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When Diagnosis Does Not Always Mean

Disability: The Challenge of Employees
with Attention Deficit Hyperactivity
Disorder (ADHD)
a
Eric Patton PhD
a
Department of Management, Erivan K. Haub School of Business ,
Saint Joseph's University , Philadelphia, Pennsylvania, USA
Published online: 15 Sep 2009.

To cite this article: Eric Patton PhD (2009) When Diagnosis Does Not Always Mean Disability: The
Challenge of Employees with Attention Deficit Hyperactivity Disorder (ADHD), Journal of Workplace
Behavioral Health, 24:3, 326-343

To link to this article: http://dx.doi.org/10.1080/15555240903176161

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 Journal of Workplace Behavioral Health, 24:326–343, 2009
Copyright # Taylor & Francis Group, LLC
ISSN: 1555-5240 print=1555-5259 online
DOI: 10.1080/15555240903176161

When Diagnosis Does Not Always Mean

Disability: The Challenge of Employees
with Attention Deficit Hyperactivity
Disorder (ADHD)

ERIC PATTON, PhD

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Department of Management, Erivan K. Haub School of Business,

Saint Joseph’s University, Philadelphia, Pennsylvania, USA

Although commonly conceptualized as a childhood disorder,

researchers in the fields of medicine and psychiatry now acknowl-
edge that attention deficit hyperactivity disorder (ADHD) persists
into adulthood. In fact, evidence exists that ADHD is one of
the most prevalent mental disorders among American adults.
Although ADHD can be covered under the Americans with
Disabilities Act (ADA), there are several challenges that sufferers
face when requesting accommodations for their conditions.
Although some of these challenges relate to the vagueness of the
legislation, perhaps of the greatest difficulties facing adults with
ADHD are human resource departments’ policies toward mental
illness and managers=coworkers attitudes about the condition. This
article provides an overview of ADHD in adults and explores human
resource department’s positioning vis-à-vis psychiatric disorders.

KEYWORDS attention deficit hyperactivity disorder, bias, mental

health, stigma

Traditionally, attention deficit hyperactivity disorder (ADHD) has been

viewed as a childhood disorder that recedes with age. The stereotypical
image that might come to mind when thinking about an individual with
ADHD would be of an unruly young boy who has difficulty sitting still
or achieving academic success. Recent medical research, however, has

Address correspondence to Eric Patton, PhD, Department of Management, Erivan K.

Haub School of Business, Saint Joseph’s University, 5600 City Avenue, MV 358, Philadelphia,
PA 19131, USA. E-mail: epatton@sju.edu

326
 Employees with ADHD 327

demonstrated that ADHD persists into adulthood in upwards of 50% of

childhood cases (Barkley, 1990; Matza, Paramore, & Prasad, 2005; Searight,
Burke, & Rottnek, 2000). A recent study by Kessler, Adler, Ames, Barkley,
et al. (2005), using a large broad-based sample, found that 4.2% of adults
are afflicted with ADHD, an estimate that the researchers consider conserva-
tive. This finding suggests that ADHD is one of the most prevalent mental dis-
orders in the United States (Kessler, Adler, Ames, Barkley, et al., 2005).
If ADHD is one of the most common mental disorders for adults in
society, its impact on work becomes of natural interest. The limited research
that exists, which has primarily been conducted in the fields of medicine and
psychiatry, suggests that ADHD in adults leads to work performance
deficiencies, absenteeism, turnover, and interpersonal conflict at work
(Kessler, Adler, Ames, Barkley, et al., 2005; Weiss & Hechtman, 1993). In
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the field of human resource (HR) management, these topics represents

among the most important and studied dependent variables. To date,
however, basically no consideration of ADHD has occurred in HR research.
The purpose of this article is to introduce management researchers to ADHD,
suggest areas for research, and highlight important practical implications that
the condition can have on the workplace. Although ADHD is treatable, it
cannot be cured (Murphy, 2005). As such, it requires a long-term approach
to treatment that can be improved by a supportive environment and
adequate resources. Unfortunately, most adults with ADHD are unaware they
have it, or if they are, have difficulty finding resources to help them deal with
their problem (Nadeau, 2005). Although most family physicians are not
knowledgeable concerning the disorder, child psychiatrists are usually
unwilling to take on adult patients (Weiss & Murray, 2003). Furthermore,
HR professionals do not usually have ADHD on their radars when develop-
ing recruitment, selection, and training techniques. ADHD, however, is
relevant to each of these issues.
In addition to employee performance or well-being concerns, there is
also a legal imperative for organizations and HR professionals to pay atten-
tion to ADHD in working adults. As a recognized psychiatric disorder, ADHD
can be covered under the Americans with Disabilities Act (ADA) of 1990. As
such, organizations can have a legal obligation to provide reasonable accom-
modation for employees suffering from ADHD. However, vagueness
surrounding the definition of disability, particularly as it pertains to mental
illness, makes requests for accommodation a risky proposition for ADHD
sufferers and also for managers (Florey & Harrison, 2000; Sanders, 2005).
Furthermore, as noted by Carroll and Ponteretto (1998) and Murphy
(2005), the onus is on the employees to inform their employer that they have
ADHD and are requesting special accommodation. This aspect is compli-
cated by the aforementioned fact that many sufferers of ADHD are unaware
that they have the disorder, and exacerbated by another issue: the fact that
ADHD may not be recognized as a legitimate ailment for adults.
 328 E. Patton

