Understanding Adults Diagnosed with ADHD
By the Centre for ADHD Awareness Canada (CADDAC)
Adult attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 4.4 per cent of adults worldwide. It was previously believed that children outgrew their ADHD symptoms in adolescence. However, we now know that more than 60 per cent of individuals maintain some of their impairing core symptoms into adulthood. Core symptoms include attention dysregulation, difficulty with under-focusing, over-focusing, and switching and prioritizing focus, hyperactivity and impulsivity for some. There are three presentations of ADHD: Primarily inattentive (formerly known as attention deficit disorder), primarily hyperactive–impulsive (extremely rare) and combined inattentive–hyperactive–impulsive. Another, less well-known common symptom of ADHD is impaired emotional regulation. Adults with ADHD can become frustrated and angry more quickly than those without the condition, and often express those emotions in inappropriate ways.
While impairment in attention regulation continues into adulthood, outward hyperactivity often decreases. However, many adults describe a consistent feeling of internal restlessness, with some reporting that they have simply learned how to channel their restlessness into more appropriate outlets. Impulsivity can also decrease in adulthood, or at least change in its presentation, but many adults with ADHD find their verbal impulsivity, impulsive reactions and impulsive spending habits can get them into a great deal of trouble. Executive functioning impairments such as difficulty with working memory, organization, time management, planning and prioritizing, as well with as social skills, are also common in adults with ADHD.
ADHD can substantially impact almost all aspects of an adult’s life: Work, home, relationships, finances, and mental and physical health. Although generalized symptoms help us to diagnose the disorder, how these symptoms impact the individual depends on many factors, such as the condition’s presentation and severity, other personality traits, the presence of coexisting disorders and learned healthy or unhealthy coping strategies.
Education is the first step in managing adult ADHD. Educating individuals with the condition about what ADHD is and, more importantly, how it impacts them as a person, is the first step in the treatment process. Educating their family is the next step. This can be beneficial in repairing emotional rifts caused by ADHD-related behaviours. Understanding that forgetfulness or impulsivity is not due to a lack of caring, but is rather caused by a disorder, can significantly help to heal some of the hurt and confusion. However, this knowledge must be followed up by openness to change and the implementation of strategies and treatment. For educational videos, please access the Centre for ADHD Awareness Canada (CADDAC) YouTube Channel (youtube.com/user/adhdvid/videos) or past webinars (caddac.ca/adhd/past-webinars-1).
ADHD and the workplace
Many adults with ADHD perform their jobs extremely well and find that some of their ADHD traits, such as high energy, problem solving, creativity and being able to hyperfocus, are significant benefits in their chosen career. However, others will find that at least some of their ADHD symptoms cause difficulties in the workplace. Some examples of how ADHD symptoms can impact job performance include:
• an inability to stay focussed during tasks or meetings, or to switch focus quickly
• difficulty following lengthy instructions
• inattention to detail
• spontaneity, such as jumping into projects without a plan or blurting out inappropriate comments
• underestimating the time required to complete tasks and missing deadlines
• arriving late to work
• forgetfulness, organizational difficulties and procrastination
• difficulty maintaining relationships with co-workers
For a complete list, visit the “Your ADHD in the workplace” page of the CADDAC website (caddac.ca/adhd/document/your-adhd-in-the-workplace).
If ADHD symptoms are causing difficulties at work, it can be useful to assess the individual’s strengths and weaknesses. This may include:
• acquiring feedback from a trusted co-worker
• reviewing past job performance assessments
• asking for feedback from the individual’s spouse, significant other or family (traits seen at home often translate into the workplace)
• referring the individual to a professional evaluation from a career counsellor, therapist specializing in ADHD or ADHD coach—these professionals will also be able to assist with potential strategies and accommodations
Remember to assess strengths as well. In which parts of their job does the individual excel?
A variety of both medication and non-medication treatments now exist for those with adult ADHD. Receiving a proper assessment and using multimodal treatments can be extremely helpful in increasing the individual’s focus and attention, decreasing distractibility, impulsivity and hyperactivity, and assisting with emotional regulation and organization. However, there is no magic cure or solution for those experiencing difficulties in the workplace. Taking the time to assess the situation, and implementing strategies and accommodations where appropriate, can also help a person to find success in their chosen career.
Should an individual reveal their diagnosis to their employer?
This is a very personal decision and remains a controversial topic. Disclosing ADHD can have good or bad consequences. Disclosing ADHD to those who do not understand the condition can lead to the individual being viewed negatively, since stigma and misunderstandings about ADHD still exist. If, on the other hand, the employer is open to discussing the implementation of accommodations but requires a reason for those accommodations, disclosing an ADHD diagnosis can be very beneficial.
The employer will need to understand ADHD as a medical condition with symptoms that can impact job performance, both positively and negatively. It may be necessary to educate the employer on ADHD, since misinformation continues to exist. Providing examples of how ADHD can impact an individual both negatively and positively can be beneficial.
An alternative approach to full immediate disclosure is for the individual to initially meet with their supervisor to request certain changes in the work environment that are likely to make them
more productive. Placing the discussion in the context of a win for both sides, with a potential increase in productivity, is an excellent way to begin the conversation.
Although employees’ rights vary from province to province, a 2012 Ontario Human Rights Commission report titled “Minds that matter: Report on the consultation on human rights, mental health and addictions” has helped to clarify the duty of employers to accommodate individuals with mental health conditions. It is, however, also important to note that the report states: “The accommodation process usually begins when someone identifies they need accommodation due to a disability-related need.” It is therefore the responsibility of the person with the disability to inform their employer of their needs.
Awareness of adult ADHD has increased in recent years, leading to more diagnoses. Even so, research tells us that the vast majority of adults with ADHD remain undiagnosed and untreated.
For help with assessment and treatment options, contact CADDAC (caddac.ca).
The Centre for ADHD Awareness Canada (CADDAC) provides leadership and support in awareness, education and advocacy for ADHD organizations and individuals across Canada.
• Adult ADHD presents differently to childhood ADHD.
• Individuals do not need to be hyperactive to have ADHD.
• ADHD can cause individuals to over-focus as much as under-focus.
• ADHD is not a new disorder—it was first mentioned in 1902.
• Most people do not outgrow ADHD. Two-thirds of those diagnosed as children continue to experience symptoms throughout adulthood.
• ADHD does not just affect men. Nearly equal numbers of men and women have adult ADHD, although the presentations may differ.
• 85 per cent of adults with ADHD also have an additional
mental health disorder, such as anxiety or depression.