Accommodation and Compliance Series:
Employees with Attention Deficit Hyperactivity Disorder
JAN’s Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.
The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee’s individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.
For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar.
What is AD/HD?
Attention deficit-hyperactivity disorder (AD/HD) is a neurobehavioral disorder with a persistent pattern of inattention and / or hyperactivity-impulsivity that interferes with functioning or development.
The common characteristics of AD/HD are impulsivity, inattention, and/or over-activity (DSM-V-TR, 2013). Failure to listen to instructions, inability to organize oneself and work tasks, fidgeting with hands and feet, talking too much, inability to stay on task, leaving projects, chores and work tasks unfinished, and having trouble paying attention to and responding to details are the primary symptoms of AD/HD. Although individuals may have both inattention and hyperactivity symptoms, many individuals predominantly display one symptom more than another. Therefore, the DSM-IV-TR identifies three subtypes that can be diagnosed:
- AD/HD predominantly hyperactive-impulsive type: The major characteristics are fidgeting, talking excessively, interrupting others when talking, and impatience.
- AD/HD predominantly inattentive type: The major characteristics are distractibility, organization problems, failure to give close attention to details, difficulty processing information quickly and accurately, and difficulty following through with instructions.
- AD/HD combined type: The individual with combined type meets the criteria for both hyperactive-impulsive and inattentive type.
What causes AD/HD?
Scientists are not sure what causes ADHD. Like many other illnesses, a number of factors can contribute to ADHD, such as genes, cigarette smoking, alcohol use, or drug use during pregnancy, exposure to environmental toxins during pregnancy, exposure to environmental toxins, such as high levels of lead, at a young age, low birth weight, and brain injuries.
ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention. Other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse, are common in people with ADHD. (NIMH, 2016).
How is AD/HD treated?
While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments. (NIMH, 2016).
Is AD/HD a disability under the ADA?
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC Regulations . . ., 2011). Therefore, some people with AD/HD will have a disability under the ADA and some will not.
A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment (EEOC Regulations . . . , 2011). For more information about how to determine whether a person has a disability under the ADA, visit http://AskJAN.org/corner/vol05iss04.htm.
Note: People with AD/HD may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with AD/HD will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.
Questions to Consider:
- What limitations does the employee with AD/HD experience?
- How do these limitations affect the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine accommodations?
- Can the employee provide information on possible accommodation solutions?
- Once accommodations are in place, can meetings take place to evaluate the effectiveness of the accommodations? Can meetings take place to determine whether additional accommodations are needed?
- Would human resources or personnel departments, supervisors, or coworkers benefit from education, training or disability awareness regarding learning disabilities? Can it be provided?
Time Management: Individuals with AD/HD may experience difficulty managing time, which can affect their ability to mark time as it passes incrementally by minutes and hours. It can also affect their ability to gauge the proper amount of time to set aside for certain tasks. It may be difficult to prepare for, or to remember, work activities that occur later in the week, month, or year.
- Divide large assignments into several small tasks
- Set a timer to make an alarm after assigning ample time to complete a task
- Provide a checklist of assignments
- Supply an electronic organizers and/or apps, and train on how to use effectively
- Use wall calendar to emphasize due dates
- Develop a color-coded system (each color represents a task, or event, or level of importance)
- Allow co-worker or supervisor to add entries on the calendar, or to double-check entries added by the employee with AD/HD
Memory: Individuals with AD/HD may experience memory deficits, which can affect their ability to complete tasks, remember job duties, or recall daily actions or activities.
- Provide written instructions
- Allow additional training time for new tasks
- Offer training refreshers
- Use flow-chart to indicate steps in a task
- Provide verbal or pictorial cues
- Use post-it notes as reminders of important dates or tasks
- Use apps
Concentration: Individuals with AD/HD may experience decreased concentration, which can be attributed to auditory distractions (that can be heard) and/or visual distractions (that can be seen). People with AD/HD report distractions such as office traffic and employee chatter, opening and closing of elevator doors, and common office noises such as fax tones and photocopying.
- To reduce auditory distractions:
- Purchase a noise canceling headset/earbuds
- Hang sound absorption panels
- Provide a white noise machine
- Relocate employee’s office space away from audible distractions
- Redesign employee’s office space to minimize audible distractions
- To reduce visual distractions:
- Install space enclosures (cubicle walls)
- Reduce clutter in the employee's work environment
- Redesign employee’s office space to minimize visual distractions
- Relocate employee’s office space away from visual distractions
Organization and Prioritization: Individuals with AD/HD may have difficulty getting or staying organized, or have difficulty prioritizing tasks at work.