Researchers (Florey & Harrison, 2000; Freedman & Keller, 1981; Hall &
Hall, 1994; Stone & Colella, 1996) have suggested and demonstrated that
there can exist social and psychological barriers operating in the workplace
that have a negative impact on disabled workers. These social and psycholo-
gical barriers, involving stigmas, attitudes, fear, and judgments on legitimacy
cannot be adequately dealt with through ADA legislation. As noted by
Murphy and Adler (2004), media coverage has led to misconceptions, myths,
and confusion surrounding ADHD. Given the association of ADHD with
children, controversies surrounding the use of medications such methyl-
phenidate (Ritalin), and media presentations that often portray ADHD in
adults as a phony ailment that is simply an outgrowth of our increasingly
hectic lives or as an invention of pharmaceutical companies, adult sufferers
of ADHD face some unique obstacles compared with other employees with
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disabilities. As such, in addition to work outcomes and HR issues, this article

also focuses on the social and psychological barriers confronted by ADHD
sufferers in the workplace.
Although there is a great deal of negativity surrounding ADHD, indivi-
duals suffering from this condition can also be valuable employees with
the ability to multitask in fast-paced environments, and possessing high
levels of creativity. As such, rather than dealing with employees as problems,
they also represent opportunities for companies and should be part of a
broad focus on diversity in the workplace.

ATTENTION DEFICIT AND HYPERACTIVITY

DISORDER: AN OVERVIEW

Symptoms and Assessment

According to the American Psychiatric Association (APA; 1994), ADHD can
be defined as a persistent pattern of inattention and=or hyperactivity that is
more frequent and severe than is typically observed in individuals at a com-
parable level of development. There is a growing consensus that ADHD is a
neurodevelopmental disorder representing a failure in the brain’s circuitry
that underlies inhibition and self-control (Wadsworth & Harper, 2007) and
entails behavioral, cognitive, and affective difficulties that emerge early in life
and persist chronically (Nigg et al., 2002).
The Diagnostic and Statistical Manual of Mental Disorders (4th ed.)
(DSM-IV: APA, 1994) identifies three subtypes of ADHD: (1) predominantly
hyperactive, (2) predominantly inattentive, and (3) mixed symptoms.
Although the DSM-IV ADHD assessment tool is widely recognized as a valid
method of determining the presence of the condition, several authors
(Murphy & Adler, 2004; Weiss & Weiss, 2004) have noted that the wording
of the DSM-IV suggests that the disorder is for children only and that the
DSM-IV does not cover common symptoms that manifest themselves in
 Employees with ADHD 329

adults. Although children with ADHD are often identified as hyper and
somewhat unruly, adults with ADHD often present different but related
symptoms. Inattention for adults with ADHD manifests itself through an
inability to get organized and to focus on something for an extended period
of time, which causes difficulty in time management and procrastination.
Childhood hyperactivity is replaced in adulthood with impulsivity and
overactivity ( Jackson & Farrugia, 1997). Impulsivity is manifested in beha-
viors such as the inability to delay gratification, not thinking through the
consequences of actions, disregarding the feelings, thoughts and actions of
others, and an unwillingness to wait in lines. Overactivity can be seen
through nervousness, anxiety, restless tapping of pens and pencils, feeling
uncomfortable sitting in meetings, and overreacting to frustrations.
Over the last several years, new assessment tools for identifying ADHD
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in adults have been developed. The Wender Utah Rating Scale (Wender,
1985) is a tool developed specifically for adults that, in addition to hyperac-
tivity and poor concentration, requires the presence of two of the following
five symptoms to make a positive diagnosis: (1) brief, intense emotional out-
bursts that can swing dramatically in a short period of time; (2) hot temper;
(3) disorganization or the inability to complete tasks; (4) stress intolerance;
and (5) impulsivity (Searight et al., 2000). For the Wender scale, it is impor-
tant to note that symptoms must have been present since age 7. When using
the DSM-IV to detect ADHD in adults, in addition to the presence of symp-
toms, childhood onset must also be established and impairment must affect
at least two domains in life among school=work life, social life, home=family
life (Adler, 2004). Recently, Kessler, Adler, Ames, Demler, et al. (2005) have
developed the World Health Organization Adult ADHD Self-Report Scale
that features a short 6-item version, which demonstrates strong capacity to
identify adults with ADHD. The full version of the Kessler, Adler, Ames,
Demler, et al. (2005) tool is useful for classifying adults with ADHD into
the subgroups (i.e., mainly inattentive, mainly hyperactive, mixed). Clinical
interviews conducted by psychiatrists are also commonly used to identify
adult ADHD (Jackson & Farrugia, 1997; Murphy & Adler, 2004). In most of
these modes of diagnosis, the establishment of symptoms in childhood is a
key element. For adults, this can represent a difficulty as retrospective mea-
sures can be subject to different biases. To corroborate the childhood onset
and the presence of symptoms in different life domains, input from parents,
siblings, former teachers, and spouses is often necessary for diagnosis (Murphy
& Adler, 2004). Although this may be sometimes difficult, the determination
that the adult with ADHD has had symptoms since childhood and that these
symptoms span different life domains is crucial for assessment, particularly
because many symptoms (procrastination, anxiety, discomfort in meetings,
frustrations) are common for most adults to some degree or in certain situa-
tions, which often fuels the misconceptions surrounding the disorder and the
opinion that either everybody has it or that it is a phony disorder. As noted by
 330 E. Patton

