Are you an ADHD-friendly employer?

Do you have an ADHD-friendly work environment and management?
Yes
No
1.          Can you be trusted by your employee for the disclosure of his/her ADHD?
2.          Are you aware of the professional needs of your neurodiverse employees? – Boss: Is there anything that I’m doing or that anyone else is doing here at work that’s interfering with your success[1]?
3.          Are you incorporating reasonable accommodations (flexible work style/role innovation/closer supervision/reward systems[2]) to create a positive and productive work environment for your neurodiverse employees?
4.          If not, do you think the only solution would be to replace your neurodiverse employee with a neurotypical?
5.          Have you taken or are you willing to take professional trainings for tackling talented but sometimes difficult employees?
6.          Do you figure out your employees’ strengths and form a strength-based approach[3]?
7.          Do you foster a work culture of compliments more than that of complaints?
8.          Would you be open to personally work on the integration of diversity besides having personal sympathy and/or professionally capitalizing on the neuro-developmental disorders?
9.          Do you truly believe that organizational problems of your neurodiverse employees are the outcomes of ADHD and not the grounds for firing them?
10.       With neurodiverse people in your workplace, do you offer training/coaching to support their skills and for the organization to create an inclusive culture?
11.       Can you recognize ADHD (or other diversity) in your workplace?
12.       Most importantly, are you inclined towards being an ADHD-friendly employer and manager?
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  • “I did see my job at risk but could not change anything”

– A freelancer (late thirties), worked for an e-commerce and cloud computing company, double Master’s degrees holder and with ADHD

“I don’t remember failing the deadlines. How? I had to work overtime and give up on my personal interests. The projects I was allocated did not fit my strengths. I wouldn’t say dealing with customers is my biggest strength. Further adding to my misery, I was made responsible for overseas clients which played havoc with my sleep cycle. My continuous requests for switching the duties and departments were never well received. Instead, I came across as a demanding, an arrogant and inflexible person.

I thought I had made a few friends at work but nobody wants to hang out with the boss’ not-so-favorite person. I was given a three-month termination period; I could not utilize it to find myself another job, as I was looping within the company’s projects. It was followed by a stretch of depression, and multiple but feeble psychotherapy sessions.

This was not my first job. I indeed have a 7 year experience (starting in my late twenties) in one of the richest and best known Information Technology multinationals. Looking back, I spent most of my professional life stuck in the office for hours with my laptop, could never actually build networks, and had the uncountable guilt trips of cancelling on friends and family.

How do people with ADHD even get closer to managing both personal and professional life? I am now trying to make a living as a freelancer. It has been two years since that full-time job, but the downers don’t let me re-enter the corporate sector or raise a family of my own. I feel I had wrongly prioritized my entire life by putting the professional part first. I have lost a lifetime.”

  •  “I did not even see it coming!”

– A dietitian (late thirties), parent, worked in academia and with ADHD.

“As an independent professional, I had been doing well. Why I switched to an academic position? I think of myself as a cheerful and people’s person. The idea of working in academic teams was quite fulfilling. I am so intrigued by nearly everything I am a part of.

With a mind full of too many and rational ideas, I can sometimes be challenging for others to work with. I finish the assignments, but with delays; thanks to the perfectionist within me. I spend too much time on perfecting things that at the end everybody is just relieved to get it submitted rather than appreciating the quality. I wish I could “just do it” rather than “doing it right”, and direct my creativity and research habits into the truly rewarding tasks.

At first, everyone seemed to like my company but things suddenly changed one day! My job dismissal – with an immediate effect jolted me. I had naively thought the boss would probably be more supportive after knowing my ADHD and where I was struggling. I loved my work that I was originally hired for but the unsaid overwhelming paperwork!

I have always been a bit clumsy, or much clumsier than the average person. People notice my ineptness, but not the frustration I internalize in those situations, like re-doing documents just because I lost track of originals, or re-booking flights that incur me hefty losses.

Struggling professionally, financially to support myself and kids, I now feel like a juggler.”

What-does-it-feel-like-to-have-adhd

And what do the employers come up with for firing the ADHD employees?

Their same old EXCUSES – Late for meetings! Late for handing in submissions! Unrealistic ideas! “Off track”! Does not sync with the team members! Impulsive! Continue reading Are you an ADHD-friendly employer?

Do genes explain the overlap between ADHD and other conditions, such as cognitive functioning, obesity, mood disorders and substance use?

