Attention Deficit Hyperactivity Disorder (ADHD) is a mental disorder consisting of inattentive type, hyperactive type, and combination type. According to the American Medical Association, ADHD is “one of the best-researched disorders in medicine, and the overall data on its validity are far more compelling than for most mental disorders and even for many medical conditions.” In the article, “A Brief History of ADHD,” Stephen Faraone PH.D. paints a simplified timeline of the diagnostic term used today. The symptoms of ADHD were observed and recorded as early as 1798. It wasn’t until 1980 however that the term Attention Deficit Disorder (ADD) was coined and more recently replaced with Attention Deficit Hyperactive Disorder (ADHD) in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM5).

What is ADHD really? In Jessica McCabe’s youtube video, “How to (Explain) ADHD,” McCabe explains it this way. “...fun fact: despite the name, we don't actually have a deficit of attention. When we forget to change the laundry or have trouble focusing in class, it's because our brains have trouble regulating or effectively shifting our attention. So sometimes our brains jump from one thing to the next and other times our brains actually zero in or hyperfocus on one thing and it can be hard for us to pull ourselves away.” What does this look like for your business? When people with ADHD are in the workplace, symptoms aren’t left at home. Treatments such as medication and Cognitive Behavioral Therapy (CBT) can be life-changing, however, treatment is no cure. It’s symptom management. The good news? Helping ADHD employees thrive can mean simple changes that in turn make a big difference. In order to better support those with ADHD, we need a proper understanding of their challenges.

Everyone is forgetful, has trouble focusing, and loses track of time every now and then. So how is ADHD different? The main differences are the consistency of symptoms, settings in which symptoms occur, and their impact on “academic, social, and/or occupational functioning.” According to the diagnostic criteria outlined in the DSM5, other symptoms include forgetfulness, inability to prioritize and process stimuli, regularly misplacing needed items, lacking the ability to engage in leisure, and impulsivity beyond the degree that would be found in individuals without ADHD. What do these symptoms generally look like at work? While no two people have the exact same symptoms of the same severity, it’s in everyone’s best interest to evaluate where ADHD is causing pain points and discern the best ways to accommodate needs.

Per the DSM5, the diagnostic criteria for the inattentive type are:

This can look like “zoning out,” misplacing documents (or that darn stapler that was just in their hand), regularly becoming side-tracked by surroundings, asking you to repeat things more than once, being late to meetings, or getting sucked into an unimportant task. When talking to an employee who shows symptoms of the inattentive type, ask them to evaluate their primary pain points. You can even use the list as a basis. Remember, small adjustments that can have a big impact. For example, if your ADHD employee notices they get side-tracked going back to their desks to staple documents they just printed, invest in a few extra staplers to keep at the printer. If they are forgetting personal protective equipment (PPE), having extra equipment somewhere visible and easily accessible could help. What if the problem is remembering tasks? Make sure the employee has a constant supply of post-its, a large whiteboard, or task management software such as ClickUp. The trouble with time management can be greatly reduced by having a time tracking aid such as Time Timer which offers a visual representation of time. Do they forget their medication? Look into a keychain pill holder. Whatever their struggles, communicate with your employee to see where their symptoms persist and brainstorm solutions together.

Per the DSM5, the diagnostic criteria for the hyperactive/impulsive type are: Hyperactive Symptoms:

Impulsive Symptoms:

At work, this can look like foot tapping, being out of their seat often, trouble taking breaks, taking too many or too long/short breaks, rearranging their office on a whim, calling in last minute, being the first to jump on projects and promise far more than what is possible, scrapping old systems to start from scratch, taking multiple bathroom breaks during meetings, being a “workaholic”, interrupting often (while usually displaying over-excitement about their ideas), and talking a lot/very quickly. What help can we offer the hyperactive/impulsive ADHD employee? Again, communicate with them. Show them understanding and support. Brainstorm where their symptoms manifest and the tools available for them. Fidget tools do more than look cool and keep your hands busy. In a CHADD article, child psychiatrist Matthew Lorber states, “If you are trying to focus on a task, but your hands are busy doing something else, it actually forces your brain to increase your efforts to focus on the task at hand. There have been some small-scale studies that show people with ADHD do better on tasks if given some sort of outlet to get out their energy, to distract their hands. There have been studies that have shown in general that someone with ADHD with something to fidget with—such as tapping a pen—perform better on tasks.” Other ways to help could be offering 5-minute breaks every hour to help them release some energy and switch gears. You could also require that employees take notes during meetings as this decreases the impulse to blurt out ideas and puts a buffer between conceiving and stating an idea. That buffer helps them decide if they should speak at the moment, speak after the meeting or not say anything at all.

