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Career Choices and Workplace Challenges for Individuals with ADHD
Kathleen G. Nadeau, Ph.D.
Remarkably, although work life dominates the waking hours of most adults, little
research has focused on ADHD as it affects workplace functioning. As so often is the
case, clinical experience precedes research that can quantify and validate clinical
observations. In this chapter, I’ll share observations and experiences over many years of
clinical practice, addressing workplace issues of young adults and older adults with
ADHD.
A strong working knowledge of workplace issues is essential in treating adults
Very few psychologists who treat adults with ADHD have been trained or have
extensive experience in addressing the career or vocational issues of their clients. Career
issues are viewed as the specialty of master’s level “career counselors”. A doctoral level
psychologist would typically refer their client to such a counselor if career issues related
to ADHD needed to be addressed.
But for a psychologist who treats adults with ADHD to be unable to help their
client to make a career selection that is compatible with his ADHD, or to help them
identify and change ADHD-related problems in the workplace is the equivalent of a child
psychologist who didn’t address a child’s academic functioning. While there are certainly
educational advocates and educational specialists who may be referred to, the typical
child psychologist knows far more about educational/academic functioning related to
ADHD, and has much interaction with teachers, tutors, school placement specialists and
school personnel in the process of treating a child with ADHD. The psychologist reviews
report cards, makes recommendations for IEP’s (Individual Educational Plans), confers
with teachers and tutors, and works with parents to develop improved patterns around
completion of homework and long-term academic assignments.
As a psychologist who shifted from a focus on ADHD in children to working with
adolescents, young adults, and older adults, I quickly became aware that many of the
challenges of living with ADHD in adulthood relate to workplace functioning. A
psychologist is far better equipped than a career counselor to help an adult with ADHD
understand his workplace challenges from a brain-based perspective as well as to help
him make choices and find solutions that are consistent with his particular neuro-
cognitive strengths and weaknesses. And yet, few, if any of us have received in-depth
training in doing career assessments, much less in treating adults with ADHD in a
workplace context. This chapter is intended to provide an overview of the approach that I
have gradually developed over the course of more than twenty years in my specialized
ADHD-focused clinical practice.
The “old” view of ADHD in the workplace
One of the first, classic, and highly respected books on ADHD in adults by
_______________, __________________, had little to say about work issues, but most
was negative. The image they painted was that adults with ADHD were typically
underemployed, often unemployed, and moved frequently from job to job. There
continue to be many adults who fall into this category, however few of them are likely to
seek treatment as adults for a variety of reasons. Many young males with ADHD and
learning disabilities are unemployed due to incarceration. Poor judgment and impulsivity
often results in jail time for young men with little education and few employment
opportunities. Others struggle along in low-paying jobs with no health benefits and
cannot afford treatment for ADHD. Still other young adults, although diagnosed with
ADHD as children, no longer view themselves as needing treatment and may have
resented being “required” to take medication or being placed in “special education”
classes during school years.
A broader view of ADHD in the workplace
The adult seeking treatment for ADHD in adulthood functions at a much higher
level. In my practice I have treated many professionals with ADHD – physicians,
attorneys, computer specialists, scientists, and business consultants, among others. Many
adults, by virtue of high IQ and less severe ADHD, are not severely impacted by ADHD
until the demands of academic or career demands increase to a level beyond their ability
to cope.
Many mental health professionals might question the validity of an ADHD
diagnosis for someone with a graduate or professional school education. Sadly, a number
of clients who later consulted me, reported that a psychiatrist or psychologist had told
them that they “could not possibly have ADHD” because they had done well in school or
had a professional position. The reality, however, is that the incidence of ADHD among
highly intelligent, highly educated individuals is significant, and involves significant
disability – for example the physician who was unable to pass her medical boards despite
repeated trials; a physician who was forced to close his medical practice (after many
years of post-graduate medical training!) because he was completely overwhelmed by the
organizational demands of his work; numerous doctoral candidates who never earn their
degree due to an inability to organize and complete their dissertation, and the very bright
accountant who was fired from several jobs due to his lateness, boredom and extreme
procrastination patterns in a career for which he was ill-suited.
How does ADHD “look” in adulthood and how does it impact employment?
Most clinicians have been taught about the “holy trinity” of ADHD, i.e.,
hyperactivity, impulsivity, and inattention. As children grow from childhood, through
adolescence, and into adulthood, levels of hyperactivity and impulsivity tend to lessen
while problems with inattention and distractibility continue. A larger and perhaps more
challenging set of ADHD-related symptoms come to the foreground – related to the
complex set of cognitive abilities clustered under the term “executive functions.”