ADHD is a heritable disorder, which means that genes contribute to the risk for getting the disorder. There are hundreds or even thousands of genes that contribute to ADHD, and while each single gene itself will not cause ADHD, together they contribute to the risk. But it is important to note that genes are not everything – environmental influences, such as preterm birth or exposures during pregnancy, may also contribute to the risk for ADHD.

 

Individuals with ADHD sometimes have other co-occurring conditions, such as mood disorders, obesity and substance abuse. This has led to the important research question of why do these conditions often co-occur with ADHD. Are there shared risk factors?

Comorbidity

We know that people with ADHD not only tend to have a family history of ADHD, but they also are more likely to have siblings or parents with certain other co-occurring traits and disorders. This suggests that there are overlapping familial risk factors – which could be genes – between ADHD and other conditions.

 

A very large and recent genetic study that examined thousands of common genetic markers across our DNA, identified for the first time several genes that underlie risk for ADHD2. This information allowed us to investigate the genetic overlap between ADHD and other disorders using actual genetic data. In our new paper published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging3, we selected a bunch of genetic markers that most strongly underlie risk for ADHD, identified in the previous genetic study, and tested if they showed an overlap with other traits and disorders that often co-occur with ADHD. We tested this on a very large sample of 135,000 people in the UK. We found that some of the genetic risk factors were shared between ADHD and co-occurring conditions in the general population, specifically – atypical cognitive functioning, higher body mass index, neurotic behaviour, anxiety, depression, risk-taking behaviour, smoking and alcohol use.

 

Our study findings suggest that genes do, at least to some extent, explain the overlap between ADHD and co-occurring conditions. These genetic factors contribute to cognitive functioning, body mass index, mood symptoms and substance use in the general population.

 

The aim of this research is to further our understanding of ADHD and co-occurring traits and disorders. A better understanding of why ADHD often co-occurs with other conditions may help in the development of new treatments. Also, if we know how to predict which individuals with ADHD are at risk for other co-occurring disorders, we will be in a better position to offer early interventions that could prevent such further problems from developing.

 

Ebba Du Rietz and Jonna Kuntsi

 

References:

  1. Faraone SV, Perlis RH, Doyle AE, Smoller JW, Goralnick JJ, Holmgren MA, Sklar P. Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005; 57:1313–1323. doi: 10.1016/j.biopsych.2004.11.024.
  2. Demontis D, Walters RK, Martin J, et al. Discovery of the first genome-wide significant risk loci for ADHD. bioRxiv 145581. 2017. doi: https://doi.org/10.1101/145581.
  3. Du Rietz E, Coleman J, Glanville K, Wan Choi S, O’Reilly PF, Kuntsi J. Association of polygenic risk for attention-deficit/hyperactivity disorder with co-occurring traits and disorders. Biol Psychiatry: CNNI. In press. doi: https://doi.org/10.1016/j.bpsc.2017.11.013

 

ADHD and school failure

Patient involvement is essential in health care, as well as in medical research.

For this purpose, our research group at the University of Bergen is collaborating with a board of ADHD patient representatives. The panel is committed to provide suggestions for future research topics and feedback on our work. During a recent meeting, panel members were asked what they considered the most urgent (research) needs in this field.

Much to our surprise, all four panel members expressed almost univocal messages: “You must fix the school system”. “There is too little knowledge about ADHD among teachers”. “Schools either ignore our problems, or offer too little assistance, too late “.

Perhaps these complaints shouldn’t be that surprising? After all, ADHD symptoms typically appear in school settings. Whether an ADHD condition is formally diagnosed during childhood, or the diagnosis is made retrospectively in adults, most people with an ADHD diagnosis will tell that they had negative experiences during school and many also suffered from academic failure.

The connection between learning difficulties, ADHD symptoms and dropping out of school are obvious also in genetic studies. In fact, this connection inspired us to perform a molecular genetic study, where large scale data collected about the genetics of educational attainment (EA) was coupled to a genome wide association (GWA) studies on ADHD genetics. Taking advantage of this connection, this design was able to boost the statistical power of the ADHD GWA study.

