The Republic of T.

Black. Gay. Father. Vegetarian. Buddhist. Liberal.

Time Out of Mind, Pt. 1

This got a laugh out of me when I spotted the title, and then a nod of recognition once I started reading the article. Apparently, ADHD can make you miss 20 days of work per year. Well, kinda.

When “Fidgety Philip” grows up, the problems of attention deficit disorder can multiply into loss of nearly a month’s work per year.

Long seen as a problem for children, attention deficit hyperactivity disorder was first described in 1845 by Dr. Heinrich Hoffman, who wrote “The Story of Fidgety Philip.”

More recently, it has been recognized as continuing into adulthood for some people, and new research seeks to estimate the effect of ADHD on workers.

This lack of ability to concentrate costs the average adult sufferer 22.1 days of “role performance,” per year, including 8.7 extra days absent, according to researchers led by Dr. Ron de Graaf of the Netherlands Institute of Mental Health and Addiction.

It’s almost funny that, for folks with ADHD, those “missed days” occurred when they were actually at work. Almost.

I say almost because, well, I resemble that remark.

Here’s model of how executive functioning is impaired in people with ADD/ADHD.

Now, let me just go down the list.

In my case, before getting treatment, that belief stemmed from experiencing the real-world results of the “impairments” of executive function mentioned in the chart above

  • Activation? Yeah. I was often terrified of beginning a new project or assignment. Why?
  • Focus. There was a time when I could sit through an entire meeting and walk out not having heard a thing, including the assignment I was just given. My choices at that point were to either (a) wait until someone asked me about the task and see if I could get more details on it or (b) ask for the details of the task I was just given in the meeting I just attended. Neither were good choices, because I could either (a) already be behind when I was told again what the assignment was, or (b) risk irritating or even angering a boss or co-worker by asking them to repeat what was just said five minutes ago, and have them wondering what was wrong with me. (Something I wondered myself.)
  • Emotion. Well, can you imagine?
  • Effort. Assuming I managed to get some to tell me again what I was supposed to do, I’d probably mess up the details no matter how hard I tried not to. And trying to get it right would mean extra effort, which usually meant it took me longer to get it done than anyone thought it should.
  • Memory. Even if I managed to get the details of the assignment, chances were I’d forget some crucial step or information, and not discover it until far, far too late.
  • Action. Again, if I don’t do anything, then I can’t do anything wrong.

Of course, it doesn’t make sense, does it? After all, if something has to get done, and I have to do it, it doesn’t matter that I won’t get it wrong if I don’t do it. Because there’s also a penalty for not getting it done. So, in the context of the above, you’re damned if you do and damned if you don’t, as someone with ADD (treated or not, actually, because some symptoms persist regardless). If you do it, you have more of a likelihood than most people to muck it up, and you’ll pay for it when you do. If you don’t do it, you’ll pay the price for not getting it done.

So, you see, having ADD can mean “missed days” at work, even when you are at work. Especially if you’re trying to compensate. I spent more time than I care to remember chasing down the details I missed about tasks I’d been given. Not to mention the extra time spend cleaning up mistakes — sometimes big, sometimes huge, sometimes … well — before anyone else found out about them, or at least soon enough so that when someone did find out about it I’d have it nearly fixed. (Or at least it would look fixed.)

Sound exhausting? It is. And remember, you’re doing all that just to keep your head above water and stay a step or two ahead of disaster. It’s also stressful. Very. Stressful. And that can have physical consequences. I remember getting so stressed out at one job that my neck and shoulders started to tense up. It got to the point where I couldn’t turn my head because my neck and shoulder muscles were so tight. That was pre-diagnosis. So, I ended up making several trips to the doctor, getting an MRI done, and eventually being prescribed therapeutic massage. Of course, that took care of the symptom, but problem. Sometimes I stayed home and took a mental health day

Oh, and just to add a little more stress to the mix, if you’re undiagnosed, you’re doing the above while you and everyone you work with wonder what’s wrong with you. The difference is, they’re asking in exasperation. You’re asking that question in desperation. If you are diagnosed, even with treatment you’ll still have symptoms, but you can’t tell anyone you work with what’s really happening. That’s a reality the article seemed to miss.

It might be cost-effective for employers to screen workers for ADHD and provide treatment, the researchers suggest.

“There were many more people than most of us who have done these studies had expected,” that were affected by adult ADHD, said Dr. Ronald C. Kessler of Harvard University, a co-author of the report. “People don’t come for treatment for this … it’s kind of one of those hidden things,” he said in a telephone interview.

“It’s an enormous impairment,” Kessler said, citing absences, accidents and low performance on the job.

Kessler said he had worked with workers suffering depression and found that treatment costing $1,000 could help prevent $4,000 in lost productivity.