Murphy and Adler (2004), there is no single litmus test, either through a
single scale or neurological testing, that can be used to diagnose adult ADHD.
As such, a multifaceted assessment program is recommended. Still, ongoing
research in the neurosciences may shed clear light on the disorder in the future,
and the creation of the short World Health Organization (Kessler, Adler, Ames,
Demler, et al., 2005) screener is an important development.
Another element that complicates the diagnosis of ADHD in adults is the
high level of comorbidity between ADHD and other problems. Adults with
ADHD often suffer from depression, substance abuse, hyperthyroidism,
learning disabilities, and personality disorders (Biederman et al., 1993).

Prevalence, Outcomes, and Treatment

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According to Wender (1998), ADHD is the most common chronic undiag-

nosed psychiatric disorder in adults. In children, it is estimated that 6% to
10% of kids have ADHD (Wender, 1995). Of these children, upwards of
50% are believed to continue having the disorder into adulthood (Barkley,
1990; Matza et al., 2005; Searight et al., 2000; Wadsworth & Harper, 2007).
As previously underlined, a recent study by Kessler, Adler, Ames, Barkley,
et al. (2005) on mental health disorders among English-speaking households
in the United States, which employed a nationally representative sample of
more than 3,000 adults between the ages of 18 and 44, found that 4.2% of
those surveyed have ADHD. As noted by the authors, such a percentage
would represent one of the highest point prevalence estimates of any mental
disorder for American adults. It is also interesting to note that there was no
difference in prevalence in terms of gender. The lack of differences along
gender lines for adults is of interest as ADHD is more commonly diagnosed
in male children as compared to young girls. Taylor and Keltner (2002)
suggested that this may be due to female children being underdiagnosed
due to different manifestations at an early age. Specifically, though young
boys with ADHD may be hyperactive and unruly, girls with ADHD may be
shy, compliant, and internalize feelings of inadequacy leading to guilt and
shame (Taylor & Keltner, 2002). Such low-key behavior for young girls
may mask the problem. However, as girls grow up and boys calm down,
the data from adults indicates that both genders suffer equally from ADHD.
Outcomes for adults suffering from ADHD can be serious. Given that
fewer than one in four adults who have ADHD are aware that they have it,
perhaps the most insidious consequence of ADHD for adults is a chronic
sense of underachievement, frustration, disappointment, and disillusion-
ment, low self-esteem, and regular failures in social, academic, or occupa-
tional pursuits (Murphy, 2005). In addition to the higher rates of
depression, anxiety, and substance abuse in adults with ADHD, this group
is also more likely to drop out of college, get divorced, and end up in jail
(Jackson & Farrugia, 1997). From an academic standpoint, despite high levels
 Employees with ADHD 331

