From the desk of Melanie Whetzel, M.A., CBIS, Lead Consultant – Cognitive/Neurological Team
On a recent conference call I had with an employee and his supervisor regarding accommodations for the difficulties the employee was having on the job, the issue of executive functioning versus ADHD came up. As we talked about the limitations and the job difficulties, I mentioned that the employee probably had limitations associated with executive functioning, based on what he was citing as his most problematic job tasks. He stated that he had been diagnosed with ADHD, but never with issues involving executive functioning. It is a common misconception that executive functioning is a diagnosis when it is more of a description of the brain’s self-management system. Individuals with cognitive difficulties or disabilities will often have problems with executive functioning - in other words, their brains may not be proficient in managing the tasks that are required of them. So while ADHD is a specific diagnosis, executive functioning deficits are very closely connected, but aren’t diagnosed as such.
Executive functions are high-level mental processes or abilities that influence and direct more basic abilities like attention and memory. The term executive function describes a set of cognitive abilities that include the ability to plan, organize and strategize, pay attention to and remember details, start and stop actions, and form concepts and think abstractly. Executive functions also keep us from behaving in inappropriate ways. People with executive functioning deficits may have difficulty monitoring and regulating their behaviors. These difficulties can include monitoring and changing behavior as needed, planning future behavior when faced with new tasks and situations, and anticipating outcomes and adapting to changing situations. People with executive functioning deficits will often have problems interacting with others and fitting in socially.
Some people with executive functioning deficits may need accommodations on the job. Identifying the job tasks that are most problematic is the first step in helping to determine effective accommodations. This information can be more helpful in determining accommodations than the diagnosis of ADHD will be. Even though many people with ADHD have the same diagnosis, the limitations they present and the jobs they do will vary greatly. Accommodation ideas are as individual as the persons requiring them. Just as each job is distinct, with different tasks and various levels of difficulties, the accommodations each employee needs may be very distinct as well.
Let’s look at some examples. The following employees all have ADHD, but look at the difference in their accommodation needs as determined by their job tasks, environments, and difficulties:
- Sally has difficulty remembering procedures for setting up various catering presentations so she requests written instructions for each one. Sally’s supervisor does a thorough job of providing her with a complete and detailed description of the procedures for each presentation. However, when trying to use the instructions, Sally claims they are too detailed and she needs more of an action plan with less description. Her supervisor reworks the procedures by using a color-coded system. The main action steps are now highlighted in one color while the instructions in more detail follow but are highlighted in another color, helping Sally to differentiate between the two immediately.
- Todd is a reporter who has difficulty focusing with all the distractions around him while working in a crowded, noisy, and busy newsroom. He asks for the accommodation of working from home when he has a deadline. Todd’s employer is concerned about his isolation from co-workers as well as from the downtown area where most of the news occurs, but offers him a trial accommodation of telework contingent upon his ability to get to the scene of breaking news quickly. The accommodation turns out to be so highly successful that the employer decides to provide telework on a long-term basis.
- Jo, a case manager, has difficulty with organizing and completing her required documentation in a timely manner. She works in a cubicle in a noisy open area that limits her ability to focus and concentrate. With no private space available, she feels a change in office hours might help. Her supervisor agrees that the office is hectic when fully staffed, so she approves the schedule change of working two hours early — not only before co-workers’ arrival, but also when Jo has the most mental acuity and ability to focus.
- Rico has limitations in managing time and struggles to complete his job tasks except for the ones he deems the most interesting. Rico works with his manager to prioritize the tasks that are complicated and mundane in order to complete those during times when he has the most ability to focus. Then he fills in with the tasks he likes to do that are more interesting, enabling him to complete more of the essential functions of his position. The use of organizational apps helps him stay the course.
- Shae, a high-level liaison in a federal office, has persistent difficulty in getting to work on time. The employer agrees to flex Shae’s starting time by 30 minutes, but 30 minutes only due to his supervisory level and the timely tasks his position requires. Shae is simply unable to get to work within the 30-minute flexed starting time. As an alternate accommodation, he asks to be reassigned to a position as equivalent as possible that doesn’t require as strict an adherence to the starting time.
- Lee is a new employee who is quite impulsive. Lee has been reprimanded several times for interrupting meetings, interjecting his own personal opinions (often unrelated to what is being discussed) in meetings with coworkers as well as clients. When his supervisor gives him a second written warning, Lee discloses his ADHD and states that he just can’t help himself. He and his supervisor discuss what accommodations might be most helpful to him and decide on an advanced agenda of meeting topics with a space for notes so he can gather his thoughts around what is appropriate to speak about in meetings and what is not.
As seen in the examples above, the characteristics of ADHD that are likewise characteristic of executive functioning deficits can have a huge impact on the ability to successfully perform the essential functions of a job. Individuals may have difficulty paying attention, staying focused, and retaining information. Individuals may also have difficulty with self-control, managing emotions, and thinking before acting. Difficulty initiating tasks, getting and staying organized with materials and time, completing longer-term projects, and keeping track of what work has been done and what yet needs to be accomplished can also be difficulties individuals with ADHD and executive functioning deficits experience on a daily basis.
Executive functioning deficits can also be present with other disabilities/diagnoses that involve cognitive operations and thinking skills. Individuals with brain injuries, learning and intellectual disabilities, autism, sleep disorders, and mental health impairments can very likely experience difficulties with their executive functioning as well.
There are many effective accommodations that can be put into place to help employees be more productive. See JAN publications on ADHD and Executive Functioning for assistance. And as always, feel free to contact JAN for an individualized consultation.