People who have attention deficit hyperactivity disorder work 22 fewer days each year than their colleagues who don't have ADHD, according to a new World Health Organization study.
Some of those are sick days, but most are days of lost productivity as a result of the symptoms of inattention and hyperactivity that characterize ADHD.
"It's a surprisingly serious disorder," says study co-author Ronald Kessler, a professor of health-care policy at Harvard Medical School, who said ADHD has a more significant impact on work performance than he expected. "There's an enormous societal cost."
Dr. Kessler says he hopes his research, based on a WHO survey of 7,075 people in 10 countries, will prompt employers to offer more support to workers with ADHD.
But people with the disorder received the study skeptically, saying it will only make their life in the workplace harder.
"I understand research is needed, but you begin to wonder, what were they thinking?" says Steven, a contracts administrator who asked that his full name be withheld because he doesn't want people to know he has ADHD. Although about 4 per cent of the adult population has ADHD, it carries a stigma - one that Steven fears will worsen as a result of the recent findings.
"Mental disorders as a rule do not have a good face in public," Steven says. "ADHD is a very misunderstood disorder. A lot of people think you just give someone medication and they're cured."
Now 47, Steven discovered he had ADHD when he was 31, after his son was diagnosed. He'd spent years bouncing through a series of unfulfilling jobs: driving a bus, working in restaurants, performing customer service. "I was a smart person, yet I couldn't seem to figure out a job," he explains.
His diagnosis forced him to become more self-aware and to take stock of what he liked to do, what he was good at and what his weaknesses were. That sort of self-inventory would help anyone, but Steven says it's crucial for people with ADHD.
"I finally got a job that suits my likes, my personality and my mental aptitude," he says of his current position. He writes lists to keep himself on track, he's careful not to take on more responsibilities than he can handle, and at the end of the day he's usually exhausted - but the important point to him is that his ADHD doesn't stop him from doing a good job.
Nor does it stop Denise Difede, an office administrator who works for a supportive employer - the Canadian Centre for ADHD/ADD Advocacy in Toronto. Sometimes she feels that her flickering attention span is an asset.
"I have an uncanny ability to multitask," Ms. Difede says.
But she has to work hard to stay organized, writing down everything in the day-planner her children call "the bible." Like Steven, she says learning about her ADHD helped her figure out how to stay on track.
"I don't allow myself to let anything go," she says. "If I don't write it down in my date book immediately it will not get done."
The WHO survey asked people to report how often they did not work, cut back their hours or cut back on the quality of their work; the results were compared with data from the survey that included diagnostic interviews for ADHD.
Dr. Kessler says the next step will be to get some large employers to offer treatment - probably a combination of medication and coaching - to people with ADHD, then compare the treatment group with a control group.
"My guess is that [treatment]is going to be a smart thing for employers to do," he said, comparing it with workplaces offering free flu shots to employees each winter.
Some advocates for people with ADHD applaud Dr. Kessler's goals, but question the idea of employee screening and treatment. "My concern is that it not be used to discriminate when hiring," says Heidi Bernhardt, national director of the Centre for ADHD/ADD Advocacy. "We have to be careful because there's a double-edged sword here."
Screening isn't as easy as just handing out a questionnaire, Ms. Bernhardt says. Only a trained psychologist or psychiatrist can diagnose ADHD. Ms. Difede notes that she fields dozens of calls a week from adults desperately seeking a psychiatrist who can assess them.
"There are only two in the [Greater Toronto Area]accepting new adult patients, and that's two more than I had last month," she says.
Still, Ms. Bernhardt says she welcomes any effort to educate employers and the public.
"Most people think of ADHD as little boys running around being hyper, and that's probably one-100th of it," she says. Adults often don't show the same obvious signs of ADHD, she says, but suffer instead from internal feelings of restlessness. In terms of public understanding, she says, ADHD is now where depression was 20 years ago - many people don't understand it and think that people with the disorder should just snap out of it.
Bill Wilkerson, president and co-founder of the Global Business and Economic Roundtable on Addiction and Mental Health, spends his days explaining to business leaders why they should be concerned with mental disorders. Employers shouldn't play psychiatrist, he says, but it makes financial sense for Corporate Canada to strengthen employee-assistance programs and help people with ADHD obtain treatment.
"It's really about prognosis, not diagnosis," says Mr. Wilkerson, a former insurance industry executive. "Whether an employee has ADHD, depression or diabetes is immaterial. ... You don't need to know what's wrong with someone in order to facilitate their getting care and getting back to work."
Signs in the workplace
About 4 per cent of the adult population has attention deficit hyperactivity disorder. The three major facets of ADHD are inattention, hyperactivity and impulsivity; in adults, the outer symptoms of hyperactivity often become internalized - instead of the person physically racing around a room, their mind is racing. Here are some symptoms of adult ADHD that may surface at work:
Inability to track details, prone to careless mistakes.
Forgetting to complete tasks, even when they are daily activities.
Frequently losing necessary things.
Talking at inappropriate times, interrupting.
Struggling to pay attention in meetings.
Spending hours at work, but getting little done.
Sources: Centre for ADHD/ADD Advocacy, caddac.ca; Helpguide.org