Let us consider career assessment before returning to a discussion of Garber’s
resilience factors. The extent of assessment should be determined in response
to each client’s individual situation. A full assessment would include
the following: • Clinical interview to take a work history and assess
current workplace functioning, • Neurocognitive testing to measure strengths
and weaknesses, • Psychological testing to evaluate comorbid psychiatric
conditions, • Personality testing to assess temperament and values related
to career, and • Interest testing to assess goodness of fit between career
choice and interests. Not every client, however, needs such a thorough and
costly evaluation before beginning treatment. I will address each aspect of
the assessment process, discussing the circumstances under which each might
be advisable.
Current Workplace Concerns. The first consideration in a
career consultation should be to understand the multiple factors involved in
current workplace difficulties. Whether a client who has ADHD seeks to remain
in his or her current position for an extended period or will only 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.
Past Employment History. Although the client may want only
to focus on 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. The clinician can guide the client through an analysis
of current job problems, helping him or her to consider many different aspects
of the job that may contribute to current problems. A job analysis is often
more complete and accurate if it is guided by the clinician in a structured
way. Degree of Job Match With Strengths and Weaknesses. Assist your
client to think about her strengths and interests as well as weaknesses and
how they are matched with her current job. The clinician should always keep
in mind that undiagnosed learning disabilities frequently accompany ADHD. It
is important to explore reading speed, reading retention, spelling, and writing
ability. Degree of Match With Client’s Supervisor. Does the
client’s supervisor have traits that may directly exacerbate his ADHD?
For example, a highly critical supervisor may increase the client’s anxiety
and thereby increase ADHD symptoms. A micromanaging supervision style may feel
diminishing to an adult who has ADHD, leading to feelings of demoralization
and reduced motivation. A supervisor who is forgetful and disorganized will
only contribute to similar traits in the client. Compare Client’s
Concerns and Those of the Supervisor. Problems identified by the client
and by the supervisor are often quite different. For example, your client might
feel that required overtime work and unclear instructions from the supervisor
create her greatest challenges. The supervisor, however, might be more concerned
about chronic late arrival at work or about lack of follow-through with paperwork.
The clinician needs to help the client address both sets of concerns if she
is to succeed in her current job. Explore ADHD Traits That May Affect Interpersonal
Interactions at Work. ADHD traits that may lead to interpersonal difficulties
include missing nonverbal cues, interrupting, and overreactioning emotionally.
Other ADHD traits can be misinterpreted by coworkers or supervisors as poor
motivation, for example, chronic lateness or missing deadlines. The clinician
may want to refer to my book ADHD in the Workplace (Nadeau, 1996) for a more
detailed discussion of ADHD tendencies that can lead to interpersonal conflict
or performance problems on the job. Explore ADHD Traits That Affect Performance.
The cluster of executive function challenges often associated with ADHD in
adults can lead to numerous difficulties. For example, impulsivity can lead
an employee to overcommit and then be unable to fulfill a promise or may lead
him to jump from task to task with little follow-through and task completion.
Restlessness and hyperactivity may lead an individual to find excuses to roam
the halls rather than work productively. Memory difficulties can lead an individual
who has ADHD to be seen as unreliable when verbal requests are repeatedly forgotten.
Patterns of procrastination can lead coworkers and supervisors to see the employee
who has ADHD as unreliable or unmotivated. And general messiness, which so
often accompanies ADHD, not only is a very public display of disorganization
but also greatly increases the challenge of keeping track of and completing
the multiple tasks. Explore Match Between Client and Work Organization.
Some organizational features may exacerbate ADHD symptoms, for example, reduced
administrative support, downsizing, demands for overtime, or unrealistic productivity,
or a crisis-prone poorly organized firm.
Testing Neurocognitive Testing: A full neurocognitive assessment
can be very helpful in guiding the client but should not be initiated automatically
because of its significant cost. If the client plans to return to school,
a full up-to-date neurocognitive evaluation is necessary in order to obtain
reasonable academic accommodations. A full evaluation will also be required
if the client is in the process of disclosing ADHD as a workplace disability
in order to obtain workplace accommodations. In a general sense, the same
tests designed to measure IQ and academic achievement can be used to identify
both areas of strength and areas of weakness. At minimum, an IQ test and
selected Woodcock-Johnson achievement tests can help the clinician create
a profile of strengths and weaknesses. Tests of memory and executive functioning
are often useful in such an assessment. The clinician who chooses to refer
the client to a specialist for such testing should nevertheless be knowledgeable
about these tests and able to make his own career-focused interpretations
of the findings. The clinician should be the primary person who provides
feedback of test results and makes specific recommendations to the client
on the basis of these test results.
Psychological Testing: The majority of adults who have ADHD
also struggle with comorbid psychiatric conditions. The presence of comorbid
conditions does not ipso facto call for psychological testing. Possibly these
comorbid conditions have already been evaluated and are currently being treated.
