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Tag: neurodiversity

The managers guide to understanding ADHD

(and why it’s often misunderstood for CIS women in particular)

Let’s talk about ADHD

We’ve all seen characters with ADHD on TV and in books etc, try and think of a few examples and I bet they all fit in one stereotypical box; “the naughty young white boy acting out in class”. But not only is this stereotype wrong, it’s actually really harmful!

Calvin and Hobbs
Calvin and Hobbs (Calvin is a ‘typical’ boy with ADHD

Historically ADHD was seen as only (or as least predominantly) affecting boys (often white boys, but that’s a whole other subject I’m not qualified to talk about), but evidence shows that many girls do have ADHD, however it is often the inattentive presentation of ADHD which tends to be under-recognised or under-diagnosed, because it doesn’t fit the stereotypical (hyperactive) trope and kids with it aren’t causing problems in the classroom etc; instead they’re just being labelled as ‘day dreamers’ and are left to slowly fall behind or put under pressure to sort themselves out with no support.

Ironically, whilst the Hyperactive/impulsive symptoms are more well-known, due to being more visible, they are in-fact less common than inattentive ones, both for women and adults in general. These symptoms often become more “internal” when they persist; as adults learn to manage their hyperactivity; which historically led medical practitioners to believe that ADHD symptoms decreased after childhood, which is now known to be incorrect. Currently 2.8% of adults in the UK have ADHD, but many are undiagnosed and the number of adult diagnosis’s is increasing every year; it is believed that as many as 1 in 20 adults in the UK are likely to have ADHD.   

So, what is ADHD?

ADHD as a developmental disorder that affects the brain’s executive functions. Executive functions are the cognitive processes that organises thoughts and activities, prioritises tasks, manages time efficiently, and makes decisions. They’re basically the little office manager that lives in our heads.

Research suggests that many people with ADHD tend to be perfectionists who fear getting things wrong; they struggle to cope with failure or letting others down. Most people with ADHD are seen to be extremely empathetic to others’ emotions and suffer from Rejection Sensitivity Dysphoria (an extreme emotional sensitivity and pain triggered by a sense of falling short—failing to meet their own high standards or others’ expectations; being rejected or criticized by important people in their life.)

Many people with ADHD struggle with procrastination issues; at one time this was seen as people with ADHD being ‘lazy’ or ‘stupid’ however, research has shown that due to issues with executive functioning, people with ADHD struggle with ‘knowing where to begin’. When the size or scale of the work needed to complete things is ‘too big’, or ‘there is too much to do’ they are unable to start for fear they won’t be able to finish and will only fail or disappoint. 

This often leads to people with ADHD leaving everything to the end when a deadline looms or the amount of work becomes overwhelming, and the work cannot be delayed any longer. From the outside it can be viewing as everything being ‘rushed’ at the end rather than logically planned and spaced out to give enough time. 

However, this ‘scramble’ to complete work before a deadline, will produce a larger dopamine release as the brain views it as a bigger win vs. a scheduled timely plan, which will produce less dopamine, and therefor offer less ‘reward’. Studies suggest that ADHD brains have lower levels of the neurotransmitter dopamine (a chemical released by nerve cells into the brain that allows us to regulate emotional responses and take action to achieve specific rewards. It’s responsible for feelings of pleasure and reward.)

Due to this inability to regulate dopamine properly, ADHD brains are constantly seeking more; leaving people with ADHD with the constant desire to move from task to task, focusing on ‘the most interesting’ or ‘most urgent’ work which will offer the greatest feeling of reward; and struggling to start or complete ‘boring’ or ‘mundane’ tasks that aren’t interesting and don’t offer the ‘dopamine hit’. 

Many people with ADHD also have Sensory Processing Disorder, which means they could be ‘over-stimulated’ by sounds, sights or smells, with unexpected noises or changes in light levels etc. causing sensory overload and breaking their concentration or making it harder to focus.

How to best support employees with ADHD

Because ADHD is so misunderstood, many employers worry about disclosing their ADHD status; and many employers struggle to understand how to best support their staff. Studies suggest that adults with ADHD are change jobs frequently and are more likely to be fired, to miss work, and to have troubled relationships with co-workers; but employees with ADHD can thrive in the right environments and with the right support. There are many useful places out there offering advice on how to best tailor workplace environments so as to take the best advantage of people with ADHD’s strong points (such as their creativity or people skills), whilst also minimising any negative impacts of their ADHD; and I’ve captured many of the commonly agreed useful strategies below.

