ADHD in the Workplace: What You Should Know–and What Can Help
BY Lesley Alderman, LCSW May 15, 2024Pete came to our weekly psychotherapy session frustrated with work. He had just returned to his office, post pandemic, and found the new, open plan noisy and overwhelming. Pete, which is not his real name, has attention-deficit/hyperactivity disorder (ADHD) and is easily distractible and sensitive to noise. He had trouble concentrating, was irritated by the constant chatter of colleagues, and, as a result, was feeling less productive.“Could you talk to your manager about getting some accommodations?” I asked.“No way!” he said. “That would be a career killer.”Pete’s wariness is not uncommon. A few of my psychotherapy patients with ADHD have confided in their managers, but most feel it’s unwise to do so. They fear they will be stigmatized and sidelined.Edward Hallowell, M.D., agrees with their concern. The founder of the Hallowell ADHD Centers and one of the leading authorities on the disorder, explained to From Day One: “We’re not there yet. Most corporate professionals think of ADHD as some kind of mental illness.”Given that ADHD is not well-understood in the workplace, how can employees speak up about their needs in a way that feels safe? And how can managers and HR leaders better understand how to respond to those needs–whether employees want to name their ADHD, or not? A well-accommodated employee is, after all, a happier and more productive one. “It’s in everyone’s best interest to remove obstacles to someone’s performance,” said Hallowell. Here’s what experts recommend:Know What It IsADHD is a neuro-developmental disorder characterized by symptoms of restlessness, impulsivity and difficulty sustaining attention to boring tasks. It tends to run in families and is often inherited from a parent. There are three types: inattentive (dreamy and distractible), hyperactive-impulsive (restless and talkative), and a combination of the two. Most adults with ADHD have the inattentive type. Though it was long considered to be a childhood disorder affecting mostly boys, research has shown that it persists into adulthood—about 30% to 70% of children with ADHD continue to have symptoms later in life.Ned Hallowell, M.D., a pre-eminent expert on ADHD (Photo courtesy of the Hallowell ADHD Centers)An undiagnosed adult may think of themselves as spacey, messy, or undisciplined—and they often suffer from low self-esteem. A recent study found that only 10% to 25% of adults with ADHD receive an accurate diagnosis and adequate treatment. “They are often inaccurately diagnosed with anxiety or depression, which are really just the fallout of untreated ADHD,” said Ari Tuckman, a psychologist in West Chester, Penn., who specializes in the treatment of ADHD. As Hallowell puts it: “It’s like driving on square wheels.” In dealing with tasks, you will make progress, but it may take longer.And That the Diagnosis Is On the RiseWhile children are still the most likely group to be identified with the disorder, the number of adult diagnoses has been rising for decades. The pandemic accelerated the trend: the overall incidence in adults (30 to 49 years old) nearly doubled from 2020 to 2022, fueled mainly by an increase in diagnoses among women, according to Epic Research, a medical-record software company. While it’s not clear exactly why women are being diagnosed more often, experts theorize that it may be due to increasing smartphone and technology use, which can amplify distractibility and stress, as well as a greater awareness that ADHD can be also be a women’s issue. As more adults are diagnosed, they—like Pete—often face workplaces that are not ADHD-literate.How It Affects Work Performance–But Not Always in a Bad WayPeople with the disorder may have difficulty with organization, time management and procrastination—all of which can make it hard to meet deadlines and work within teams. They find tedious tasks, such as scheduling and filling out expense reports, unusually challenging and have a different sense of time than others. “People with ADHD have more difficulty seeing time and feeling the future,” notes Tuckman,More than half (56%) of adults with ADHD said they believe the disorder “strongly impacts their ability to succeed at work,” according to a 2008 survey by McNeil Pediatrics. A more recent survey by Akili, a therapeutic-technology company, interviewed 500 adults with ADHD and found that employees with ADHD felt the disorder had a negative impact on their career. And yet, people with ADHD often display qualities that work in their favor, notes Hallowell, who himself has ADHD. He sees the condition as a trait, not a disorder, that has positive benefits like creativity, humor, and spontaneity. “There’s more to it than most people realize,” he said. “ADHD is terrible term. We have an abundance of attention. Our challenge is where to put our focus.” People with ADHD can spend hours on topics that interest them and see details that others might miss, a trait sometimes called hyperfocus. Many successful people have talked openly about their ADHD, including Michael Phelps, Simone Biles, James Carville, astronaut Scott Kelly and JetBlue founder David Neeleman.How to Get DiagnosedIf you persistently miss deadlines, are