…it’s off to work we go!” …or not.  …or not today.  …or not productively.

A number of studies conducted within the past decade provide evidence that adults with ADHD experience poor occupational outcomes. ADHD is associated with unemployment, more days out of work, less productivity, reduced work quality, and occupational underachievement relative to expectations. Research is now turning its eye toward understanding which symptoms contribute the most to these results, and the mechanisms by which they have effect.

Gjervan, B., Hjemdal, O., & Nordahl, H. M. (2016). Functional impairment mediates the relationship between adult ADHD and inattentiveness and occupational outcome. Journal of Attention Disorders, 20, 510-518.

The researchers examined how ADHD leads to lower occupational outcomes via quality of life perceptions including vitality, mental health, social function, and role-emotional function.

Self-report and medical records data were gathered from a voluntary sample of 149 adults with ADHD. The average age of respondents was 33.7 years, and the sample was balanced between women (78) and men (71).
•    Participants completed the Adult ASRS, with two 9-item scales reflecting symptoms of
Inattention and of Hyperactivity/Impulsivity.
•    They also completed the Medical Outcomes Study SF-36, an instrument commonly
used to measure Health-Related Quality of Life (HRQoL) which is divided into Physical
and Mental Components; only the latter were of interest to the researchers. The Mental
Components scales are Vitality (4 items), Mental Health (5 items), Social Function (2
items) and Role-Emotion Function (3 items).
•    Occupational Outcome was measured as the number of months within the past 12 that the individual had been either working or in school; 32.5% of the sample was fully employed (9-12 months) by this definition, while 44% of the sample was unemployed, with the remainder partially employed.

Regression analyses were used to test whether the mental components of HRQoL mediated the relationship between self-reported ADHD symptoms and months of employment.

Inattentive ADHD symptoms were found negatively related with the occupational outcome in this study, r = -.20 (p < .05). That is, the greater the inattentiveness, the poorer the occupational outcome. Occupational outcome was also positively correlated with the quality of life indicators Role-Emotion Function, r = .24 (p < .05) and Social Function, r = .20 (p < .05). When a mediation model was tested, it was found that Inattentive ADHD symptoms directly affected the quality of life factors, which in turn affected the occupational outcome.

In non-research terms, the findings indicate that difficulties with ADHD symptoms such as attention regulation, organization, and task completion lead adults to experience challenges at work as a result of emotional problems (e.g., feeling depressed or anxious); these emotional problems also interfered with normal social activities. Specifically, people reported spending less time working, accomplishing less than they would like, and/or not doing work as carefully as usual. Decrements in these aspects of work resulted in individuals working fewer months during the past year.

Conservatively, adults spend at least half of their waking hours at work. Given that, we want our adult clients to experience more positive results in their work lives as well as their personal lives. Indeed, many of the issues and skills explored through coaching are readily applicable to the employment context.

A recent meta-analysis (Shaw, et al., 2012) examined over three hundred studies to see whether ADHD treatment yielded a beneficial long-term effect. While a positive effect was found for the majority of outcome variables, notably treatment did not benefit occupational functioning. “Treatment” in these studies was considered medication, therapy, or skills training; coaching was not specifically identified as a form of treatment in any of the studies examined.

Coaches may be well-positioned to close the gap between traditional treatment alternatives and occupational outcomes. We’ve oft repeated that “pills do not teach skills,” and the research is bearing this out. Even with medication management and therapy, adults with ADHD need additional support in achieving the work outcomes enjoyed by their peers without ADHD. The research reviewed here suggests that coaches can help clients learn strategies and skills for managing emotional interference with respect to (a) work tasks/products and (b) social aspects of work.

While each of these studies identified above has limitations, research examining the means by which ADHD impacts employment outcomes is fruitful as it uncovers more specific ways in which professionals – especially ADHD coaches – can help people with ADHD experience a better quality of work life.

Gjervan, B., Hjemdal, O., & Nordahl, H. M. (2016). Functional impairment mediates the relationship between adult ADHD and inattentiveness and occupational outcome. Journal of Attention Disorders, 20, 510-518.

Shaw, M., Hodgkins, P., Caci, H., Young, S., Kahle, J., Woods, A. G., & Arnold, L. E. (2012). A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: Effects of treatment and non-treatment. BMC Medicine, 10:99.


Rebecca ToneyRebecca Toney, Ph.D.