I recommend psychological testing only if the clinician believes that there
are hidden disorders that need assessment or if differential diagnostic issues
require it. The clinician can opt for a general, computer-scored psychological
test, such as the Minnesota Multiphasic Personality Inventory—II (MMPI-II)
or the Millon Clinical Multiaxial Inventory- III (MCMI-III), as a screening
tool and can make a decision about the need for further testing after reviewing
test results.
Personality Testing: A good (or bad) match between career
choice and personality type can have a major impact upon the satisfaction
and success that an individual is likely to attain. I use the Myers-Briggs
Type Inventory (MBTI) in career assessments because I find it helpful in
considering aspects of personality, preferences, and values not measured
by tests designed to measure psychopathology.
Interest Testing: A standard interest test, such as the
Strong Interest Inventory, can help match the client’s interests with
those of people who have been successful in a variety of fields. In my experience,
the specific Strong occupational scores are of limited usefulness. Of greater
utility are the broader themes—Is the client more interested in the
investigative sciences, in the helping professions, in entrepreneurial activities,
in artistic endeavors, in more routine office-related work, or in some combination
of these fields? Interest in a particular career is crucial, of course, but
if interest and abilities are incompatible, the task of clinician and client
together is to chart a new career direction that respects both stated career
interest and client abilities.
Building Recommendations Based on Assessment Findings
Once the clinician has a clear picture of the client’s workplace challenges
and career directions, she should develop a set of recommendations based on
of the assessment. A discussion of recommendations is a point of departure
for future work together. It is at this point that the clinician becomes the
psychotherapist/career counselor, guiding the client in implementing the recommendations.
Environmental Resilience Factors
Let us now return to our discussion of the common factors shared by successful
adults who have ADHD and/or a LD and consider how the assessment process
functions to help the client find or create these external factors that so
strongly relate to career satisfaction and success.
Goodness of Fit: A central purpose of the assessment process
is to enable the client and the clinician working with him to assess the "goodness
of fit" between client and job. Goodness of fit relates to many topics
discussed earlier, including fit • Between strengths and weaknesses and
job requirements, • Between the job’s stress level and the client’s
stress tolerance, • With the client’s interests, • With the
client’s temperament and values, • Between the client’s sensory
sensitivities and the physical environment (i.e., space, temperature, lighting,
noise), • Between the degree of structure provided and the client’s
need for structure, and • Between the client’s capacity for speed
and efficiency and the productivity demands of the job.
Supportive Social Environment: The second external factor
concerns the people whom one surrounds oneself with—the interpersonal
aspects of the environment that are characteristic of successful adults who
have ADHD. These include certain characteristics: Mentoring.
Garber found that most successful adults who had ADHD had experience early
in their career with a mentor. The clinician can provide structure and support
for the client to help guide him to seek such a relationship, either in the
current workplace environment or in a future job. Supportive and Encouraging
People. The importance of support and encouragement to an adult who has
ADHD cannot be overemphasized. Many adults who have ADHD have experienced a
lifetime of criticism, exasperation, and irritation from people who cannot
tolerate their ADHD tendencies. In my experience working with adults struggling
with low self-esteem and performance problems at work, the opportunity to work
for people who appreciate and encourage them had a positive, often life-changing
impact. Support Services—If the Shoe Fits, Wear It. A lifetime
of struggling with tasks for which one is ill suited is like a life of never
wearing shoes that fit. Sure, you can walk, but you will have blisters, your
feet will ache, and you will never be graceful or fast. Working in a job that
calls on your strengths, to continue the metaphor, is comparable to wearing
well-fitting running shoes. With these one can sprint or go the distance without
stumbling or struggling to accomplish what others seem to do with ease. Support
services are a key component to creating a job that "fits" as those
wonderful running shoes do! Successful adults who have ADHD and LD find others—personal
assistants, business partners, office managers, accountants, computer specialists,
professional organizers, or spouses—whose skills lie in their areas of
weakness to perform critical tasks for which the adult who has ADHD is ill
suited. The clinician may need to work with clients on several levels to bring
about needed change. Clients may feel that they must wear shoes that resemble
those of the people
around them, even if they hurt. A basic step in psychotherapy is to help the
client reach a level of self-acceptance—to reach a point at which she
can celebrate her strengths without apologizing for his weaknesses—to
wear shoes in which she can move with comfort. A subsequent task is to problem-solve,
to find ways to surround herself with people whose strengths are complementary,
to allow each individual in the workplace to wear shoes that fit.
Differentiating
Between a "Job" and a "Career"
There are important distinctions between a job and a career, as these terms
are used in this article. The term job is used to refer to specific employment.