of intelligence, only 5% of ADHD sufferers who go to college complete a

degree (Arnst, 2003). Although intelligence may be sufficient to get children
and teens through grade school and high school, the increasing demands of
college often lead to failure at this level (Nadeau, 2005). In terms of relation-
ships, the disorganization, the inability to stop themselves from immediate
responding, and the intense emotions of adults with ADHD often lead to
marital problems. Spouses of ADHD sufferers often feel overburdened with
managing the household and report feeling as if they have another child
rather than a partner (Murphy, 2005). Higher rate of criminal behavior by
adults with ADHD has been noted by several researchers (Jackson &
Farrugia, 1997; Matza et al., 2005), and some estimate that from one-third
to one-half of the inmates in U.S. prisons have ADHD (Arnst, 2003).
One of the consequences of the relatively recent recognition of adult
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ADHD as an actual problem is a lack of resources and support for those suf-
fering from this disorder as adults. In their large sample study, Kessler, Adler,
Ames, Barkley, et al. (2005) found that only 16% of adults they identified as
having ADHD were receiving any treatment for the disorder; however, more
than 32% reported seeking help for some form of emotional problems. Given
the links between ADHD and depression, substance abuse, and so on, many
individuals may be receiving help with problems without getting to the root
cause of their issues. As noted by Weiss and Murray (2003), though child psy-
chologists who have expertise in this area are not interested in treating adult
patients, most family doctors are not familiar with the condition in adults. In a
2003 Harris poll, 77% of doctors reported that ADHD in adults is not under-
stood by the medical community (Szegedy-Maszak, 2004). Still, treatment
options for adults suffering from ADHD exist. Although the condition cannot
be cured, its management is possible through various treatment techniques.
On of the most important steps in the treatment of ADHD for adults is
education about the disorder (Jackson & Farrugia, 1997; Murphy, 2005; Weiss
& Murray, 2003; Weiss & Weiss, 2004). After a lifetime of frustrations and
disappointments, of being labeled lazy, stupid, or difficult, and a general
sense that something is wrong, it can come as a tremendous relief to learn
that there is an actual disorder involved that can be managed. Although relief
may occur, there is also the chance that fear and anger could also be experi-
enced as sufferers come to grips with having a psychiatric disorder and
realize the effect it has had on their lives. Still, information on the condition
from a medical professional is an important first step in creating awareness
and fostering hope (Murphy, 2005).
In terms of interventions, researchers and other experts have made sev-
eral suggestions to help adults with ADHD (Murphy, 2005; Nadeau, 2005;
Weiss & Murray, 2003; Weiss & Weiss, 2004). Self-management skills training
are strongly advocated to help adult sufferers become more organized and
systematic in their approach to tasks and issues. The use of calendars,
agendas, and creating an organized, clutter-free environment are regular
 332 E. Patton

features of such strategies. Cognitive-behavioral therapy focusing on

self-awareness, self-monitoring, stress management, and coping skills can
also be useful (Weiss & Murray, 2003). Finally, help with related problems
such as substance abuse interventions and marriage counseling should also
be considered if needed. Although all of these interventions have face
validity, it is important to note that more systematic, empirical study is
required to ascertain their true effectiveness.
Drugs such as Methylphenidate (Ritalin) and Dextroamphetamine
(Dexedrine) have been shown to help children and adults with ADHD
(Searight et al., 2000). These drugs now have a strong track record of being
effective and safe, with few side effects. Antidepressants are sometimes pre-
scribed to help with ADHD, but, though sometimes helpful in alleviating
ADHD symptoms, these drugs do not specifically address ADHD and have
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more side effects than Ritalin or Dexedrine. Although effective, many are
hesitant to take ADHD medications given the negative publicity surrounding
overmedication of children. Furthermore, some fear that the predisposition
of adults with ADHD for substance abuse makes a pharmacological approach
to ADHD treatment risky. Experts, however, suggest that such fears are
unfounded noting that it is the absence of ADHD medication that creates a
risk of substance abuse and that proper medication will negate the desire
for illicit drugs (Lamberg, 2003; Pliszka, 2000; Sanders, 2005).
Overall, as noted by Weiss and Weiss (2004), an important facet of
managing ADHD involves identifying the treatment targets, that is, finding
out where the symptoms are causing problems.

Individual and Organizational Outcomes

According to the Job Accommodation Network (Kitchen, 2006), a service
affiliated with the U.S. Department of Labor, the consequences of ADHD
can play out in different ways in the workplace. A common problem at work
for adults with ADHD concerns time management. Workers with ADHD can
get bogged down in tasks that should be completed quickly and give insuffi-
cient attention to important activities. As such, a problem in setting priorities
is common for adults with ADHD. Memory lapses, a common characteristic
of ADHD sufferers, can also lead to problems at work. Difficulty in sustaining
concentration also affects workers with ADHD, as they can easily be side
tracked by distractions such as office traffic, chatter, and elevator noise.
Related to all of these points is an overall challenge is organization skills
for workers with ADHD. In addition to task-related issues, the poor social
skills that often characterize workers with ADHD can also play out in the
workplace. Employees with ADHD have trouble reading the feelings of
others and displaying appropriate emotions. Finally, hyperactivity for
workers with ADHD can make it excruciating to sit in meetings or work
on monotonous tasks. A case study of a worker with ADHD by Katz
 Employees with ADHD 333