chronically late, and feel like staying organized is a big effort, first ask a trusted friend or colleague if they find you more scattered than others. Then, make an appointment to see a psychologist or psychiatrist who specializes in treating the condition. There is no one standardized test—instead a professional will take a thorough history and may ask family members and friends to complete questionnaires about your behavior. You may be asked questions like, How often do you misplace items, feel bored and restless, or lose track of what needs to be done? If you meet the criteria, your doctor may talk to you about medication, therapy or coaching and, if needed, provide a diagnosis so you can receive accommodations at school or at work.Understand What HelpsMost people diagnosed with ADHD rely on medication to control their symptoms. Typical medications include stimulants such as Ritalin and Adderall, which increase the levels of the neurotransmitters dopamine and norepinephrine in the brain. There are also non-stimulant drugs such as Strattera. Stimulant medications that treat ADHD are the “most effective of medications in psychiatry,” said Tuckman, and help tame distractibility and impulsivity. About two thirds of people with ADHD diagnoses are prescribed stimulant medications, and that percentage has remained fairly consistent since 2013, according to Epic Research. Some people can help manage their symptoms by exercising regularly, getting proper sleep, and implementing strict organization and reminder systems. Or they hire very competent assistants.Once you are diagnosed and have figured out the best treatment, it’s like “getting fitted for the right eyeglasses,” said Dr. Hallowell. “Things come into sharper focus.”How to Make the Workplace More ADHD-FriendlySmall modifications can go a long way to helping people with ADHD perform better on the job. Tuckman suggests considering adjustments in the three domains described below. As an employee, you can make tweaks on your own or ask your manager for help. As for managers, if you have a worker who is struggling with organization and meeting deadlines, you could take the lead at putting these practices into place.Make distractions softer. Quiet spaces, headphones, and working on off-hours (say, early or late), can help mitigate the clatter of a bustling office. Often working from home is a good solution.Make important information stand out from the chatter. Putting assignments in writing, recording meetings, and highlighting deadlines can help workers whose focus is not great to stay on task.Bring the future closer to the present. Those who struggle with adhering to deadlines will benefit when big projects are broken into smaller chunks, and check-ins are on the calendar with frequent reminders of when tasks are due.So, Should You Tell Your Boss?If you have ADHD, you may be covered under the Americans with Disability Act (ADA). However, you might not want to play that card unless you absolutely must, says Belynda Gauthier, a retired HR director and past president of Children and Adults with ADHD (CHADD). “The first time I did a presentation on ADHD in the workplace, I launched into detail about how the employee should approach his supervisor or manager and suggested that he might want to go directly to HR first. An audience participant interrupted to tell me that her HR office actually is the problem for her. Oops! I took this to heart, did some serious thinking, and revamped my presentation. I no longer recommend revealing one’s diagnosis until and unless it’s necessary.” Indeed, 92% of surveyed adults with ADHD believe that their colleagues hold misconceptions, the most common of which is “people with ADHD just need to try harder.” A better strategy might be to simply approach your manager with a positive attitude and a few solutions. “Be sure to tell them what you are good at,” advised Hallowell.Gauthier suggests something like: “I am really enjoying processing these widgets, and I think I’m doing a good job. I believe I could do an even better job if I could move to that cubicle that’s farther from the copy machine. So many co-workers use it all day and everyone stops to say hello.” Avoid the use of the word “but” to qualify your suggestions and don’t be whiney, she says. Accommodations can help, but sometimes the best solution is finding the right job in the right environment with the right supports. “When I finally figured out I had it, it was a relief,” David Neeleman said in a recent interview with Forbes. “I was just really careful to surround myself with people that could complement my ADHD. I have people around me that help implement a lot of the ideas I have.” When you can turn your intense focus on something that truly fascinates you, ADHD can be a bonus rather a deficit.Lesley Alderman, LCSW, is a psychotherapist and journalist based in Brooklyn, NY. In her therapy practice, she works with individuals and couples. She writes about mental health topics for the Washington Post and has been an editor at Money and Real Simple magazines and a health columnist for the New York Times.(Featured photo by Valentin Russanov/iStock by Getty Images)
There’s a New Benefit in Town: Psychedelic Therapy. Are Companies Ready to Embrace It?