- Develop color-code system for files, projects, or activities
- Use weekly chart to identify daily work activities
- Use the services of a professional organizer
- Use a job coach to teach/reinforce organization skills
- Assign a mentor to help employee
- Allow supervisor to assign prioritization of tasks
- Assign new project only when previous project is complete, when possible
- Provide a “cheat sheet” of high-priority activities, projects, people, etc.
- Use apps
Social Skills: Individuals with AD/HD may have limitations in adaptive skills, such as communicating with others, or exhibiting appropriate social skills. This might manifest itself as interrupting others when working or talking, demonstrating poor listening skills, not making eye contact when communicating, or inability to correctly read body language or understand innuendo.
- Provide a job coach to help understand different social cues
- Identify areas of improvement for employee in a fair and consistent manner
- Make attendance at social activities optional
- Use training videos to demonstrate appropriate behavior in workplace
- Encourage employees to minimize personal conversation, or move personal conversation away from work areas
- Provide sensitivity training (disability awareness) to all employees
- Encourage all employees to model appropriate social skills
- Adjust the supervisory method to better fit the employee’s needs
- Allow the employee to work from home
- Adjust method of communication to best suit the employee’s needs
- Use role-play scenarios to demonstrate appropriate behavior in workplace
Hyperactivity/Impulsivity: Individuals with AD/HD Hyperactivity-Impulsive type may exhibit over-activity or impulsive behavior. This could be disruptive to the work environment or could inhibit efficient and effective work performance.
- Provide structured breaks to create an outlet for physical activity
- Utilize a job coach to teach/reinforce techniques to control impulsivity
- Allow the employee to work from home
- Review conduct policy with employee
- Adjust method of supervision to better prepare employee for feedback, disciplinary action, and other communication about job performance
- Use services of EAP
- Provide private workspace where employee will not disturb others by tapping, humming, or fidgeting
Multi-tasking: Individuals with AD/HD may experience difficulty performing many tasks at one time. This difficulty could occur regardless of the similarity of tasks or the frequency of performing the tasks.
- Separate tasks so that each can be completed one at a time
- Create a flow-chart of tasks that must be performed at the same time, carefully labeling or color-coding each task in sequential or preferential order
- Provide individualized/specialized training to help employee learn techniques for multi-tasking (e.g., typing on computer while talking on phone)
- Identify tasks that must be performed simultaneously and tasks that can be performed individually
- Provide specific feedback to help employee target areas of improvement
- Remove or reduce distractions from work area
- Supply ergonomic equipment to facilitate multi-tasking
- Clearly represent performance standards such as completion time or accuracy rates
Paperwork: Individuals with AD/HD may experience difficulty completing paperwork efficiently and effectively. This is due in part to workplace distractions and difficulty with time management, disorganization, or prioritization.
- When possible, automate paperwork by creating electronic files
- Use speech recognition software to enter text or data into electronic files
- Save time filling out paper forms by completing information in advance, using pre-filled forms, or adhering pre-printed stickers
- Use checklists in place of writing text
- Supply large quantities of regularly-used forms
- Color-code forms for easy identification
- Re-design commonly used forms
- Use large font
- Double space or triple space
- Provide adequate space for hand-written response
Situations and Solutions:
An employee who had difficulty remembering procedures for setting up the various catering presentations she was responsible for requested written instructions for each one. Her supervisor responded with the provision of a complete and detailed description of the procedures for each presentation. However, when trying to use the instructions, the employee claimed they were too detailed and she needed more of an action plan with less description. The supervisor reworked the procedures by using a color-coded system. The main action steps were highlighted in one color while the instructions in more detail followed but were highlighted in another color, helping the employee to differentiate between the two immediately.