But as an employee or manager, there here are a couple of important things to note:

  • Many people (between 25-50%) with ADHD also suffer from sleep issues; and many ADHD medications can make these issues worse.
  • While ADHD medication can be beneficial in helping combat the symptoms of ADHD, medical titration can be a long process which can cause some symptoms to get worse before they get better and have many side effects.

The Scottish ADHD coalition wrote this guide for employers which offers helpful advice and guidance.

Some helpful strategies people with ADHD use: 

  • Having clear priorities, reviewed daily; with no more that 5 items on to complete at any one time. 
  • Making colour-coded lists and notes, to make it easy to find information easily. 
  • Breaking tasks down into smaller chunks that can be tackled independently rather than all at once. ADHD brains tend to work best in 15 minute intervals; many people with ADHD find setting a timer for 10 to 15 minutes to focus on one task; then when the timer chimes, deciding if they have the energy to continue on that task or, if completed, start a new timer for an additional 10 to 15 minutes. If they still feel motivated, resetting the timer and continue working in short intervals for as long as they can.
  • Avoiding multi-tasking. This is more likely to lead to distraction; only work on one thing at any time (working in 15 min chunks where possible). 
  • Setting time-limits for decision making. 
  • Setting a ‘WIP limit’ to avoid over-committing to work, For each new commitment made, giving up an old one.
  • Associating ‘rewards’ with mundane task completion, “if I complete X then I can spend 5 minutes doing Y before I move onto Z”
  • Clustering similar tasks together under the same time umbrella, i.e. Answering emails and returning phone calls once in the morning and once in the afternoon, instead of throughout the day, to avoid getting side tracked from priority work; 
  • Replaying instructions, repeating back verbal instructions, or confirming in writing to ensure they have been understood correctly. 
  • Setting electronic alarms and reminders, to remind them to move onto the next task or meeting. 
  • Setting aside time each day to deal with ‘additional thoughts and ideas that have popped up’ to avoid getting side tracked when completing tasks. 
  • Using noise-cancelling headphones or listening to music when focusing on a task. Research shows that music structure helps the ADHD brain stay on a linear path and address timing deficits.
  • Overestimating how long it will take to complete something, adding at least 10 minutes to how long it will take to finish a task.
  • Building in a 5 minute break between tasks to allow the brain time to reset before focusing on the next thing. 
  • Using a “body double.” Many people with ADHD find when tackling mundane or boring tasks, sitting with someone else who is quietly doing another ‘mundane’ task creates a productive atmosphere.

So, to sum up; Not all folks with ADHD are hyperactive boys. If you have a member of staff who has (or you suspect has) ADHD; great! Research shows employees with ADHD can be more curious, creative, imaginative, innovative, and inventive. They tend to be out-of-the-box thinkers, with an approach that can be highly prized in the workplace.

Any potential weaknesses can be overcome with just a little bit of effort and some open, honest conversations; talk to them, focus on their strengths (there are lots of them) and what they do well; and put some plans in place to help them succeed and you’ll all be happy!

5 positive traits of ADHD.

Neurodiverse parenting

One thing I’ve noticed, since I started blogging and talking more openly about being Neurodiverse myself, is how many people have reached out to me virtually or in real life to chat about how they as parents support their children who are (or might be) neurodiverse.

I’ve spoken publicly many times (especially on twitter) about the journey we’ve been on as a family to get my son’s diagnosis; and to get him the support he needs at school etc. The process to get an EHCP in and of itself was a minefield; and finding a secondary school that could not just ‘cope’ with his ASD and ADHD, but actually allow him to thrive; far harder than it should have been!

Interestingly, since joining Kainos and the Neurodiversity working group, I’ve had a number of colleagues approach me to get advice from someone, or just have someone to talk too; who has a neurodiverse child themselves and is perhaps ‘further along in the process’. Far more people in fact than have contacted me to chat about having ADHD myself.