While executive functions such as organizing, prioritizing, planning, persisting,
re-evaluating, and anticipating are certainly areas of weakness for children with ADHD,
we rarely focus on these as much as the more visible and difficult behavior patterns
typical of children with hyperactive/impulsive type ADHD. Expectations begin to change
in middle school, where children are expected to become more independent and better
organized, and it is often at this juncture that bright children with ADHD begin to
experience stress and ADHD patterns become more obvious.
This pattern continues on an upward trend through adolescence and into young
adulthood, where the demands for independent functioning may become overwhelming.
For adults with ADHD, the patterns which are most problematic directly affect workplace
functioning. Poor time management skills result in late arrival at work and in repeated
missed deadlines. Problems with organization result in cluttered desks, misplaced
paperwork, and difficulty with scheduling and prioritizing tasks. Working independently,
and working on long-term complex tasks are especially challenging for those with
ADHD.
As a result, the adult who seeks consultation from a clinician regarding ADHD-
related problems is much less likely to report that their major issues relate to
hyperactivity or impulsivity (though these continue to pose difficulties in adulthood) and
more likely to talk about feeling that the management of their daily life, both at work and
at home, feels overwhelming and out of control.
Neuro-cognitive Psychotherapy – a brain-based approach to the treatment of ADHD
Because ADHD is clearly a neurobiological disorder, (some would argue that all
psychiatric disorders have a neurobiological basis), any treatment approach needs to be
“brain-based” – that is, whether we are treating a child experiencing behavioral or
academic problems, or an adult experiencing workplace or interpersonal problems,
effective treatment must begin with an understanding of the dominant neurobiological
factors that underlie functional difficulties – in other words, “brain-based” treatment.
I have written in depth (citations) about neurocognitive psychotherapy and refer
the reader to these for a fuller discussion of these approaches. In the context of focusing
on workplace issues in psychotherapy, a briefer introduction to these concepts is in order.
Neurocognitive psychotherapy is an approach that borrows from a number of
other treatment models and cognitive behavioral psychotherapy, cognitive rehabilitation
techniques. The clinician is encouraged to conduct the therapy session with the cognitive
challenges of ADHD in mind – such as forgetfulness, a tendency to stray off topic, need
for structure and direction, and difficulty with independent goal setting and follow-
through. In some ways, the clinician needs to take on multiple roles, at times attending to
the emotional issues of low self-esteem, demoralization, and ADHD-stress-related
anxiety; at other times functioning more like a coach, making concrete suggestions,
assigning “homework” to be accomplished between sessions, and engaging in active
problem-solving with the client; and interwoven throughout, the clinician needs to keep
in mind the ongoing difficulty with focus and structure, using techniques such as
allowing the client to tape record the session for later review or encouraging the client to
take detailed notes during the session.
Conducting a career assessment
The assessment process described in this section is the most complete assessment
that I conduct. In many cases, such a comprehensive assessment, with its inherent cost, is
not necessary. Before discussing instances in which I would recommend a less
comprehensive assessment, I’ll describe the full assessment process.
A good career assessment needs to take many diverse factors into account: the
individual’s cognitive strengths, gifts and talents; the individual’s cognitive challenges
(either learning disabilities or areas of relative weakness); the individual’s interests,
personality type, goals, values, and limiting circumstances. A full history of all previous
employment is essential as well. Let’s consider each of these individually.
Assessing cognitive strengths, gifts, and talents
In a general sense the same set of tests designed to measure IQ and academic
achievement can be used to identify both areas of strength and areas of weakness. In the
case of a young adult, particularly a young adult who seems to have little sense of career
direction or interest, a very specific set of tests called the Highland’s Ability Tests (check
exact name and give citation) can be extremely helpful. This is a battery of tests that can
only be administered by specific franchised testing centers. The Highland’s battery was
initially developed by the Colgate Palmolive Company for in-house use in personnel
selection. It consists of ?? separate and highly diverse tests designed to measure a very
broad range of specific abilities or talents. The test battery is designed to identify an array
of “clusters” of ability that have been linked, through extensive research, to success in a
variety of career categories. Unlike the standard career interest tests, the Highland’s
battery does not identify specific careers that would be a good match for the individual’s
strengths, but rather identifies categories of careers. One of the great advantages of the
Highland’s battery is that it focuses on strengths, as opposed to IQ or academic
achievement tests that often elicit anxious or defensive reactions in individual’s being
tested. To learn more about the Highland’s battery, the reader can go to ____________.
