focus and tend to lose or misplace school materials or supplies resulting in low grades the same type of behavior in adults "will have more dire consequences." (Robinson and McNamara, nd, p.5)

It is reported that the National Resource Center on ADHD lists the symptoms and problems associated with ADHD as follows:

(1) Poor attention; 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 other workers with impulsive verbal outbursts;

(14) Workers have trouble getting started on and completing tasks and projects;

(15) Workers are disorganized -- misplaced tools, poor planning and time management; and (16) Workers unintentionally neglect tasks and assignments. (Robinson, 2009, p.1)

Robinson and McNamara state as an example as follows:

"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 as well as clients, Ted tends to shift frequently between ideas, either 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 some 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, nd, p.5 citing Dendy, 1995, p. 26).

It is reported in the work of Murphy (1995) that "some of the more common emotional correlates to be low self-esteem, avoidance/anxiety, and depression. He cited that approximately 80% of the adult population at the ADD Adult Clinic of the University of Massachusetts Medical Center have admitted to having low self-esteem. Murphy (1995) also noted that because of behavioral manifestations of ADD (impulsivity, interrupting, forgetfulness, inattentiveness, temper, mood swings) in adults, others view these ADD patients as "rude, insensitive, irresponsible, or obnoxious" (p. 137 cited in Robinson and McNamara, nd, p.5). The result is that some sufferers of ADHD "associate social interactions with either embarrassment, disappointment, criticism, or failure. When confronted with future opportunities for social interaction, these adults will often prefer to stay on the sidelines . . ." (Murphy, 1995, p. 137 cited in Robinson and McNamara, nd, p. 5). It is also related that Murphy (1995) states that other individuals have had the experience of failure so many times in the past that they do not attempt work or school in the future.

Robinson (2009) states that ADHD drug therapy has scarcely been researched. However, it is suggested by the NRC (2004) that drug therapy serves to level "…the neurobiological playing field" so adults are able to learn and hone coping skills. Psychostimulants are the primary pharmaceutical intervention for ADHD. These include methylphenidate and amphetamines. Pemoline is a third, less prescribed psychostimulant due to rare instances of severe liver damage. Secondary pharmaceutical interventions have been found to be less effective and expose patients to more health related risks. These include atomoxetine, tricyclic antidepressants (desipramine and nortriptyline), monoamine oxidase inhibitors (MAOIs), bupropion, venlafaxine, antihypertensives (clonidine and guanfacine), and madafinil, a wake-promoting agent." (Robinson, 2009, p.1) Sometimes antidepressents are prescribed although there is no documentation on the efficacy of these in treating ADHD. (Robinson, 2009, paraphrased) Robinson (2009) reports that drug therapy "should not be considered as the only treatment…" (p.1) When medication is used it should only be used "….under medical supervision, and only as part of a comprehensive treatment program that includes a careful diagnostic evaluation; education about ADD and associated learning problems; practical suggestions as to how to restructure one's life and manage one's moods; counseling, coaching, or psychotherapy; as well as family or couples therapy as needed." (Robinson, 2009, p.1)

Vocational Counseling

Stated to be a question that is of a persistent nature is "where does vocational counseling end and personal counseling begin?" (Robinson, 2009, p.1) 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 AD/HD." (Robinson, 2009, p.1) ADHD is reported to manifest differently in each individual and this means that vocational counselors must make sure to assess the weaknesses and strengths of each individual and to assist them in the identification of options that are most closely aligned with the individual's manifestations of ADHD. Adults with ADHD are reported as workers who are competent since ADHD is a treatable mental health issue. However, the complexity of ADHD and the differential manifestation among individuals makes diagnosis a critical first step in successful treatment of ADHD in adults.

Harpin (2005) reports that approximately 60% of individuals with ADHD symptoms during their childhood continue to have difficulties when they reach adulthood. Adults with ADHD are reported to be "more likely to be dismissed from employment and have often tried a number of jobs before being able to find one at which they can succeed." (p.1) Adults with ADHD are self-employed quite often and have a need to choose certain types of work since adults with ADHD "…experience more interpersonal difficulties with employers and colleagues." (Harpin, 2005) Additional problems result from "…lateness, absenteeism, excessive errors, and an inability to accomplish expected workloads. At home, relationship difficulties and break-ups are more common." (Harpin, 2005, p.1) Further reported is an increased risk of drug and substance abuse in adults with ADHD symptoms that persist and who have not been receiving medication." (Harpin, 2005, p.1) In addition, adults with ADHD are more likely than are other adults to have children with ADHD due to the genetic factors of ADHD, which creates further difficulties for the adult with ADHD. Adults with ADHD may be affected by comorbid disorders. For example, ODD and conduct disorder coexist in approximately 30% of cases. The following figure shows the Driving-related offences in young adults with ADHD and controls.

Figure 1: Driving Related Offenses in Young Adults with ADHD and Controls

Source: Harpin (2005)

Interventions

The work of 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 for establishing one's adult identity. Individuals with attention deficit hyperactivity disorder (ADHD), in particular, seek jobs that allow them to put to good use their skills and aptitudes and that do not emphasize various academic skills that may represent areas of relative weakness for them." (p.1) Ramsay reports that young adults who have ADHD and who attend college and ultimately pursue graduate or professional education have plans and goals of the establishment of a professional position in the workplace. According to Ramsay "Regardless of one's particular occupational path, the ability to function in a work setting, including self-employment and stay-at-home parenting, is an inescapable feature of adult life that requires individuals to function relatively independently in terms of organization; time management; planning, prioritizing, and following through on tasks; and other skills related to self-management. Although the academic demands of school can be very stressful for individuals with ADHD, the workplace presents similar challenges for adults with ADHD." (Ramsay, 2010,… [END OF PREVIEW]

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