A Research Paper By Mindy Greenberg, Executive Coach, UNITED STATES
Helping Professionals with Attention Deficit-Hyperactivity Disorder Achieve Success in the US Workplace
What is AD/HD?
According to the National Institute of Mental Health (NIMH), “Attention-deficit/hyperactivity disorder (AD/HD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”[1] Lifetime prevalence in US adults is approximately 8.1 percent,[2] and symptoms include inattention, hyperactivity, and impulsivity. This means that individuals may have difficulties organizing their time, completing tasks, staying focused, and fidgeting.
Why Working Professionals with AD/HD Seek Coaching
The majority of occupations require workers to achieve goals within reasonable timelines. People with AD/HD struggle with time management and execution, so it is more challenging for them to succeed in this environment. Some individuals seek treatment early and may use a combination of medication, coaching, and software applications to assist, but others unfortunately only seek help once faced with a poor performance review. Proactivity is a best practice when possible, and this paper will focus on methods to help individuals with AD/HD flourish in the workplace.
My Background Working with Professionals with AD/HD
I am currently employed at a large tech company, and my role in the past 4+ years has been to provide support to employees with disabilities. My time has been split between providing ADA accommodations to employees, managing cross-functional projects, and coaching. I’ve assisted hundreds of people with various disabilities like vision impairment, hearing loss, mobility impairment, chronic pain, injuries, learning differences, and more, but my primary focus has been helping neurodiverse[3] individuals, and in particular, employees with AD/HD.
What Is the ADA (Americans with Disabilities Act)?
The ADA was originally enacted in 1990[4] to provide protection for people with disabilities (PWD) against discrimination. The ADA was amended in 2008 to become the ADAAA (Americans with Disabilities Act Amendments Act) to broaden the definition of disability and ensure more protection for PWD. This was in response to multiple cases of discrimination escalating to the Supreme Court, where disability was narrowly defined and the individual’s cases were denied.[5]
The regulations of the ADAAA in 2008 kept the ADA’s definition of the term disability “as a physical or mental impairment that substantially limits one or more major life activities; a record (or past history) of such an impairment; or being regarded as having a disability”,[6] but widened how the terms should be interpreted in favor of providing PWD with additional protection.
Examples of health conditions that may be considered disabilities if they meet the above ADA criteria include addiction, AD/HD, anxiety disorders, autoimmune disorders, autism spectrum, Bipolar, cancer, celiac, cerebral palsy, chronic pain, Deaf & hard-of-hearing, degenerative neurological conditions, depression, diabetes, dyslexia, dyscalculia & dysgraphia, dyspraxia, epilepsy, gastrointestinal disorders, heart disease and blood disorders, injuries (including RSI), migraines, mobility & motor impairments, respiratory impairments, plurality, PTSD, schizophrenia, sleep disorders, stuttering & speech impediments, Tourette Syndrome, and visual impairments.
What Are the ADA Accommodations?
In the workplace specifically, “the ADAAA prohibits discrimination against “qualified individuals with disabilities” in all employment practices, including job application procedures, hiring, firing, advancement, compensation, and training. A “qualified individual with disabilities” is an employee or job applicant who meets all legitimate skill, experience, education and other requirements of a position and can perform the essential functions of the position with or without reasonable accommodation.”[7]
“The law requires an employer to provide reasonable accommodation to an employee or job applicant with a disability unless doing so would cause significant difficulty or expense for the employer (“undue hardship”). The law also protects people from discrimination based on their relationship with a person with a disability (even if they do not themselves have a disability). For example, it is illegal to discriminate against an employee because her husband has a disability.
Undue hardship means that the accommodation would be too difficult or too expensive to provide, in light of the employer’s size, financial resources, and the needs of the business. An employer may not refuse to provide accommodation just because it involves some cost. An employer does not have to provide the exact accommodation the employee or job applicant wants. If more than one accommodation works, the employer may choose which one to provide.”[8]
A reasonable accommodation is defined as “any change in the work environment (or in the way things are usually done) to help a person with a disability apply for a job, perform the duties of a job, or enjoy the benefits and privileges of employment.”[9]
This means that larger employers with greater assets have a larger responsibility to provide accommodations to employees. For example, a smaller company with limited financial means may deny a very expensive piece of equipment as an accommodation if it causes them undue hardship. A larger company would have a more difficult time making that argument.
Another example may have to do with the schedule. Let’s say an employee with AD/HD’s medical provider requests to shift their hours from 8 AM-5 PM to 10 AM-7 PM because they don’t concentrate well in the early mornings. A smaller company may not have to accommodate if they don’t have other employees to help balance the hours. A larger company would be held to a stricter standard as they are more likely to be able to balance hours across multiple employees. Of course, every situation is unique, and the ability to accommodate is situation by situation and influenced by other measures outside of the size and financial means of a company.
An important point to consider when assessing whether an accommodation is reasonable is whether an employee will be able to perform the essential functions of their job. “Essential functions are the basic job duties that an employee must be able to perform, with or without reasonable accommodation.”[10]
As an example, it is more likely that a software engineer with anxiety whose medical provider requests they are allowed to not do public speaking would have the accommodation approved than someone who is a facilitator and must do public speaking as a core component, i.e. essential job function, of their position.
Accommodations that are commonly considered reasonable, (subject to an individual’s essential job functions), include: “making existing facilities accessible; job restructuring; part-time or modified work schedules; acquiring or modifying equipment; changing tests, training materials, or policies; and providing qualified readers or interpreters.”[11]
Accommodations That Are Helpful to AD/HD Professionals
I’ve seen the following ADA accommodations significantly help professionals with AD/HD:
- Schedule flexibility: the ability to shift hours and start the workday earlier or later, or spread hours across a shorter or longer workweek.
