Research suggests that around 5% of the population globally have ADHD in some form. It is a neurodiverse condition diagnosed through observing behaviours to see if impulsivity and/or difficulty paying attention are having a negative impact on a person’s day-to-day life or their development as children. What is it that can make day-to-day life so challenging for people with ADHD and how can we help our colleagues living with it bring their strengths to the forefront?
Increased understanding has of course brought higher levels of diagnosis but sadly, cynicism can creep in, with media voices piping up that it is over-diagnosed or people are excusing ‘naughty’ children or ‘lazy’ adults. However the challenges ADHD presents are very real and connected to way the brain is ‘wired’.
A key issue for people with ADHD is executive function deficits – executive function consists of ‘cognitive skills that help us plan, prioritize, and execute complex tasks’. So ADHD can manifest as difficulty planning, thinking ahead, remembering information and self-motivating, for example; the ADHD brain simply can’t do these sorts of things as easily as most people are able to take for granted.
Then there is the more widely familiar facet of hyperactivity, creating difficulties with focus, impulsivity and distraction, and often a source behavioural challenges for children, especially once they start school. Not all ADHD predominantly features hyperactivity, with many people having inattentive type ADHD – this can be harder to spot, especially in girls and women, as we will explore further. A third type of ADHD has presents both aspects equally.
ADHD in children can mean they lag behind their peers in developing each of their executive functions; they can seem immature although they may catch up over time by degrees – it is thought around a third of children with ADHD will no longer be affected as adults, a third affected to a less marked degree in adulthood and the remaining third will continue to have notable ADHD symptoms throughout their lives.
Jonathan Strong, an Occupier Accounts Director at CBRE, embarked on getting a diagnosis for his daughter when it became clear she was struggling at school: ‘Due to preconceptions about what ADHD was, especially the hyperactivity, it seemed unlikely to me that this would be her diagnosis. I have since learned that external hyperactivity is not necessarily the defining symptom, and an assessment confirmed ADHD.’
The ADHD impacted on his daughter’s ability to learn in the classroom to such a degree that home schooling was the best solution, allowing her to learn 1:1 and for a flexible approach so they can ‘wrap things up as soon as it is clear that something is not working’, says Jonathan.
Many parents and people with ADHD worry that medication for the condition could make them or their child seem ‘drugged’ or not themselves, but this would only happen if using the wrong dose or maybe the wrong specific medication for them.
As the parent of a child with ADHD, I can confirm that my son seems every bit his usual sparky self, and he says he doesn’t feel any different after taking it – but my husband and I have observed he is much more able to get started on a piece of work and see it to completion. Before the medication, he would often struggle to start at all, or even to ask for help as he would seem to be unaware of how long he had been sitting in front of a blank piece of paper.
Friends with recent adult diagnosis – often after their child has been diagnosed – have described relief after a lifetime of feeling constantly overwhelmed by the demands of daily life, as the medication helps them to deal with these in a more focused way.
There are also behavioural and therapeutic pathways to manage ADHD, which can be employed with or without medication alongside. This can include cognitive behavioural therapy to help change how we respond to certain thoughts – managing impulsive behaviour, for example. Parents can also work with a therapist to help manage their child’s behaviours and symptoms positively, and there are coaches who work closely with people with ADHD to give them practical strategies that strengthen executive function. What works best, both for medication and therapeutic approaches, will vary from individual to individual and depend on the ways that their ADHD impacts them.
Differences for men and women
Although ADHD is diagnosed much more often in men (3:1 or 4:1 by some measures), it is now increasingly understood that it can manifest quite differently between the sexes and may simply be underdiagnosed among women. Women are less likely to display hyperactivity, and more likely to display inattentive behaviour – they may also be better at adapting socially and emotionally to mask their difficulties. In addition, those around them are more likely to see their ADHD symptoms as simply facets of their personality – they’re the girl or woman who is ‘scatty’, ‘dizzy’ or a ‘space cadet’. As Jonathan Strong says, the issue people need to understand for women and girls is that ‘diagnosis does not simply centre around disruptive behaviour and not being able to sit still. There are those who are hyperactive and externalise their behaviour and then there are those who are more inward looking and distracted. Without this understanding, people will fall through the net and not receive the help they need’.
Katherine Killerby-Schoeman, Global Project Tiger Transformation Manager at CBRE, was diagnosed as an adolescent. For her ‘It impacts the way I learn and work; I struggle to maintain concentration and get very easily bored. Often when I meet people for the first time, they are a bit overwhelmed by me, as I speak, think, work and walk at superspeed!’
ADHD at work
ADHD can bring challenges to the work environment, but it also has real upsides for employers. Katherine says ‘I wish people just had a better understanding of ADHD and how it affects people, but also how having a person who has ADHD work for you can benefit you and our neurodivergence often makes us think outside the norm. I wish people also took the time to find out to help and support someone with ADHD cope on their “bad” days when even doing the simplest task is impossible because their brain will not let them.’
It's important to create an environment where people with ADHD feel safe to let people know about it and where they are supported to deal with challenges on the ‘bad days’ Katherine mentions. People with ADHD may need surroundings with fewer distraction and perhaps some more ‘time out’ at stressful times to help avoid overwhelm. Other actions that can help include:
· encouraging work in shorter bursts
· giving written instructions
· breaking tasks down into smaller steps
· frequent management check-ins if your report feels that would help them.
And of course it’s important to find ways for colleagues with ADHD to bring their strengths to bear – these can include:
· attention to detail
· the ability to hyperfocus on projects of particular interest
· a creative approach.
The bigger picture
Ten years ago, few people had heard of the concept of neurodiversity, and ADHD, if recognised at all, was usually thought of in terms of hyperactivity alone. Social media has allowed many more people with ADHD and other neurodiversities reach out to one another, and to recognise it in themselves or family members. It’s also supported a more positive focus on neurodiversity, reshaping our view to understand ADHD not as a ‘deficit’ or a ‘disorder’ – it’s a different way of thinking and being that can benefit everyone if we accommodate it with support and sensitivity.