BY Lesley Alderman, LCSW October 16, 2023Especially since the pandemic, companies have been trying to increase access to quality mental health care for their distressed employees. For good reason: Nearly one in five Americans are currently being treated for depression and three out of four workers report feeling burned out, according to Gallup. At the same time, there’s been rising interest in an unconventional approach to treat mental maladies: psychedelic therapy. Many researchers believe that psychedelics, paired with psychotherapy, have the potential to transform health care.The prospect that psychedelics could become mainstream has inspired entrepreneurial interest. One company, Enthea, has become the first to offer psychedelic-assisted therapy (PAT) as an employee benefit for U.S. companies. Launched last year with $3.3 million in seed money, led by Tabula Rasa Ventures, Enthea now has seven customers signed on—including Dr. Bronner’s, Launchbox, and Black Swan Yoga—and 50 more in the pipeline, according to Sherry Rais, Enthea’s co-founder and CEO. To be sure, advocates of PAT will face a complicated road ahead, since psychedelics vary widely in their properties and are covered by a crazy quilt of state and federal regulation, but assertions of PAT’s beneficial effects are being supported by a growing field of scientific research.How Psychedelics Can Help It takes time for our brains to change longstanding patterns. Psychedelics, including ketamine, psylocibin (a/k/a magic mushrooms), and MDMA (a/k/a ecstasy) can speed up the process and create profound changes in perspective. How? Taking psychedelics has the potential to change one’s brain for the better. They silent repetitive ruminations, promote neuroplasticity, and can surface new emotions and memories.When used under the guidance of trained clinicians, research has found that psychedelics may help “patients to achieve meaningful improvements in function, symptomatology, and overall outlook in a relatively short amount of time,” according to a review published in 2022. Here’s how PAT works: the patient takes a measured dose of a psychedelic substance under the supervision of a clinician. A trained therapist prepares the patient for the experience, which can last one to several hours, and helps them make sense of what comes up during and after, a process called integration. “It’s not just as simple as taking a capsule and hoping for the best,” said Paul Hutson, director of the Transdisciplinary Center for Research in Psychoactive Substances at the University of Wisconsin-Madison, in a December 2022 presentation.By quieting the hum of worries and concerns that plague one’s brain, anxieties may soften. New cell growth and connections help make some of these changes more permanent. Meanwhile, new emotions can be processed and new insights into the past or patterns of behavior can be explored. These developments can lead to feelings of relief and often long-term change.“I felt like I let go of a lot of anger and resentment towards my parents,” a cancer patient in a psylocibin trial at New York University explained in a paper published in 2017. “I mean, I thought I had already done that, but I really hadn’t, and I kind of saw them more as, like, these flawed human beings who did the best they could,” the patient said.“Psychedelics are mind manifesters,” Alex Belser, a psychedelic researcher and psychologist at Yale University, told From Day One. “Some aspect of the mind is being manifested that had not been present before. The challenge is to transform altered states into altered traits.”A Healthcare Entrepreneur’s JourneyFor nearly a decade, Enthea co-founder Sherry Rais traveled the globe working on poverty-reduction programs in the developing world. One of her conclusions: You can’t solve poverty without also addressing mental health. And to address mental health, you need effective, low-cost, and accessible treatments. She started to look for novel solutions and was “blown away,” she said by the research on psychedelic medicines. But she realized that implementing these treatments in the developing world would be premature, she told From Day One.Sherry Rais, Enthea’s co-founder and CEO (Company photo)Instead, she and her partners founded Enthea as a public benefit corporation, deriving its name from the term entheogen, which describes substances that can produce changes in consciousness, perception, and mood. Besides offering PAT as a benefit for employers, the company plans to initiate programs for underserved communities, such as formerly incarcerated individuals. Said Rais: “Access and health equity are extremely important to Enthea’s mission.”Over the next few years, Rais hopes to be working with hundreds of employers, millions of employees and to have increased awareness about and acceptance of psychedelic therapies, which at the moment is rarely covered by insurers.What’s In It for EmployersWorkers are struggling, and they expect their companies to help. A recent workplace wellness study by the Employee Benefit Research Institute (EBRI) found that 79% of employees agree with the statement, “Your employer has a responsibility to make sure employees are mentally healthy and emotionally well.”According to an EBRI survey, about 61% of employers offer mental health benefits and despite the uncertain economic environment, they are not likely to cut back in benefits of this kind. A healthier workforce, after all, is a more productive workforce—and a less expensive one. Workers who rate their mental health as fair or poor report four times more absences than their colleagues with good or