- Work remotely: be able to work from somewhere where it’s easier to focus. This might be a home, a cafe, a conference room, or another office location.
- Desk change: being assigned to a new desk. Requests have included facing a wall, not being near noisy areas, not facing artwork, or sitting near a window.
- Noise-canceling headphones: be reimbursed for a pair of headphones to block out noise.
- Lighting changes: add or remove lighting, or change the type of lighting (e.g. fluorescent lights can cause overstimulation in some people).
- Dividers for open workspaces: provide physical objects to block out distractions. Some examples are panels that attach to desks, rolling whiteboards, or large plants.
- Structured breaks: the ability to take breaks at regular intervals.
- Private office space: be given an office instead of sitting in an open floor space.
- Medical leave: be allowed time off for medical reasons. In the case of AD/HD, this occurs most commonly when someone is starting a new medication or changing their medication routine. Another reason may be if a comorbid condition exists and leave is required due to symptoms of the other condition (or most commonly, a combination of both). “A comorbid diagnosis of AD/HD and depression occurs in approximately 20% to 30% of patients, and AD/HD and anxiety in more than 25% of patients.”[12]
- Mentorship: many individuals benefit from entering into a formal mentoring arrangement at work. I’ve seen this be most effective when the mentor is either equal in seniority or slightly senior, and either on the person’s team or a closely related one. The more familiar the mentor is already with the mentee’s work, the better. This is because, unlike a coaching relationship, the primary role of the mentor is to help the individual with AD/HD prioritize and break down their work. While a coach may be able to help with organizational skills, the mentor is able to specifically understand each task that needs to be accomplished and helps the individual know where to focus.
- More frequent check-ins with the manager: be granted the ability to meet more often. This helps the individual gain structure and prioritization feedback sooner so they can course-correct and stay on track.
- Coaching: access to a coach for a fixed period of time.
Coaching Methods for AD/HD
ADHD coaching tends to be a blended model of coaching and consulting. Programs are usually limited to 6-8 sessions, but some relationships continue long-term. Foundational aspects of coaching are education about AD/HD and self-awareness. The individual needs to be able to tie the mechanism of the condition and how their brain processes information into how symptoms of the condition affect their work.
This enables the coach and employee to come up with focus areas and is typically accomplished after 2 to 3 sessions. The focus areas are variable, but always include organization, concentration, and communication, so we’ll delve deeper into these three below.
Areas of Focus
Organization
Classic coaching using powerful questions will help the individual get clear on their motivations for being more organized and how it will benefit them. Once motivation is established, then tools and habits are discussed.
At times, the person will already have access to or be using the most appropriate tools, but not using them robustly or efficiently, and other times there may be a tool mismatch or lack thereof that can be addressed. Once the most effective tools are identified, then it’s useful to help the employee establish processes and habits for maximum utilization. This typically involves a combination of software for keeping to-do lists, project task trackers, and calendar reminders.
Concentration
Techniques to help reduce distraction and increase focus are imperative. Typically, this involves delving into the person’s work environment, and schedule, and exploring positive reinforcement. For the work environment, reducing excess stimulus can be extremely helpful. The person’s desk should be in a location where they don’t feel overly distracted by visual or auditory stimuli.
Scheduling their day with more structure can also aid concentration. For example, some individuals do their best work with a focus time of 30 minutes and then a 10-minute break throughout the day, while others benefit from different-sized sessions. No two individuals are alike, so it’s important to find what works best for the client. Blocking that time on their calendar or using a timer can be an effective way of ensuring compliance with the schedule.
Positive reinforcement is also key. This can occur in many forms, but common ones I’ve seen range from checking off boxes in to-do lists; to social media time allocation; snacks; or exercise.
Communication
Some individuals have difficulty communicating with their manager and/or peers about their work. This can be problematic if project deadlines are not being met or if teamwork is not being completed and blocking others from making their own progress.
Coaching methods can help the person understand how solid communication will benefit them and commit to progress. Once the person exhibits clear motivation, methods can be discussed, like email communication vs. verbal interactions and at what duration. For example, some individuals will block time at the end of their day to email their manager with questions or share any delays they might be experiencing. The coach has an opportunity here to act as an accountability partner and help the individual tweak their communication style over the course of the sessions.
Individuals with AD/HD
Individuals with AD/HD are invaluable members of the workforce. Many are successful without interventions, but some find they are more successful with the help of workplace accommodations. AD/HD coaching (obtained privately or as an accommodation) can be very useful when the coach provides education about the condition; self-awareness skills; organizational techniques; concentration training; and guidance on effective communication methods.
References
https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd.shtml
https://en.wikipedia.org/wiki/Neurodiversity
https://www.ncld.org/archives/action-center/learn-the-law/americans-with-disabilities-act-amendments-act
https://www.ada.gov/nprm_adaaa/adaaa-nprm-qa.htm
https://www.eeoc.gov/laws/regulations/adaaa_fact_sheet.cfm
https://www.ncld.org/archives/action-center/learn-the-law/americans-with-disabilities-act-amendments-act
https://www.eeoc.gov/laws/types/disability.cfm (quoted verbatim because these are regulations)
https://www.eeoc.gov/laws/types/disability.cfm
https://www.eeoc.gov/facts/ada17.html
https://www.dol.gov › odep › topics › Accommodations
https://www.psychiatrictimes.com/adhd/what-are-common-comorbidities-in-adhd