Until recently, genome wide studies on ADHD have been small and failed to provide reliable genome wide significant association signals. When a conditional false discovery rate method was applied to GWA data on ADHD educational data, to identify ADHD-associated loci and loci overlapping between ADHD and EA, we identified five ADHD-associated loci, three of these being shared between ADHD and EA. These five novel loci associated with ADHD confirm that there is a shared genetic basis between ADHD and EA and may increase our understanding of the genetic risk architecture of ADHD .

http://www.jaacap.com/article/S0890-8567(17)31863-4/abstract

From this study, we have learned: (1) the importance of patients and society being engaged our work, (2) that there is a strong connection between ADHD and failed educational attainment and (3) that this connection can be used to find ADHD susceptibility genes.

Finally , as our patients have explained; this is not only about persons with ADHD failing at school, but also about a school system failing to adapt their teaching to persons with ADHD-related problems. This is obviously also a field in need of future research and interventions.

Adult ADHD and gender differences in psychiatric comorbidity

Interestingly, ADHD symptoms are usually different in girls and boys during childhood. Girls show less hyperactivity and this may lead to later identification and later treatment. Could this affect the development of other psychiatric disorders in adulthood? This was the big question behind a study examining differences in mental health among men and women with ADHD.

Previous studies have tried to figure out differences among men and women with ADHD in the risk of psychiatric comorbidities. Our study is the first to actually show such differences.

In our study, we linked information from four large national registries in Norway, and identified 40,000 adults with ADHD, which is 2.4% of the adult population. We compared them with the remaining population of 1.6 million Norwegian adult inhabitants without ADHD. The psychiatric disorders we studied were anxiety, bipolar, depression, personality disorder, schizophrenia spectrum (schizophrenia) and substance use disorders (SUD).

Both men and women with ADHD were 4-9 more likely to be diagnosed with these psychiatric disorders compared with the remaining population. We also found that there were significant differences in risk of a psychiatric diagnosis between men and women with ADHD.

Figure_colour_Acta_Psych_Scand_160917_title

Women with ADHD were significantly more often diagnosed with anxiety, depression, bipolar and personality disorder than men, while men with ADHD had more schizophrenia and SUD.

We also found that a considerable proportion of anxiety, bipolar disorder, depression, schizophrenia, SUD and personality disorders in the population could be explained by an underlying ADHD. About 6 percent of depression and 13 percent of bipolar disorders in women could be related to ADHD.

What clinicians need to know is that when treating adults with ADHD, they should be aware of these gender-specific psychiatric comorbidities, in order to both detect the conditions and offer early treatment if diagnosed. Importantly, clinicians should also be aware of a possible underlying ADHD when adults present with symptoms of other psychiatric disorders.

It is also important to identify children and adolescents with ADHD at earlier stages in order to reduce the risk of future psychiatric comorbidity. This may be particularly important in girls and women with ADHD, who often have a lower degree of hyperactivity and are therefore at an increased risk of being undiagnosed in childhood. This could result in a higher risk of developing other psychiatric disorders as a possible consequence as they grow older.

This study was done at Stiftelsen Kristian Gerhard Jebsen Center for research on Neuropsychiatric disorders, University of Bergen, Norway, and published OnlineOpen in Acta Psychiatrica Scandinavica, December 2017, with the title: “Gender Differences in Psychiatric Comorbidity: A Population-based Study of 40,000 Adults with Attention-Deficit Hyperactivity Disorder”

http://onlinelibrary.wiley.com/doi/10.1111/acps.12845/abstract;jsessionid=9377E31A46561F6810527AC39EC90981.f02t04

Poor sleep quality in adult ADHD

We don’t realize how important sleep is. In a recent review of a new popular science book “Why We Sleep” by Matthew Walker (and you should really check it out) [1] a commentator wrote that our attitude towards sleep reminds her of what ancient Egyptians did just before they mummified a body: they always dumped the brain because they had no idea what it is, so why bother with the mushy pudding inside the skull? (www.tinyurl.com/y85pbmck) It seems that the way we treat sleep today has similar negative consequences for our physical and mental health as if we were thrashing our brains. It certainly doesn’t help to mummify our bodies as lack of sleep can considerably shorten our lifespan [1].

Poor sleep quality disturbs all aspects of cognition and emotion [2] resulting in poor concentration and high sleepiness during the day [3]. If you suffer from ADHD you are very likely know what I’m talking about, regardless how old you are [4, 5].

Sleep problems have long been a part of daily (or rather nightly) struggles of people with ADHD [6]. In fact, it is estimated that more than 50% of adults with ADHD experience sleep concerns [7] and suffer from low sleep quality [8-11]. This makes the burden of ADHD even higher by further lowering the quality of life. Imagine being exhausted by ADHD by day and then not being able to get any rest at night… No wonder poor sleep quality in ADHD results in poor academic performance, negative relations with significant others and higher chances for obesity [12]!