excellent mental well-being, according to a Gallup survey.Will employers embrace PAT as a new offering? Paul Fronstin, PhD, director of health-benefits research at EBRI, is circumspect: “Most employers don’t want to be first,” he told From Day One. “They will wait on the sidelines to see what others are doing and how it’s working out.” And he added that ultimately, companies want benefits that help their bottom line. If PAT prevents workers from requiring expensive in-patient hospital stays, it could be a win-win for employees and employers. Psychedelic Properties ExplainedThere’s a lot of hype around psychedelics and a lot of time and money being poured into investigating them. These mind-bending drugs, which include ketamine, MDMA (methylenedioxymethamphetamine), psylocibin, and LSD, can help soothe suffering in people with terminal illnesses, veterans struggling with PTSD, individuals with treatment-resistant depression and even those grappling with persistent addiction. However, most are not legal or FDA approved.Ketamine, an anesthetic that can also alleviate depression, has a leg up on the others: it’s legal and has been used safely in surgical settings for more than 50 years. In 2019, the Food and Drug Administration (FDA) approved a version of ketamine, Spravato (esketamine), for treatment-resistant depression. Many clinics use ketamine off-label to treat a range of a ailments (beyond the approved use of treatment-resistant depression) from mild depression to anxiety. Some companies sell ketamine lozenges via email and then monitor patients via telemedicine. The FDA recently issued an alert about the dangers of treating psychiatric disorders with compounded versions of ketamine. MDMA, which was developed in 1912 to control bleeding and became celebrated in the 1980s as a “club drug,” may be effective at treating a range of mental health issues, and is gradually gaining traction for therapeutic use. In 2017 the FDA granted Breakthrough Therapy status for MDMA as a potential treatment for PTSD; this status allows clinical trials to be conducted to test MDMA’s safety and efficacy. The following year, the FDA granted the same status to psyilocibin. An important study published last month showed that MDMA-assisted therapy was effective at reducing symptoms of PTSD. The drug is on track to be an FDA-approved drug in 2024. If approved, “MDMA-assisted therapy would be the first novel treatment for PTSD in over two decades,” Berra Yazar-Klosinski, the senior author of the study, told the New York Times. “PTSD patients can feel some hope.”Psychedelics, except ketamine, are illegal on the federal level for recreational use, but states and cities are making their own laws, the pattern followed with the decriminalization of cannabis. In 2020, Oregon approved decriminalizing small amounts of psychedelics and the supervised use of psilocybin in a therapeutic setting. Colorado passed a ballot measure to decriminalize psychedelic mushrooms and to create state-regulated centers where participants can experience the drug under supervision. Several cities in California–Oakland, San Francisco, Santa Cruz, and Berkeley–have decriminalized psylocibin.Enthea, as this time, offers only ketamine-assisted therapy to its customers. The company has a credentialing process to ensure that the clinics providing the therapy meet high standards of care, Rais said. According to Enthea’s website, a typical ketamine session is one to two hours in length and patients will experience “a sense of detachment from normal reality and self. This may foster increased creativity, purpose, and perspective. It can also enhance feelings of tranquility, insight, inspiration, and gratitude.”Once MDMA receives regulatory approval for therapeutic use, Enthea will offer that therapy as well. Said Rais: “I really believe people need access to these medicines.” Lesley Alderman is a psychotherapist and journalist based in Brooklyn, NY. In her therapy practice, she works with individuals and couples. She writes about mental health topics for the Washington Post and has been an editor at Money and Real Simple magazines and a health columnist for the New York Times.(Featured photo by Mathia Alvez/iStock by Getty Images)
Emotional Support: Showing Compassion for Your Workforce
BY Lesley Alderman, LCSW March 27, 2020Most of us have become so vigilant about watching for the physical symptoms of coronavirus that we figure if we don’t have a sore throat or 104° fever, we’re OK. But we’re not, really. What we’re going through, as a daily experience, is abnormal. The global pandemic has upended our work lives, our personal lives, and shattered our sense of security, safety and–well–normalcy. The symptoms of stress and disorientation can be more stealthy, but they need urgent care too. Nine in 10 Americans say they are concerned about the coronavirus, while half are worried about keeping their jobs and paying their bills, according to the new Axios-Ipsos Coronavirus Index. Forty-three percent of those surveyed report that their emotional well-being worsened in the last week. “We’re grieving. Collectively,” observed David Kessler, one of the world's foremost experts on healing and loss, in a recent interview with the Harvard Business Review. “We feel the world has changed and it has.” With all the bad news, here’s some good: Americans trust you, their employers (68%), far more than they trust the federal government (53%) to look out for their best interests, reported the Aixos-Ipsos survey. Business leaders have a unique opportunity to support their workers in new and creative ways–in fact, they are