The official services that exist to support neurodiverse children and their families are massively over subscribed and underfunded so trying to get accurate advice and support isn’t that easy. This leaves many parents and carers relying on the internet for help. If you google “does my child have ADHD or Autism” you’ll get a bazillion results back, and it can be quite overwhelming knowing where to start. They’re a millions of Facebook groups and online forums out there for parents and carers looking for help or advice on how to best support their neurodiverse children. The problem is different countries and regions do things in different ways; so what worked for one family in the US, won’t necessarily work for another family in the UK; heck the process a family in London followed won’t even necessarily be the same process that a family in Manchester has to follow.

Many organisations ask staff to disclose if they are the parent to a child with caring needs; but many parents won’t think about ticking that box unless their child has complex physical healthcare conditions, which can leave them in a tricky position (unless they have an understanding manager) when they start needing time off in order to navigate the confusing waters of getting their child a diagnosis or support for neurodiversity.

When I first started down the diagnosis pathway for my son (over 6 years ago) I was still working in the public sector, and was very lucky to have a line manager who herself was in the process of trying to get a diagnosis for her son; we were able to swap tips and advice; and she was very understanding of the multiple appointments I had to attend to try and get my son help. But I know from talking to other parents, not everyone is that lucky. Many have had to either go part time, or give up work altogether, in order to be able to support their children, let down by the systems that are meant to support them.

As we move into ‘the new world’ post pandemic, so many organisations are recognising the importance of focusing on their culture and their staff’s wellbeing; which is great to see. Within Kainos we’ve been having a number of really good conversations about how we better support our neurodiverse staff to thrive; and how we can create an inclusive culture that ensures ‘our staff who choose to remain working from home for what ever reason are fully supported.

Twitter post announcing the Kainos Neurodiversity Employee Network launch

More companies now a days are prioritising private healthcare as part of their staff offer; however, as ADHD and Autism etc. are not acute disorders; most healthcare insurers don’t cover them, nor will they cover any treatment for conditions relating too or arising from them. The ones slight exception to this seems to be Bupa. Recently, Bupa has removed ADHD from its general restrictions list which means they will now cover mental health conditions (such as anxiety, stress, and depression) even if they relate to or arise from ADHD; and they will also fund diagnostic tests to rule out ADHD when a mental health condition is suspected. 

With waiting lists for adult diagnosis averaging at 2 years+ for the NHS, and 6 months+ for private diagnosis; the picture for children isn’t much better; with the average NHS waiting list being around 18 months; but some trusts have been reporting waiting lists of up to 7 years for diagnosis and titration (where appropriate). Should you choose to go private, the costs for children’s assessments are higher than for adults; with the costs for a child ADHD assessment ranging from £700 to £1,500 for the diagnosis alone; and for ASD the costs range from £1700 to over £3,500; and while the waiting times may be shorter; not all local authorities will accept a private assessment as proof of a diagnosis or eligibility for support.

Leaving aside the process of getting diagnosed; for parents and careers there’s also the stress of trying to get your child the help they’ll need at school. The process of getting an EHCP is a logistical nightmare; and there are whole forums and sites out there dedicated to helping parents figure out how to apply for an EHCP. Even once you’ve managed to figure out how to get the ball rolling, getting the EHCP finalised and put in place as no easy task. While the law states EHCP’s should be finalised within 20 weeks; some local authorities had such large backlogs, even before the pandemic, that the process was reported to be taking over two years to get in multiple areas.

On top of that, a 2012 survey of teachers found that over 70% of mainstream teachers didn’t feel that their training adequately prepared them to teach pupils with special educational needs. It’s possibly no surprise in that case that almost 30% of neurodiverse children in 2019 were being homeschooled; and that number is believed to have gone up during the pandemic.

The pandemic has had another impact on children and young people; with the number of children suffering with mental health issues rising dramatically. Perhaps unsurprisingly, that spike has been especially high for neurodiverse children; and that in turn has been impacting their families. One study in particular noted the negative impact the pandemic has had on parents and families of neurodiverse children.

As such, as employers, we need to be considering not only how we best support our neurodiverse staff, but we also need to acknowledge the extra responsibilities and pressures our staff with neurodiverse children might be facing. We need to create a culture that supports them, so that they can balance their work and parental responsibilities successfully without having to worry; enabling them to thrive at home, and at work.