Assessing areas of relative cognitive weakness
Because adults with AD/HD very often have other types of learning challenges, a
standard psychoeducational or neuropsychological battery can be very useful as part of a
career assessment. If the individual has already undergone such testing within the past
several years, and is able to make a full report of test results available to the clinician, it is
rarely necessary to undertake a second evaluation. IQ testing, academic achievement
testing (such as the Woodcock-Johnson battery), memory testing, and tests of executive
functioning are often useful tests to include in such an assessment.
Assessment of personality type and values
The Myers-Briggs Type Inventory (MBTI) can be a very useful addition to a
career assessment. In my experience, an intensive MBTI training workshop is highly
useful in making this deceptively simple test reveal the full range of information that it
can provide. Otherwise, clinicians often refer to brief, simplistic descriptions of “type”
that are available in numerous books on the MBTI, and only gain a fraction of the career-
related information that can be gleaned from a well-interpreted MBTI.
The MBTI is useful in helping the individual consider many aspects of his
personality and his value system that may not readily be related to career choice, but
which have a major impact upon the level of satisfaction and success that an individual is
likely to attain if a career choice is made that is compatible with personality type. The
MBTI is a self-assessment tool and is only as useful as the individual’s self-assessment is
accurate. It focuses on the inter-relationship between four major parameters:
• E-I Extroversion - Introversion
• S-N Concrete – Abstract (i.e., interested in things or ideas)
• T-F Logical/analytical – Empathic/intuitive
• J-P Structured/order-seeking – Flexible, freeform
These four parameters combine to create sixteen “personality types” that have been
studied and matched with career choices and career satisfaction. An excellent MBTI
“primer” is Please Understand Me by _____________________.
Assessing Interests
A standard interest test such as the Strong Interest Inventory can be very useful as
a way of matching the client’s interests with those of people who have been successful in
a variety of fields.
Once these various types of assessment have been completed, it becomes the task
of the clinician to carefully interweave the results for the client so that job selection
and/or career direction can take into account his strengths, his interests, his values and
personality type, his areas of weakness, and the pattern of ADHD symptoms that seem to
have the greatest negative impact upon job performance. In addition, although very little
has been written about this concept, it is important that the clinician also emphasize those
aspects of ADHD that may work as strengths in particular jobs and/or careers. (cite lynn
weiss and thom Hartmann)
Helping Young Adults Make ADHD-friendly Career and Job Choices
When working with a young adult, his or her worklife lies ahead. This is an ideal
time to help a young adult reach a sophisticated understanding of himself – not over-
emphasizing ADHD issues, but helping them fully participate in the evaluation,
understanding that their interests, preferences and strengths may have more to do with a
good career match than their ADHD does.
Most often a young adult, or his parents, enter the career assessment process
asking what the “best” jobs are for those with ADHD. It becomes the task of the clinician
to reframe the focus of the career assessment. Each young adult comes to the task of
selecting a career with a very complex set of traits that all must be considered if a good
choice is to be made. An emphasis upon strengths and preferences, accompanied by a
plan to reduce or minimize ADHD challenges, will lead to a much more satisfactory
career choice than will a career choice made by over-focusing on ADHD-related
problems.
FOCUSING ON CAREER CHOICES WITH YOUNG ADULTS
The choice of one’s life work is a critical choice that will have a huge impact upon the
quality of life of an individual with AD/HD. As such, just as a clinician would help a
young adult carefully explore relationship issues and the choice of a life partner,
clinicians should also help a young adult with AD/HD carefully explore career options as
he or she goes through the process of selecting (or changing) a college major or goes
through a job search.
A thorough AD/HD-focused career assessment for a young adult with ADHD is an
excellent investment in his or her future. Oddly, despite the enormous and rising cost of a
college education, the choice of a college major and the related choice of career focus is
often left to the young adult with little or no intervention on the part of parents or
psychotherapist. And yet few young adults are equipped with a sophisticated
understanding of themselves, much less with an adequate understanding of the many
factors involved in a particular job or career.
Guiding a young adult in career selection
“What do you want to do with your life?” is probably one of the most daunting
questions any adult, young or old, may face. Any many choose their career direction by
default – doing what their mother or father did before them. Or happening into a job after
school years are ended with relatively little reflection on what suits them best. A lucky
few have such narrow, focused interests that they’ve “always known” what they wanted
to be. When a young adult has AD/HD, the factors influencing a good career choice are
much more complex. Not only does he or she need to consider all of the issues we must
all consider:
What kinds of jobs are available at the time I’m searching;
Am I willing to move to another part of the country to find a job;
Do I have the credentials to get my foot in the door?