(2003) illustrated many of these problems, as the focal worker struggled with
monotonous tasks, self-organization, concentration, impulsiveness, and
relationships in various jobs when the environment was not supportive.
The inability to prioritize, difficulty getting organized, and socially
inappropriate behavior have consequences for organizations as well
(Kessler, Adler, Ames, Barkley, et al., 2005; Murphy & Barkley, 1996; Weiss
& Hechtman, 1993). Adults with ADHD change jobs more frequently, have
high rates of absenteeism, and are more apt to have accidents at work. All
of these outcomes entail important costs for organizations. Kessler, Adler,
Ames, Barkley, et al. (2005) found that adults with ADHD had an average
of 35 days of work lost through absenteeism and nonproductive attendance.
Extrapolating this estimate to the entire civilian labor force of the United
States, these findings suggest a total of 120,800,000 lost days of work per year
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with a salary equivalent of $19.6 billion. Adding turnover and accidents costs
to this figure underscores the tremendous financial impact that ADHD has on
organizations. Given the links between adult ADHD and crime, it would also
be interesting to study the links between ADHD and deviant workplace
behavior. The impulsivity and difficulty in thinking through the conse-
quences of actions that contributes to the propensity of ADHD sufferers to
abruptly quit their job could also lead to such things as workplace theft. From
an interpersonal standpoint, the hot temper, low agreeableness, and socially
inappropriate behavior that often characterize adults with ADHD can lead to
problems with coworkers and supervisors. The result can be a high level of
workplace conflict. Research has consistently shown that interpersonal rela-
tionship conflict has negative outcomes for individuals and organizations
( Jehn, 1995; Jehn, Northcraft, & Neale, 1999). Even task conflict, which is
sometimes viewed as constructive, has been shown to be generally harmful
as task conflict often escalates into relational conflict (De Dreu & Weingart,
2003). Links between ADHD and workplace conflict are research areas that
would benefit from additional study.
In terms of career prospects, adults with ADHD often have low occupa-
tional status (Weiss & Hechtman, 1993). It is reasonable to assume that
educational problems suffered as children and the aforementioned low
completion rates in college contribute to this state of affairs. Unfortunately,
low-status occupations are exactly the type of jobs in which individuals with
ADHD will have the most difficulty and the poorest performance. The rest-
lessness that many adult ADHD sufferers experience on a chronic basis
can be severely compounded in blue-collar or clerical jobs, which offer very
little discretion and are characterized by monotonous, routine tasks. Kessler,
Adler, Ames, Barkley, et al. (2005) found that blue-collar workers with ADHD
had by far the worst work performance measured through days lost=poor
productivity. Although blue-collar workers with ADHD lost an average of
55.8 days of work productivity a year, the number of days of lost work
productivity for professional workers with ADHD stood at 12.2 days.
 334 E. Patton

In fact, several authors (Lamberg, 2003; Weiss & Weiss, 2004; Wyld,
1996) have suggested that adults with ADHD can be very productive in
fast-paced management positions that involve a busy and hectic environ-
ment. Consistent with this, studies have shown that a significant percentage
of entrepreneurs suffer from ADHD (Arnst, 2003; Carroll & Ponteretto, 1998).
The fast-paced environment that characterizes entrepreneurial work coupled
with the fact that entrepreneurs are not necessarily required to have a strong
record of academic achievement creates a situation in which adults with
ADHD can flourish. Unfortunately, for adults with ADHD who do not
become entrepreneurs, the management=professional career paths that
would match well with their characteristics are often cut off at an early
age, and these individuals end up in jobs that only exacerbate their condi-
tion. Given that ADHD sufferers often have a high level of intelligence, the
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inability to progress in a meaningful career and the fact that they become
stuck in low-status occupations will only add to the chronic sense of disap-
pointment and frustration felt by these individuals. At the same time, the
combination of ADHD and a management career is not a panacea as Weiss
and Weiss (2004) found that adults with ADHD are susceptible to become
workaholics.
Overall, adults with ADHD face a number of problems that can be detri-
mental to their personal well-being, to their social and family circle, and to
their employers. As such, helping adults with ADHD and the role that HR
professionals can play becomes an important concern. However, workers
with ADHD face particular challenges in terms of workplace support for their
condition. In the following section, three main barriers are explained: The
positioning of HR professionals vis-à-vis mental illness in general and ADHD
in particular, the vagueness of the ADA in regards to mental illness and
ADHD, and, perhaps most important, the attitudes of managers, coworkers,
and the general public concerning adult ADHD.

CHALLENGES FACING THE ADULT WITH ADHD

IN THE WORKPLACE

As noted in the previous section, the prevalence of adults with ADHD and
the individual and organizational outcomes linked to the condition are
strong reasons for HR professionals and managers to work toward helping
accommodate these workers. However, for several reasons, workers with
ADHD do not get the help they need. Although some of the employment
problems for ADHD workers stem from a history of academic failures,
even university educated and highly qualified employees with ADHD face
barriers in the workplace. Although most universities in North America
have services to help students deal with learning and psychiatric dis-
abilities including ADHD, these services evaporate once graduates with
 Employees with ADHD 335

ADHD enter the workforce. If universities provide services for students

with ADHD, why does this support stop when the adult enters the work-
force? Three answers come to mind: the perceived role of HR concerning
mental illness, confusion surrounding the ADA, and general attitudes
about adult ADHD.