Most adults with ADHD are not one type of another. One type may be more dominant but they experience symptoms of both. This is known as combined type ADHD. With all the symptoms mentioned so far, some can manifest in unprecedented ways. For example, hyperactivity can mean mental restlessness, sleep issues, anxiety, and more. Here’s a brief look into lesser-known ways ADHD symptoms manifest with some further information if you’d like to read more.

According to Science Direct, comorbidity is defined as the co-occurrence of more than one disorder in the same individual. For those with ADHD, comorbid disorders affect a staggering majority. The National Library of Medicine records, “As many as 80% of adults with ADHD have at least one coexisting psychiatric disorder, including mood and anxiety disorders, substance use disorders (SUD), and personality disorders. This can complicate the recognition and diagnosis of ADHD in adults, and despite the ongoing clinical controversy, the bulk of evidence suggests that ADHD remains under-recognized and under-treated in the adult population.” Naturally, you want to tread lightly when it comes to questioning your employee about their health. However, when discussing the need for accommodation, it’s appropriate to ask about any comorbid disorders in order to accommodate their needs fully. As for any type of ailment, always encourage treatment. Medication and CBT are the first intervention for those struggling with ADHD. If your company offers benefits to cover chemical and therapeutic interventions, let your employees know! They might not be aware of how many affordable treatments are available if they haven’t been pointed out.

One SHRM article takes a hard look at the common mindset surrounding ADHD in the workplace. Colleen McManus, an HR executive, and consultant who has worked extensively with ADHD issues over the course of her career say, One of the things I have frequently encountered is that many people feel they know about it, perhaps based on their own personal or family experiences, but they lack a true awareness of the range of ADHD symptoms and current treatments and possible accommodations. An example of old-school thinking occurred with a manager who came to me following an employee's disclosure that she had ADHD. This manager said, 'I suppose I'll have to provide her with a private office and treat her with kid gloves now.'” From this example, it’s easy to see why these myths can spark shame, discourage ADHD employees from talking to HR and keep individuals from seeking treatment. Colleen continues, I explained that before we assumed anything, we needed to engage in the interactive process with that employee to identify how, if at all, her ability to perform the essential functions of her job was impacted by her ADHD. I said we would base our actions and decisions on the medical guidance of the employee's health care provider, just as we would if the employee required surgery or physical therapy. This simple comparison seemed to take some of the mystery out of the issue for this manager and give him a road map for how we would move forward to address it.

Michael O'Brien, an employment law attorney in Salt Lake City, said failing to consider accommodations for employees with ADHD is a big mistake and creates serious liability risks. He continued, ADHD can be a disability covered by the Americans with Disabilities Act or similar state law, and it also might be a serious health condition triggering Family and Medical Leave Act rights. Often, it is better for an employer to engage the employee and offer reasonable help than to risk a violation of the law.

If an individual’s ADHD symptoms significantly limit a major life activity, legally your ADHD employee is considered disabled and under ADA, discrimination against these workers is strictly forbidden. This means you might be required to make accommodations for these employees.

Section 504 f of the Rehabilitation Act prohibits discrimination against individuals with disabilities and requires positive actions to assist them in all programs, services, and activities.

In addition to federal laws, look into relevant state or local nondiscrimination laws so all of your bases are covered and you understand your legal responsibilities.

The Ontario Human Rights Code is a broad law providing equal rights and opportunities to people living within this province of Canada. Likewise, in the UK, The Equality Act 2010 gives people with disabilities the right to be protected from discrimination in employment. If you are outside of these countries, look into your local laws regarding employer responsibilities towards those with ADHD.