What kind of lifestyle do I want?
How important is money? Personal time?
What careers are a good match with my values and interests?
Adults with AD/HD have other issues that will greatly affect the outcome of their
choices. Very often, adults with AD/HD are more sensitive to a variety of sensory
stimulation which means that the physical environment of the job is more critical for
them. Executive function issues make handling details, complex multi-step tasks, and
paperwork more challenging. Those with hyperactivity are much less suited to a desk job
that allows little movement throughout the day. Boredom typically has a greater negative
impact on those with AD/HD.
How much stress will this job entail?
How much structure and guidance will I receive?
How much paperwork is involved?
Will I be expected to work on long-term assignments with little supervision?
Am I expected to be a self-starter?
Will I be required to sit at a desk and concentrate for long hours?
On the plus side, many with AD/HD are great at generating new ideas. Some adults with
AD/HD who fall more toward the hyperactive end of the continuum have characteristics
that make them well-suited to being in a fast-paced career such as being an entrepreneur.
Some have good people skills in addition to high energy and would do well in a career in
politics, sales, marketing, entertainment, or television. Others with AD/HD have a strong
need for a creative outlet and are drawn to work in design, film-making, web design, or
some other aspect of the visual arts.
Differentiating between a “career” and a “job”
Assessing the level of workplace change that is needed
When an adult client seeks a consultation about workplace problems related to
ADHD, the first issue that a clinician should address is the level of change that is needed.
Does this client need to focus on:
• Identifying and addressing problems on the current job?
• Changing employers while seeking a similar job?
• Seeking a different type of job within the same general career path?
• Changing careers altogether?
In other words, what are your client’s options and what are the least costly solutions in
terms of time and money?
The type of career assessment outlined for individuals who are trying to select a
career is not necessarily appropriate or useful in working with an adult who is already
trained in a career path. My rule of thumb when a client approaches me seeking career
consultation related to ADHD is to begin with the least costly option – i.e., looking for
ways to improve the client’s situation in his current workplace.
Assessment of current workplace functioning – defining problems, seeking solutions
The first consideration in a career consultation should be to understand the
multiple factors involved in current workplace difficulties. Whether a client with ADHD
seeks to remain in his position for an extended basis, or will be there short-term while
considering other options, it is important to focus on helping the client to understand how
ADHD factors are related to the current problems and to seek ways to decrease stress and
improve the current situation. While the client may only want to focus upon leaving his
or her current employment, there is much to be learned in carefully evaluating current
and past employment history. Through this process much can be learned that will
contribute to a more informed, ADHD-friendly job choice in the future.
ADHD-related job problems can fall in a number of different areas:
1- Poor match between the individual’s strengths and weaknesses and the
requirements of the job.
2- Poor match between the individual and his or her supervisor.
3- Interpersonal difficulties related to ADHD that contribute to conflicts with
co-workers or managers.
4- Job is under-stimulating due to lack of interest, lack of variety, lack of
opportunity for creativity or change.
5- Job is frustrating due to lack of opportunity for physical movement – i.e.,
an adult on the hyperactive end of the ADHD continuum in a desk job.
6- Executive functioning difficulties related to ADHD (poor time
management; difficulty with detailed paperwork; forgetfulness; difficulty
meeting deadlines; disorganization; difficulty setting and following
priorities; tendency to over-commit; tendency to greatly under-estimate
the time required for a project, etc.) that lead to poor performance review.
7- Changes within the company that have led to increased stress, increased
work expectations, and/or decreased administrative support.
The first task for the clinician is to guide the client through an analysis of current job
problems, helping the client to consider many different aspects of the job that may
contribute to current problems. Often, a client may be fixated upon a particular problem
such as a feeling that the supervisor only emphasizes the negative aspects of their work
performance and ignores positive work efforts. “The only thing my supervisor ever talks
about is the fact that I’m often a little late to work. She completely ignores the fact that I
stay late most evenings and actually put in more than my 40 hours per week.”
A job analysis is often more complete and accurate if it is guided by the clinician in a
structured way. A good first place to start is to go through the list outlined above.
First, assist your client to think about her strengths and interests and how much she feels
she is able to use them in her current job. Explore areas of challenge of weakness as well.
The clinician should always keep in mind, especially for adults who have not had a full
neuropsychological test battery, that undiagnosed learning disabilities frequently
accompany ADHD. It’s important to explore issues of reading speed, reading retention,
spelling, and writing ability.