Human Resource Management and ADHD

Given the fact that ADHD is poorly recognized by much of the medical
community, it should not be surprising that organizations and HR profes-
sionals are also poorly informed on the topic. A survey of 41 employers
indicated very little knowledge of ADHD despite the performance and
insurance costs implications (Matza et al., 2005). However, organizational
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outcomes associated with ADHD such as turnover, absenteeism, and

performance problems are issues that HR professionals work on as
strategic partners within the organization. The fact that ADHD can have
an impact on return on investment (Rudstam & Ruiz-Quintanilla, 2007)
is in itself reason enough for HR professionals to care about ADHD, not
to mention the help that they could offer employees. So why is it an
almost nonissue in HR?
On the one hand, traditional disability issues involving HR have concerned
occupational injuries or physical disabilities rather than mental disabilities
(O’Connor, 2000). Consequently, mental or emotional issues have been viewed
as the territory of Employee Assistance Programs (EAPs), which tend to focus on
rehabilitation rather than prevention or maintenance (O’Connor, 2000). Sanders
(2005) and O’Connor (2000) suggested that HR professionals often have a ‘‘don’t
ask, don’t tell’’ approach to mental illness stemming from an exaggerated con-
cern with privacy and confidentiality. Although such concerns are understand-
able, HR professionals can lose sight that dealing head-on with mental
illnesses such as ADHD can be directly associated with employee behavior man-
agement in terms of discipline, retention strategies, and other issues related to
business necessity (O’Connor, 2000; Sanders, 2005). Instead of waiting for a crisis
situation to occur before acknowledging mental illness in the workplace, at
which point EAP may be the only possible solution, HR professionals could play
a proactive role in dealing with the issue of mental illness in the workplace,
including ADHD. If the field of HR management desires to have an impact on
strategy and organizational performance, then it must proactively tackle difficult
issues concerning employee issues. A more direct approach to ADHD would be
a step in the right direction.
Although greater attention to ADHD would represent a strategically
valuable pursuit for organizations, the traditional compliance focus of HR
is also consistent with greater attention to ADHD given the provision of
the ADA. Unfortunately, the ADA itself is confusing on the topic of ADHD
in the workplace.
 336 E. Patton

ADHD: A Disability Covered under the American Disabilities Act

Given the testing and coverage of ADHD in the APA’s DSM, adults with
ADHD can be eligible for protection of the ADA. The ADA came into law
in 1990. The ADA indicates that organizations with 15 or more full-time
employees must make ‘‘reasonable accommodation’’ for employees with
disabilities asking for help. The goal of the ADA is to reintegrate people with
disabilities to become full participants in society. The ADA replaced 1973’s
Rehabilitation Act that covered federal employees and employees of federal
contractors. Although most people associate such legislation with individuals
with reduced mobility or impairments such as hearing or vision loss, the ADA
covers a very extensive range of conditions. In fact, one of the complicated
features of the ADA is that it does not list the medical conditions covered
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but relies on a set of criteria. In the case of mental conditions, this leads to
confusion; so much so that the U.S. Equal Employment Opportunity
Commission (EEOC) on two occasions (1997 and 2004) has deemed it neces-
sary to release interpretation bulletins to provide guidance about the ADA
concerning mental disabilities (Sanders, 2005). For a condition to be pro-
tected under the ADA, one of the following criteria must be met: (1) the exis-
tence of a physical or mental impairment that substantially limits one or more
life activities including working and learning, (2) a record of impairment,
and=or (3) others regard you as impaired. Given this broad definition, the
ADA covers such conditions as illness and disease, losses (e.g., sight, limbs,
hearing), emotional or mental illness, and recovery patients (e.g., drugs,
alcohol). It can also cover adults with ADHD. The provisions of the ADA
prohibits the denial of employment solely by reason of ADHD and requires
employers to provide reasonable accommodations in the workplace for
individuals with ADHD who are otherwise qualified for employment (Carroll
& Ponteretto, 1998). For workers with ADHD, examples of reasonable
accommodations include the use of personal digital assistants, checklists,
color coordination to help with time management and organizational pro-
blems, quiet work areas and clutter-free environments to help with concen-
tration problems, and interpersonal training and assignments with little
contact with others to help with social skills problems (Kitchen, 2006).
Although these guidelines seem clear, there are several challenges that
exist. First, as previously noted, the onus is on the employees with ADHD to
disclose their condition to the employer. Given that most adults who have
ADHD are unaware that they even have the condition, protection under
the ADA is quite meaningless. It is also important to note that protection
under the ADA is not available if the employee does not disclose a condition
prior to a disadvantage brought on by the disability. More serious is the
difficult determination if an employee’s ADHD is eligible for protection
under the ADA. According to the Job Accommodation Network (Kitchen,
2006), the EEOC has determined that the difficulty in performing cognitive
 Employees with ADHD 337

functions represents a disability as per the first criteria of the ADA. At the
same time, individuals who suffer from ADHD may not require any accom-
modation depending on the job. As such, accommodations for ADHD under
the ADA require a case-by-case analysis. Given that ADHD symptoms can
vary from person to person and is not a ‘‘one-type-fits-all’’ disability (Katz,
2003), determining eligibility under ADA and proper accommodations repre-
sent a challenge. In fact, sometimes ADHD will only be covered in conjunc-
tion with another condition such as depression or bipolar disease (Equal
Employment Opportunity Commission [EEOC], 2004). The fact that, unlike
workers with physical or disease-related disabilities, outcomes for employees
with ADHD can include poor performance in certain tasks, absenteeism,
tardiness, and interpersonal conflict also complicates the reasonable accom-
modation request process. According to the EEOC (2004), companies are not
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required to grant accommodations requests if these will cause undue hard-