There is no one-size-fits-all method for supporting your ADHD workers. However, if you’re looking to get the best from these employees and create an environment where all feel valued and heard, this is a great place to start.

This is as simple as asking an individual what would be most helpful for them and following through with intentional action. Nothing can make a person feel smaller than when they’re asked what they need and nothing happens. When brainstorming accommodations with your employee, come up with reasonable action steps you can both walk away with. These could be suggestions about management styles, adding white noise machines, or even purchasing additional PPE. Stress to them your understanding that self-evaluation is a journey with no set destination and that you are always open when they discover a symptom they hadn’t noticed before or something they believe might be helpful.

Those with ADHD tend to be more influenced by the environment in which they work, so the setting itself can be a powerful tool for their success or failure. Again, communication is key. Some people work better in an open-style space while others prefer to be tucked away from distractions. Offer them the choice because they know themselves best. If possible, present them the option to work remotely. If not, have an open discussion about tools to suit their unique concentration style.

If at all possible, give your employees the freedom to choose their best time to work with the least difficulty concentrating. If it isn’t possible to veer from the typical 8-hour workday, give them whatever options are available such as morning shift or afternoon shift.

Missing details can be one of the more frustrating symptoms individuals with ADHD have to manage, so help them remember important details by keeping a written record. The win-win side is that everyone (ADHD or not) can benefit from having extensive notes. Select someone to take notes to share with the staff for meetings. When receiving an assignment, provide a bulleted list of what actions are expected. Ensure there is a constant supply of post-it notes and note pads available.

If you notice a struggle in getting things completed by the due date, offer a soft due date before the hard deadline. Setting deadlines for the small parts of the whole project can also be quite effective. This creates a sense of urgency which is a natural dopamine booster.

There are countless resources and tools available to help support your ADHD employees. Investing in something as simple as an exercise ball rather than an office chair can help your employee struggling with restlessness while taking out the fluorescent bulbs over one’s desk and offering a lamp instead can do wonders for the sensory overwhelm plaguing another. Encourage your employees to progress in their journey of symptom management. For more ideas on effective tools, click here.

As mentioned earlier in the article, when you learn your employee has ADHD, it’s important to discuss their accommodations with them. Under the Americans with Disabilities Act, employers are required to provide reasonable accommodations for employees with disabilities. Often, people with ADHD have been managing the disorder their entire lives and know what they need to do their best in the workplace. These accommodations are usually easy and inexpensive to incorporate, like allowing them to have fidget toys in the office or placing extra supplies where they are used. When possible, it’s best to provide these accommodations exactly as your employee describes them. However, at times an employee’s accommodations may be incompatible with the industry. Here are some tips for when you find yourself in a situation where you’re uncertain how to accommodate an employee with ADHD.

Let’s take a look at a few examples. Some people with ADHD use fidget rings or chewy jewelry to help manage their symptoms, but in a food service environment, these can be a serious safety hazard. In this case, it’s best to explain this to your employee and work with them to find alternative accommodations. Instead of jewelry, you could allow them to bring in a fidget cube or other stim toy that follows food safety guidelines. If someone needs music to work, but you can’t allow them to wear headphones or earbuds, consider letting them bring in a small speaker or playing background music over a system that’s already in the workplace.

ADHD manifests in many different ways, and everyone has different accommodations that help them manage their symptoms. If you have multiple employees with ADHD, one person’s way of managing their symptoms might disrupt another’s work. Tapping a pen might help one employee focus, but it might disrupt another’s work. Neither employee is in the wrong, and you should work with both of them to find a solution that works. You might have one of them switch desks with another employee so they’re in a position where the first employee can continue to tap their pen while the other can work without being distracted.

Remember, what’s most important is that all your employees can work safely, comfortably, and efficiently. As long as it still works for your employee, changing an accommodation to better suit the workplace is better than refusing to offer one at all. If an alternative to an accommodation isn’t working for an employee, it’s best to discuss it and restructure their work so they don’t have to struggle with a less-than-optimal work environment. The most important part of this process is communication, and it’s up to you to create an environment where this is encouraged and effective.