Interestingly, sleep disorders would often produce symptoms mimicking ADHD, so doctors should be extra careful not to confuse ADHD with consequences of these sleep problems [13, 14].

In our recent study involving adults with ADHD (data not yet published) we found that sleep quality is closely related to symptoms of inattention, hyperactivity/ impulsivity and emotional instability and that people with poor sleep quality make a lot of errors and respond much slower in a cognitive task which required concentration.

This means that if you have ADHD and you don’t sleep well, it’s as if you’d have more severe symptoms. And if you don’t have ADHD, lack of quality sleep could essentially make you a bit ADHD.

That’s why, regardless of whether you suffer from ADHD or not, you should do all in your power to make sure you sleep well at night (for useful tips check www.sleepfoundation.org). After all, we will all spend 20-30 years of our lives journeying into slumberland, so let’s make the best of these long and frequent trips – for the sake of our bodies and minds.

 

  1. Walker, M.P., Why we sleep : unlocking the power of sleep and dreams. First Scribner hardcover edition. ed. 2017, New York: Scribner. pages cm.
  2. Krause, A.J., et al., The sleep-deprived human brain. Nat Rev Neurosci, 2017. 18(7): p. 404-418.
  3. Durmer, J.S. and D.F. Dinges, Neurocognitive consequences of sleep deprivation. Semin Neurol, 2005. 25(1): p. 117-29.
  4. Hvolby, A., Associations of sleep disturbance with ADHD: implications for treatment. Attention Deficit and Hyperactivity Disorders, 2015. 7(1): p. 1-18.
  5. Cortese, S., et al., Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry, 2009. 48(9): p. 894-908.
  6. Konofal, E., M. Lecendreux, and S. Cortese, Sleep and ADHD. Sleep Med, 2010. 11(7): p. 652-8.
  7. Yoon, S.Y., U. Jain, and C. Shapiro, Sleep in attention-deficit/hyperactivity disorder in children and adults: past, present, and future. Sleep Med Rev, 2012. 16(4): p. 371-88.
  8. Sobanski, E., et al., Sleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: a controlled polysomnographic study. Sleep, 2008. 31(3): p. 375-81.
  9. Boonstra, A.M., et al., Hyperactive night and day? Actigraphy studies in adult ADHD: a baseline comparison and the effect of methylphenidate. Sleep, 2007. 30(4): p. 433-42.
  10. Schredl, M., B. Alm, and E. Sobanski, Sleep quality in adult patients with attention deficit hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci, 2007. 257(3): p. 164-8.
  11. Surman, C.B., et al., Association between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: evidence from a large controlled study. J Clin Psychiatry, 2009. 70(11): p. 1523-9.
  12. Um, Y.H., S.C. Hong, and J.H. Jeong, Sleep Problems as Predictors in Attention-Deficit Hyperactivity Disorder: Causal Mechanisms, Consequences and Treatment. Clin Psychopharmacol Neurosci, 2017. 15(1): p. 9-18.
  13. Bioulac, S., J.A. Micoulaud-Franchi, and P. Philip, Excessive daytime sleepiness in patients with ADHD–diagnostic and management strategies. Curr Psychiatry Rep, 2015. 17(8): p. 608.
  14. Oosterloo, M., et al., Possible confusion between primary hypersomnia and adult attention-deficit/hyperactivity disorder. Psychiatry Res, 2006. 143(2-3): p. 293-7.

A call for better mental health: How modern technology may improve access to ADHD services

Masai mobile

Kenya, Kajiado district. Isaac Mkalia (20), a Maasai and a teacher by profession, checks his mobile phone while guarding a flock of cattle. © Sven Torfinn

According to a UN report more people now have mobile phones than toilets: Of the world’s 7.5 billion people, only around 3 billion have safely managed sanitation, but there are 3.7 billion Internet users and over 5 billion unique mobile phone users in the world in 2017. One day this week, whilst bemoaning the apparent global sanitation crisis, I started to ponder what promises the widespread use of mobile and Internet technology nonetheless might hold, particularly with regards to mental health and more specifically ADHD.