Ask about her relationship with her immediate supervisor. Does she feel understood,
appreciated, and supported? Does she like and feel liked by this supervisor? Or does she
feel criticized, micromanaged, ignored, or under-supported by the supervisor? It can also
be very useful to explore relationships with past supervisors during this discussion. What
are the characteristics of supervisors with whom you’ve worked well in the past?
Educating your client about ADHD and the many ways that it can impact job
performance and job satisfaction is often part of the clinician’s work when focusing on
career issues during treatment. The clinician may want to refer to my book ADD in the
Workplace for a more detailed discussion of ADHD tendencies that can lead to
interpersonal conflict on the job or performance problems on the job.
ADHD traits that may lead to interpersonal difficulties include a tendency to miss or
misinterpret non-verbal social cues (such as when another individual no longer desires to
continue the conversation or when well-intentioned teasing is not well-received);
distractibility and inattention that may be interpreted as lack of interest; a pattern
frequently interrupting others when they are speaking; or a tendency to emotionally over-
react with anger or frustration.
Other ADHD traits can be misinterpreted by co-workers or supervisors as poor
motivation. For example, chronic lateness when arriving at work, not completing forms
and paperwork in a timely manner, or chronically missing deadlines.
The cluster of executive function challenges often associated with ADHD in adults can
lead to numerous difficulties. Impulsivity can lead an employee to agree to tasks before
they have carefully considered whether they have overcommitted and will be unable to
fulfill their promise. Restlessness and hyperactivity may lead an individual to frequently
leave his or her desk, finding excuses to roam the halls, run errands, or strike up
conversations rather than working productively. Memory difficulties can lead an
individual with ADHD to be seen as unreliable when verbal requests are repeatedly
forgotten. And patterns of procrastination, so common among adults with ADHD, can
lead coworkers and supervisors to see the employee with ADHD as immature,
unmotivated, or worse, attempting to manipulate others into doing work for them.
Difficulties with planning and organization can frequently play a role in poor workplace
performance. An employee with ADHD may avoid beginning a challenging task because
they have difficulty with organizing the task and knowing where to begin. Rather than
prioritizing, an employee with ADHD may impulsively jump from task to task with little
follow-through and task completion. And general messiness, that so often accompanies
ADHD, is not only a very public display of disorganization, but also greatly increases the
challenge of keeping track of and completing the multiple tasks the job requires.
A final area of job exploration that is critical to understanding how ADHD impacts job
performance is the aspects of their employer and their job that may exacerbate ADHD
traits on the job. For example, a badly organized supervisor, a company that is down-
sizing and has eliminated administrative support staff, a company that is under-staffed
and requires frequent over-time work, or a company in transition in which job
expectations, regulations, and chain of command are in flux.
This structured exploration with your client becomes the basis for identifying problem
areas that then need to be prioritized and addressed. As the task of prioritization is a
typical area of challenge for adults with ADHD, this very task is one in which you should
assist you client. Asking structured questions is often very helpful. For example, you
might ask your client to think about what issue at work is most troubling for them, and
then ask them to consider what problem area might be the top priority for their
supervisor. These identified problems are often quite different. For example, your client
might feel that getting control of cluttered desk and workspace is a top priority; or that
reducing demands for overtime work would be the most direct way to reduce stress and
ADHD symptoms. The supervisor, however, might be more concerned about chronic late
arrival at work, or about lack of follow-through with paperwork. Together, you and your
client can begin to create an action plan, prioritizing the problems that should be
addressed, and then developing strategies to deal with these problems.
The therapist should use a brain-based approach, as always, in working with his adult
client with ADHD, providing guidance, structure, and direct suggestions as problems and
solutions are discussed. For example, the clinician may strongly suspect that the client is
in danger of being placed on probation for poor job performance while the client with
ADHD may have missed the danger signs and remain focused on his or her own
frustrations in the workplace. In such an instance, the clinician might suggest that a
meeting with the supervisor should be a top priority action – to let the supervisor know
that the employee with ADHD is aware of job performance shortcomings and is taking
active steps to correct them.
It is critical that the clinician be aware that many adults with ADHD are poor at judging
how much they can take on at one time. While the client may want to impulsively try to
address multiple issues simultaneously, the clinician (using a brain-based approach) can
remind the client of her ADHD tendency to take on too many projects and be unable to
complete them. The clinician might then make a concrete suggestion about which
strategy to attempt initially, and how to decide when it is time to tackle another ADHD
workplace challenge. This sort of structuring is a brain-based intervention that should be
used repeatedly to assist the client to make realistic goals, stay on task, and achieve
success, one step at a time.