Employers screen workers for ADHD and provide treatment? Maybe in the Netherlands, but this is the U.S. of A. where people “don’t believe in ADHD” (see the history lesson I put together after reading a post by just such a person). We think of it as a character deficiency.

After all, it was initially called a “moral deficiency disorder.” Remember “The Story of Fidgety Philip” that was mentioned earlier? Well, like kids with ADHD are often labeled, he was just a “bad kid.”

See the naughty, restless child,
Growing still more rude and wild,
Till his chair falls over quite.
Philip screams with all his might,
Catches at the cloth, but then
That makes matters worse again.
Down upon the ground they fall,
Glasses, bread, knives forks and all.
How Mamma did fret and frown,
When she saw them tumbling down!
And Papa made such a face!
Philip is in sad disgrace.

I can only imagine what fidgety Philip would face as an adult. Actually, I don’t have to. The “naughty, restless” child turns in to the “lazy,” “crazy,” and/or “stupid” adult who can’t live up to expectations, and nobody — including him or her — sems to know why. Most of the time employers don’t want to know why. A good many of them don’t care that you have a problem, let alone what your problem is. They just want it not to be their problem.

(Back when I was being treated for depression, which was likely related to having untreated ADD, I was having a bit of trouble finding the right medication. I tried one that left me feeling lethargic and zombie-like during the day. When my boss complained about its impact on my work, I confided to her that I was being treated for depression and the anti-depressant was making my foggy. She simply said “Stop taking it.” I explained that I was working with my doctor to get the right mediation, and simply — with a bit more irritation in her voice — “Well, stop taking it.” She wasn’t concerned about my well being. I could fall apart after business hours as long as I did what she needed me to do. I supposed if I’d committed suicide she’d have complained about my lack of notice and the inconvenience of having to hire someone to replace me. I doubt she’d have come to my memorial.)

Just like you were told in school that you just needed to “try harder,” “apply yourself” more, “pay attention,” and “stop making careless mistakes.” The assumption at work will be “If you wanted to do it, you could. So, you must not want to be here.” That’s almost exactly what a my employee advocate said to me when I was going through the process of being shown the door at my first job in D.C., after the cumulative effect of having an employee with undiagnosed and untreated ADD was too much. I had a problem, which meant they had a problem. I got fired. They, then, didn’t have a problem anymore. I, of course, still had an as-yet-unnamed-and-unsolved problem. But it was now my problem. Not theirs, anymore.

All the advice I’ve received as an adult with ADD has been to proceed with caution when considering coming out to an employer about ADD/ADHD. ADD is recognized as a disability under the Americans with Disabilities Act, and you have a right to reasonable accommodations. But the reality is this: If you’ve worked anywhere for any length of time untreated ADD, that means your employer and co-workers have probably been dealing with the results all that time. They’re probably tired of it. They may agree to some accommodations. But chances are your days are numbered. Maybe they were anyway. Maybe you were already on probation, or have had several warnings about the need to improve. Whatever. You’ve probably racked up a long list of errors, foul-ups, etc., and they’ve been keeping tabs. They may simply decide to justify firing after you make your next mistake. And you will.

That leads me to one final point.

Most people think of ADHD as a children’s problem, but when it continues into adulthood people have a problem coping with the workplace and need assistance, said Anderson, who was not part of the research team.

The new study may underestimate the adult rate of ADHD, she said, noting that many victims may not have jobs. Those who do often struggle to keep up, but there are treatments available, she said.

Yup. Maybe that’s why ADD also costs adults in the U.S. $77 billion a year in lost income.

Adult attention-deficit/hyperactivity disorder costs sufferers an average of $10,000 a year in lost income — a national total of $77 billion annually, according to the results of a phone survey released May 23 at the American Psychiatric Assn.’s annual conference in Atlanta.

…While the average American holds three jobs during a 10-year period, someone with ADHD goes through six, Biederman says. “You may end up having entry-level jobs five times,” he says. “Somebody who has ADHD and is a lawyer may never succeed in becoming a partner.”

While the average loss in income for ADHD adults adds up to $10,000, the price for professionals with postgraduate degrees rises to $40,000 a year, according to the study, which was based on information gathered in 2003 interviews with 1,000 adults. “ADHD…may be one of the costliest medical conditions in the U.S.,” Biederman says.

Yup. And employers aren’t the only ones paying for it. Maybe my experiences with employers and mental health issues has left me bitter. Still, I won’t hold my breath for employers to pony up for ADD/ADHD treatment or any other mental health treatments.

How much of that stuff do their health insurance plans cover anyway.

[Photo by tph365 @ Flickr.]

One Comment

  1. I do not have ADD or ADHD. However, I *am* bipolar. When I finally found a psychiatrist who diagnosed me, I was so manic (partly from the antidepressants that the last shrink had me on because we both thought I was *just* depressed) that he couldn’t believe I was holding down a job. So I can sympathize, at least to a limited extent.