ship to the organization or if they would entail the removal of an essential
job function. Furthermore, as long as discipline is not discriminatory, compa-
nies are not required to excuse violations of codes of conduct that are job
related and part of normal business necessity, even if these are caused by
a disability (EEOC, 2004). A legal note relating to ADHD (Malko, 1998),
warns managers of the dangers of ADA-related complaints by workers with
ADHD and suggests that companies inoculate themselves by either refuting
the claim that ADHD limits a major life activity related to work or by demon-
strating that a worker’s ADHD (due to absenteeism, the inability to complete
tasks, or the inability to get along with others) no longer makes him or her
qualified for the position.
All of these points are further support for the notion that HR profes-
sionals should be aware of adult ADHD and be prepared to address issues
surrounding employees who have the condition. On the one hand, if an
employee discloses that he or she has ADHD, HR professional must acknowl-
edge the condition (Hastings, 2006a) and determine how it may affect perfor-
mance and behaviors within the job. To the extent that it is job related and
could have an impact on organizational outcomes, ignoring the problem
does not help the employee or the organization. Furthermore, an awareness
of ADHD can also enhance a systemic approach to HR management. Speci-
fically, an awareness of ADHD can influence job analysis, recruitment, and
selection procedures by determining what bona fide qualifications would
eliminate candidates with ADHD, what types of accommodations would be
required, or in which jobs individuals with ADHD might excel. Performance
management procedures and training would also require special considera-
tion in light of having employees with ADHD. Overall, instead of dealing
with ADHD problems only when they become disciplinary problems, perfor-
mance problems, or turnover problems, HR professionals would do well to
acknowledge this condition as part of a general disability management
strategy.
 338 E. Patton

Related to training, HR-related training concerning ADHD should not be

limited to special training needs of ADHD sufferers but should also be geared
toward educating managers about the condition. As discussed in the follow-
ing section, the greatest hurdle facing employees with ADHD are likely to be
attitudes of supervisors and coworkers.

Stigmas and Social Psychological Barriers for Employees with ADHD

Employees with a disability of a mental or psychological nature face unique
challenges in the workplace. Several authors (Boyle, 1997; Hall & Hall, 1994;
Stone & Colella, 1996) have underlined that though the ADA ensures struc-
tural compliance and increases the access of disabled individuals to employ-
ment, there still exist major barriers for disabled workers in the form of social
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perceptions, stereotypes, and attitudinal biases. Hall and Hall (1994) noted
that mental impairments create special barriers since, due to their invisibility,
others often don’t believe they exist or, alternatively, will have irrational fears
regarding such conditions. According to the Society for Human Resource
Management (SHRM) (Hastings, 2006b), the World Health Organization
and the World Psychiatric Association consider stigmas to be the number
one problem in the field of mental health. In another SHRM report (Hastings,
2006c), it was noted that although a survey by the APA found that 26.2% of
adults report having a psychological=psychiatric condition, 44% of the U.S.
public reports having little or no knowledge of such illnesses. Furthermore,
33% of respondents believed that emotional weakness is a major cause of
mental illness.
Murphy (2005), Katz (2003), and Wadsworth and Harper (2007)
emphasized this point specifically for ADHD by noting that, given its invi-
sibility, others perceive the adult with ADHD as capable, intelligent, and
normal, and as such often attribute the negative or inconsistent behavioral
patterns to poor character, low motivation, or willful misconduct as
opposed to the behavior’s neurological basis. In fact, Wadsworth and
Harper (2007) noted that the first definition provided of ADHD by Still in
1902, clearly presented the condition as a personal failing. Specifically, Still
(1902) suggested that a lack of moral control and an individual failure to
conform to social expectations caused ADHD symptoms. In addition to
the invisibility of the disorder, the characteristics of the symptoms can
amplify the negative reactions of others and create further barriers for
adults with ADHD. Research by Stone and Colella (1996) and Florey and
Harrison (2000) underscored this point. Stone and Colella (1996) developed
a theoretical model exploring the factors affecting the treatment of disabled
workers in organizations and how the negative perceptions of others play
an important role. They suggest that disabled workers who have displayed
strong work performance in the past and who have a pleasant interperso-
nal style will face fewer barriers in the workplace. For adults with ADHD,
 Employees with ADHD 339

both of these factors would work against them. The impulsivity and poor
social judgments that hamper adults with ADHD and is manifested through
low agreeableness and a high degree of conflict with supervisors and
coworkers will increase the negative affective response of others to their
impairment. In terms of work performance, Florey and Harrison (2000)
demonstrated that managers were more likely to approve accommodation
requests from disabled workers with good past performance as opposed
to poor. Given the history of poor work performance that characterize most
adults with ADHD, this represents a further barrier for acceptance. Finally,
several authors (Florey & Harrison, 2000; Freedman & Keller, 1981; Sanders,
2005; Stone & Colella, 1996) have underlined that managers often have
equity concerns when dealing with requests for accommodation. Freedman
and Keller (1981) noted that the broad definition of what constitutes a dis-
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ability under federal legislation leads to confusion and raises legitimacy