An employee with AD/HD disclosed to her employee after being written up for profuse tardiness, stating that because of her medical condition, she can never be on time and therefore cannot be held to the same standards other employees are. The employer informed the employee that they can hold her to the same standards, but would be willing to accommodate her by allowing her a twenty minute grace period daily, where she would make up the time difference. The employee was given a four week trial period and failed to get to work within that twenty-minute window. As a final step, the employer provided her with ideas from a JAN publication. The ideas included: keeping a routine of putting and keeping things in their place (keys, phone, glasses), preparing for the next day's work the night before, creating a checklist for herself and others, placing sticky notes on the door, dashboard, or wherever she would see them, turning off distractions – including a cell phone, and setting a timer or a programmable watch to pace herself.
A reporter had a difficult time with distractions while working in a crowded, busy, and noisy newsroom. She asked for the accommodation of working from home when she was on a deadline. The employer was concerned about her being away from the other employees, as well as being further away from the downtown area where most of the news occurred., but offered her a trial accommodation of working from home, contingent upon her ability to get to the scene of breaking news quickly. She reported back later that the accommodation was so highly successful that the employer had decided to provide telework on a long-term basis.
A case manager has difficulty with getting the required documentation completed. He works in a cubicle in a noisy open area that limits his ability to focus and concentrate. He knows that a private space is out of the question, but feels if he could change his office hours, he may be better able to finish his work on time. His supervisor agreed that the office can get hectic when everyone is there, so it was agreed upon that he would come in two hours early, not only before his co-workers’ arrival, but also when he has the most mental acuity and ability to focus.
An office worker at a large elementary school was responsible for receiving copy orders and providing the completed copies to teachers within two days. He was unable to complete the handwritten orders on time with the constant disruption of the teachers and with no organizational system. The worker’s supervisor stepped in and provided a typed form that required the teachers to supply a uniform amount/type of information. Daily labeled baskets for orders and materials allowed the employee to see which orders needed to be done first, allowing the copies to be completed in the two-day time frame.
A part-time college professor with AD/HD was having difficulty planning new courses he had yet to teach when the schedule changed quickly and he was required to do so under tight time constraints. He asked JAN how that could be accommodated. A consultant at JAN recommended he request that he only be put on the new courses that were firmly scheduled ahead of time in order to give him time to prepare. If he were to teach courses that were suddenly added, he asked that those be ones he had previously taught and planned for.
An employee in a management position has been successful in his position for quite some time but when a new supervisor comes on board, the standards for written communication are more strictly enforced. The employee, who has AD/HD, has difficulty attending to detail. This includes spelling, grammar, and punctuation errors in his written communications that go out to employees and business partners alike. The employee was accommodated with speech recognition software that allowed him to dictate whatever he needed to write. A playback feature allows him an added layer of oversight. He also requested writing/editing software that he can plug his written materials into so they will be checked over for spelling, grammar, and punctuation an additional time.
An administrative assistant in a quiet office has difficulty keeping himself calm and ends up disrupting the workplace with his foot tapping, finger drumming, and constant motion. After he discloses his AD/HD, his employer asks him for recommendations from his doctor on how to help him. After receiving the medical documentation, the employer agrees to construct a taller cubicle with a door, purchase sound absorption panels for the inside of his cubicle to help with noise reduction, and purchase the employee an under-the-desk exercise peddler to help him expend some of his excess energy.
A new employee who is quite impulsive 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, he discloses his AD/HD and states that he just can’t help himself. His supervisor provides him with an advanced agenda of meeting topics with a space for notes so the employee can gather his thoughts around what is appropriate to speak about in meetings and what is not.
An employee with limited time management skills struggles to complete her job tasks except for the ones she deems the most interesting. She works with her manager to prioritize the tasks that are complicated and mundane in order to complete those during the periods when she has the most ability to focus. Then she fills in with the tasks she likes to do that are more interesting, enabling her to complete more of the essential functions of her position. The use of organizational apps helps her stay the course.
An employee with AD/HD was applying for a promotion, one that required all applicants to pass a qualification test. This employee knew that unless he was the only test-taker, he was going to need a quiet space free from distractions in order to do his best. He requested an accommodation. The employer, concerned about confidentiality and multiple applicants, determined that each applicant would be scheduled to take the test alone. Therefore, no accommodation was really needed for the employee with AD/HD.
There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.
American Psychiatric Association: Diagnosis and Statistical Manual of Mental Disorders, Fifth Edition, Arlington, VA, American Psychiatric Association, 2013.
EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011).
National Institute of Mental Health (NIMH). (2016). Attention Deficit Hyperactivity Disorder. Retrieved October 10, 2017, from http://www.nimh.nih.gov