A job entails a specific employer, a specific supervisor, a specific workplace,
and a specific set of tasks and responsibilities. One can have many different
jobs within the same career. The term career, by contrast, refers to a general
field of endeavor. One can have a career in sales, in medicine, in teaching,
or in office work. When one changes jobs within a career, one maintains employment
that requires a core set of skills and knowledge. Even if the client enters
therapy with a clear intention to change careers, it is usually valuable
to work with the client to improve her current workplace situation. First,
this gives her practice in dealing with many workplace challenges related
to ADHD that will
likely exist in any job. Second, by improving the current workplace setting,
the client is able to consider career changes with less urgency and stress.
If the clinician and client have agreed that a change is in order, the best
plan of attack is to focus simultaneously on short-term improvements in the
current work situation and on the beginning of the longer process of a job
or career change.
Setting a Plan of Action
Adults who have ADHD are poor at judging how much they can take on at one time.
Impatience, poor time awareness, and unrealistic expectations combine to
create goals that are doomed to failure. Using a brain-based approach that
takes these ADHD tendencies into account, the clinician should carefully
guide and structure the client in setting a goal and then determining the
intermediate steps to reach the goal. For example, the clinician might say
one of the following: "I know that you have many different concerns
about how things are going at work, but in my experience, you’ll get
there faster if you take things one at a time. Let’s focus on getting
to work on time for the next couple of weeks, and then we can move on to
working on getting your office more organized so that you can be more efficient.
My bet is that if you get to work early, you’ll have a few minutes
each morning to plan your day better and even clear your desk off a bit.
Probably, when you come rushing in, already half an hour late, you don’t
have time to plan or organize. You might be surprised how many other things
improve by just getting to work a little early each morning. So, let’s
do some talking about what makes it so hard to get up and get to work." The
clinician then begins to engage the client in a detailed discussion of her
evening routine and morning routine. He may learn that the client is a night
owl who regularly stays up too late and then feels exhausted in the morning,
in which case the clinician will address the need for major changes in the
client’s routine each evening. Or the clinician might learn that the
client has always had trouble with feeling groggy and slow in the morning,
no matter how much sleep he gets, a common problem among slower-paced inattentive
type adults who have ADHD. In this case, she might counsel the client to
adhere to the following procedure: Set an alarm a half-hour earlier than
he needs to get out of bed. When the alarm sounds, the client takes his first
dose of stimulant medication and goes back to sleep. Half an hour later,
when it’s time to get up, the stimulant medication has had time to
take effect and the client feels more alert and energetic: less likely to
go back to sleep, more likely to move efficiently through his morning routine
and get out the door on time. This kind of concrete problem solving goes
hand in hand with attention to psychological matters that may prevent on-time
arrival at work, such as a passive-aggressive reaction to feeling overworked
and underappreciated. Effective ADHD-focused psychotherapy always involves
the intricate interweaving of the practical and the psychological, always
from a brain-based perspective.
- Nadeau, Kathleen G.; Career Choices and Workplace Challenges for Individual
with ADHD; Journal of Clinical Psychology; May 2005; Vol. 61 Issue 5,
p549
Personal
Reflection Exercise #10
The preceding section contained information
about conducting a workplace assessment for a client with adult ADHD. Write
three case study examples regarding how you might use the content of this section
in your practice.
Reviewed 2023
Update
A systematic review of interventions to support adults with
ADHD at work-Implications from the paucity of context-
specific research for theory and practice
- Lauder, K., McDowall, A., & Tenenbaum, H. R. (2022). A systematic review of interventions to support adults with ADHD at work-Implications from the paucity of context-specific research for theory and practice. Frontiers in psychology, 13, 893469. https://doi.org/10.3389/fpsyg.2022.893469
Peer-Reviewed Journal Article Reference: Kofler, M. J., Harmon, S. L., Aduen, P. A., Day, T. N., Austin, K. E., Spiegel, J. A., Irwin, L., & Sarver, D. E. (2018). Neurocognitive and behavioral predictors of social problems in ADHD: A Bayesian framework. Neuropsychology, 32(3), 344–355.
Kofler, M. J., Sarver, D. E., Austin, K. E., Schaefer, H. S., Holland, E., Aduen, P. A., Wells, E. L., Soto, E. F., Irwin, L. N., Schatschneider, C., & Lonigan, C. J. (2018). Can working memory training work for ADHD? Development of central executive training and comparison with behavioral parent training. Journal of Consulting and Clinical Psychology, 86(12), 964–979.
Kofler, M. J., Singh, L. J., Soto, E. F., Chan, E. S. M., Miller, C. E., Harmon, S. L., & Spiegel, J. A. (2020). Working memory and short-term memory deficits in ADHD: A bifactor modeling approach. Neuropsychology, 34(6), 686–698.
QUESTION
24 According to Nadeau, what is one strategy you might use with a client who
is continually late for work? To select and enter your answer go to Test.