Access to mental health services and evidence-based treatment can be poor in rural areas, with lower availability of services and greater distances to specialist care. In addition, psychosocial factors (e.g. stigma), financial constraints and a lack of human resources (i.e. clinicians and practitioners) may create barriers to treatment, and long waiting times, in both rural and urban areas. E-mental health could be key to tackling these problems.

E–mental health can be defined as the “use of digital technologies and new media for the delivery of screening, health promotion, prevention, early intervention, treatment, or relapse prevention, as well as for improvement of health care delivery (e.g. electronic patient files), professional education (E-learning), and online research in the field of mental health” (Riper et al., 2010). This means that e-mental health has the capacity to aid with anything from prevention and early diagnosis to behaviour management and high-quality treatment.

Online therapies have emerged as a valuable and effective approach to delivering evidenced-based care via the Internet. These types of therapies can comprise electronic modules patients can work through in their own time, (recorded or real-time) videoconferencing to conduct mental health visits within the patient’s home, or a combination of the two. One example of an evidenced-based self-administered programme is the Triple P (Positive Parenting Program) Online (Sanders, Kirby, Tellegen & Day, 2014), which provides support for parents of children with disruptive behaviour in eight self-paced modules.

Research into videoconferencing for ADHD is still in its infancy. A preliminary study recently found that, despite minor technological glitches, ADHD symptoms decreased in 20 children with ADHD at a similar rate to face-to-face sessions (Sibley, Comer & Gonzalez, 2017). Given the scarcity of mental health providers, the distance to services and problems with transportation access, especially in remote areas, as well as scheduling conflicts and long waiting times, online therapies may prove to be a useful tool to improve cost-effectiveness and access to evidenced-based treatment in underserved areas. Online therapies may also be more attractive to patients who are reluctant to seek face-to-face care due to stigma or other concerns (Christensen & Hickie, 2010).

An even more comprehensive way of employing the Internet for medical practice is the use of web portals, which can address several key aspects of healthcare, including screening, symptom tracking, patient registries and online communication between patients and their clinicians. One example of an ADHD web portal is myADHDportal.com, developed by Cincinnati Children’s Hospital Medical Center (Epstein, Langberg, Lichtenstein, Kolb, Altaye & Simon, 2011). The myADHDportal.com web portal consists of online training for community-based practitioners, ADHD assessment as well as treatment for children with ADHD. Parents and teachers can complete ADHD rating scales about patients online and rating scales are automatically scored and summarized to aid the clinician in diagnosis and treatment monitoring. The ADHD web portal also allows parents, teachers, and clinicians to communicate with each other and with other mental health professionals during assessment and treatment via an online emailing system. Although ADHD web portals can have high clinical utility, their implementation may be burdensome for healthcare professionals because these portals usually exist outside of official electronic health records and information has to be transferred between the two.

Smartphones provide considerable healthcare-related opportunities. Since their inception, the development of smartphone applications, so-called apps, has skyrocketed. In 2016, an estimated 150 billion apps were downloaded worldwide. As smartphones and apps become ever more integral to the lives of many people around the world, these technologies offer great possibilities for improving the provision of mental health services and encouraging healthy behaviours. Apps can, for instance, help with behavioural change, goal setting and education by providing both training (repeated exposure to a task to improve ability) and support (facilitation of a skill while the technology is in use). Available apps related to ADHD may improve organizational skills by employing push notifications, reminders and timers. They can also help to reduce stress and track behaviour, as well as making use of positive reinforcement through the ‘gamification’ (using badges or phrases to reward participants for meeting their goals) of arduous tasks. The CoCA-PROUD project is currently piloting an app, which monitors physical activity and light exposure, analyses the behaviour in real-time and provides encouraging feedback to the user to improve motivation in order to provide new insights into the potential of smartphones to improve ADHD symptomatology and comorbidities such as obesity and depression. Moreover, this list includes some useful examples of apps that may be beneficial to individuals with ADHD. However, some users may rightly raise concerns about digital privacy and security. Few apps to-date are supported by an evidence base, and there is currently no governing body responsible for quality control. The American Psychiatric Association has therefore developed a hierarchical model to assess health apps to guide clinicians and service users in their decision-making.

While overall more evidence for the efficacy of E-mental health services is still required, the widespread use of smartphone and Internet technology holds immense promise for the future with the lauded benefits including cost-effectiveness, geographic and temporal flexibility, the reduction in therapist time, stigma and waiting time for treatment, as well as the increase in help-seeking behaviours and treatment satisfaction (Musiat & Tarrier, 2014).