counting on you to do so. Here’s how to start: Walk in their slippers. Consider the challenges your employees are facing. Single people working from home might feel isolated, parents with toddlers may feel overwhelmed, older workers have reason to be fearful for their health. Try to be accurate in your empathy, since not everyone is reacting the same way. If your team is small, call each member individually and ask how they are doing and what support they need to do their job well. If your team is large, consider sending out a short survey. While you might not be able to solve all their challenges, you can at least acknowledge that you know they are facing them. Keep cool. Emotions are contagious, particularly on the job, explains Brandon Smith, an expert in organizational health, in his Tedx talk on emotions in the workplace. If you exude calm, your workers will feel calm–or at least calmer. If you stay positive, your employees will feel more secure. The most contagious emotions are the negative ones, so keep your gripes to yourself and make it clear to all managers that this is no time for bitch-fests. Says Smith: “Be an emotional booster shot for others.” Open up. Being cool does not mean being cold. Your mantra could be: “I’m not OK. And you’re probably not OK either. So let’s be in this together.” How? Start meetings with a thoughtful question you might deem too touchy-feely for normal times: How are you doing? What are you feeling? Where are you stuck? Feel free to share your own struggles, too. Sarah Sheehan, co-founder and president of Bravely, an employee-coaching firm, told From Day One: “This moment in time has given me permission to ask my team personal questions that two weeks ago may have felt awkward asking or spending a large chunk of time discussing,” says Sheehan, who often holds meetings with her new baby on her lap. “I feel an enormous amount of gratitude to be able to share my own personal struggles, which are many, and listen to theirs as well. I am starting to get to know people in a newer way and it feels quite wonderful.” An added benefit: “Doing this will help you to stay engaged, rather than check out to manage your stress.” Be a gifter. Send your workers a gift that lifts their spirits by showing that you’re thinking about them. Some companies have simply given cash, especially to workers on the front lines. But symbolic and practical gifts have an impact too. A foam roller is a WFH best friend. But a package including any of the following would likely be welcome: bubble bath, tea, an aromatherapy diffuser, a snack, a bottle of spirits, a succulent plant (Quarantine succs!). If your team is logging long hours and your revenue stream is strong you could spring for something more lavish, like a massage gun for aching backs, noise-canceling earbuds, or a challenging Lego set for homebound kids. Designate a no-work hour. Declare, say, 12 pm to 1 pm, a protected time when no calls, meetings or work are scheduled, and employees are encouraged to rest and recharge. Urge employees to get out for a jog, log on to a streaming yoga class, or walk the dog in a green place. Or just have a Zoom pizza party. Be concrete. These days, reality = uncertainty. You can help by communicating regularly and quite specifically to those who depend on your guidance. “Great leadership comes with clarity, quick action, and personal connection,” says Judy Levitz, founding director and board president of the Psychoanalytic Psychotherapy Study Center in New York City. Emphasize ergonomics. With so many of us working from the kitchen counter, dining room table or even the front seat of our car, our bodies are sure to start suffering. “Your home office is an ergonomic time bomb,” Inc. warned readers. You can help by ensuring that workers have the tools they need to be efficient and also the information they need to protect their backs from aching and their wrists from succumbing to repetitive stress. Offer them information about ideal desk posture, screen height and a few exercises that they can do throughout the day to combat muscle aches and pains. Explain health benefits in detail. With most workers feeling anxious and overwhelmed by the details of the crisis, the last thing they want to do is get on a call with their insurance company to find out whether an out-of-state trip to the ER (for those sheltering with friends or relatives) will be covered or how many therapy sessions they are entitled to. Create a crystal-clear fact sheet that lays out their benefits and explains deductibles, out-of-network vs. in-network, and who to call for more information. Remind them of traditional forms of help, like employee-assistance programs (EAPs) as well as new technology supporting mental health. Take care of yourself. Looking out for your own well-being will create a model that your employees can follow, while keeping yourself from burning out. “The only way I could manage this effectively was to take care of myself first,” says Levitz, who is also a practicing psychoanalyst. At the start of the pandemic, Levitz decided what she needed to do to feel safe, as well as what her organization needed to do to protect their clients. That will help create resilience and endurance as the crisis plays out. The CEO of HP, Enrique Lores, told the Wall Street Journal that he wants his workforce to seize opportunities, but also to pace itself. “We need to realize this is not going to be a very short-term thing.” Lesley Alderman, LCSW, is a Brooklyn-based psychotherapist and journalist. She has written about many of life's modern stressors for Medium and the New York Times.