questions. This, in combination with the fact that provisions for reasonable
accommodation are not well defined, creates the risk of a backlash from
nondisabled workers and the perception that accommodations are unfair
special privileges. Indeed, Florey and Harrison (2000) found that fairness
concerns were paramount in the minds of managers when considering
accommodation requests from disabled workers. In the case of adults with
ADHD, given that they would often be poor performers with difficult inter-
personal relationships and an invisible, mental condition, inequity percep-
tions concerning special accommodations seem even more likely in such
cases. Overall, none of these factors such as equity concerns, the invisible
nature of mental disorders, past performance, or interpersonal relations is
technically supposed to be relevant as far as the ADA is concerned. Unfor-
tunately for the individual with ADHD, these factors are often crucial in the
decision to disclose the condition to an employer and the type of response
that he or she will experience when requesting special accommodation.
Furthermore, even if accommodations for employees with ADHD are
provided under the ADA with the understanding of managers, coworkers
are still likely to be upset and perceive preferential treatment because
managers are prohibited by the EEOC (2004) to inform employees about
the mental disabilities of their coworkers.

CONCLUSION: THE ROAD AHEAD—A RESEARCH AGENDA

FOR ADHD IN THE WORKPLACE

Research on ADHD and research on disabilities in the workplace under-

scores the notion that issues surrounding illness within organizations is not
limited to compliance issues surrounding the ADA but involves attitudes,
stereotypes, biases, and stigmas. Any research agenda on ADHD in the work-
place must include such elements.
 340 E. Patton

A first stream of research should assess management views about

ADHD. Through a content analysis of stories in the popular press, the busi-
ness press, and HR trade journals, the social construction of ADHD in the
workplace could be understood. Of particular interest would be a compara-
tive content analysis of ADHD and one or several other disabilities. A second
research project should be aimed at testing the stigmas surrounding the
condition. Specifically, a vignette study manipulating disability (ADHD vs.
others), type of negative outcome, and type of job could be conducted
through a sample of managers at different levels and HR=EAP professionals.
Finally, case studies of workers with ADHD or surveys using yoked samples
(ADHD workers with non-ADHD coworkers) could illuminate attitudes and
work behaviors related to the illness.
In terms of HR issues, many dependent variables related to ADHD such
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as absenteeism, turnover, performance, and conflict are important HR

concerns. As such, HR research on these variables should include ADHD
as a possible independent variable. Research should also begin on job ana-
lysis and design aimed at identifying jobs particularly suited to workers with
ADHD and determining appropriate accommodations. As noted by Stone
and Colella (1996), HR policies involving job design, staffing, evaluation pro-
cedures, and rewards are usually built around a prototypical ‘‘ideal’’ worker,
which is rarely appropriate for adults with ADHD or any other disabled
worker. As such, HR policies need to be reviewed to ensure that disabled
workers are not being discriminated against. HR research represents an
important step in this direction. Not only would neglect in this area be poten-
tially discriminatory, it would also be short-sighted in terms of HR strategy
because such employees can represent a strong asset for organizations if they
are placed in the right situation.
Research on training and ADHD is also needed. First, research is required
on HR training initiatives aimed at enhancing self-management and personal
organizing skills for workers with ADHD. Second, research on the affect of
ADHD training for managers could also be useful. Training managers on
signs, consequences, and accommodation options for employees with ADHD
could serve to alleviate certain stigmas surrounding the condition and facili-
tate discussion around this somewhat controversial topic. Stone and Colella
(1996) emphasized this sort of proactive response from organizations in order
to nullify biases and fears surrounding disabilities. Overall, education is
viewed as an important part of ADHD treatment regardless of the context.
Finally, consistent with elements of Stone and Colella’s (1996) full model,
research on mentoring would also be valuable in terms of employees
suffering from ADHD.
In conclusion, adult ADHD is a real and serious problem for many
employees and can have negative consequences for organizations if it is
not acknowledged and managed. At the same time, despite the model devel-
oped in the paper focusing on negative outcomes related to ADHD, workers
 Employees with ADHD 341

with this condition are often talented, creative, and can flourish in the right
situation. The lack of knowledge and the misconceptions surrounding men-
tal illness in our society is troubling, and HR researchers and professionals
need to be part of the conversation. The research recommended in this
article is not only important from an employee and organizational well-being
perspective, but is also necessary given the greater acknowledgement of
adult ADHD and its protection under the ADA. Adults with ADHD are
present in organizations. They can be valuable and productive members
who can flourish through their special talents or through reasonable accom-
modation in understanding workplaces. For the benefit of those who suffer
from the disorder and of the organizations who employ them, more research
is needed in this area.
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