Can I have your attention? How adults with ADHD can make work work for them

FARGO — Lisa Ellingson Horner could get hired anywhere.

Creative, articulate and intelligent, Horner routinely aced job interviews. Time and time again, she landed jobs for which she didn’t necessarily have training or experience — mostly because she was so obviously personable, likable and bright.

But as the honeymoon period wore off at a job, Horner would struggle. She avoided cold-calling prospective customers or forgot to follow up on regular clients. When she realized she hadn’t followed through as she promised, she would be so embarrassed that she would avoid the client altogether.

She routinely underestimated the amount of time that it would take to do a project, then wound up cramming like a frantic college student at the last minute to complete it. When she worked as a bakery manager, she was horrified to learn those who worked under her viewed her as cold and uncaring when they called in sick. In fact, she was so worried about the added responsibility of filling their shifts that she was preoccupied.

Contributed / Lori Ellingson Horner

Then, in the fall of 2018, Horner was diagnosed with a condition that she’d assumed only affected rambunctious grade-school boys: attention deficit hyperactivity disorder. She was 49 years old.

Suddenly, the Moorhead native's entire life made sense.

She thought of the early report cards in which teachers wrote, “Lisa would get her work done if she could stop talking to the boys in class.” How she excelled in classes or hobbies in which she was interested, but found creative ways to skip courses she found boring. How she always struggled with organization, financial management and planning. Or how she was smart enough to be placed in a gifted program in grade school, but flunked out of college because — without teachers or parents cajoling her — she couldn’t motivate herself to get to class.

David Samson/The Forum

Horner is one of a growing number of adults who have realized they have attention deficit hyperactivity disorder, a neurodifference characterized by impulsivity, difficulty focusing, forgetfulness, racing thoughts and high distractibility.

ADHD is typically tied to our brain's executive function, which helps us set goals, plan, organize, prioritize, manage time, regulate our emotions, focus and self-assess.

All of these skills are essential for success in almost every part of life, including work. But as researchers are acknowledging, the idea that children grow out of this neurodifference is fading.

"Some people ... will outgrow it. But what they are recognizing now is at least 50 to 86% of cases still present in adulthood, but it just looks different," says Jodi Hedstrom.

Hedstrom and Janet Grove are certified cognitive speech-language pathologists, rehabilitation services providers for ADHD and co-owners of Progressive Therapy Associates in Fargo . As such, they provide ADHD coaching to help adults work and live more productively and effectively.

Unfortunately, ADHD can lurk undetected for years, while those who have it wind up getting treated for byproducts of ADHD — such as depression or anxiety — while lambasting themselves for failing to do "simple things" like make long-range plans, keep an organized desk or focus on routine paperwork.

ADHD can be caused by a combination of factors, although studies suggest a strong genetic component, according to Hedstrom and Grove.

While the disorder's precise cause is unknown, neuroresearchers have found people with this neurodifference possess lower levels of the neurotransmitter and hormone norepinephrine, which plays a role in mood, sleep-wake cycle, ability to focus and memory storage.

ADHD brains also seem to have lower levels of dopamine, a neurotransmitter that regulates reward-seeking, motivation and movement, according to the National Institutes of Health.

In addition, there seems to be impaired neurotransmitter receptors in the brain's frontal cortex (which controls attention, organization and executive function) and the limbic system (which controls emotion and attention).

Despite these demonstrable differences between ADHD and neurotypical brains, some people still prefer to think of ADHD as an excuse or a made-up disorder, Hedstrom says.

So a person who routinely shows up late for meetings, procrastinates because they're overwhelmed by a big project or makes mistakes while performing mundane tasks may be dismissed as lazy, inconsiderate or sloppy.

"It's seen as a character flaw, when in fact it isn't," Grove says. "Their brains have to work so much harder at those things other people take for granted."

One reason a supervisor might make these negative assumptions is because the person with ADHD is often otherwise bright, creative, quick-witted and charming. Their neurodifference has often trained them to "win over" people with a likable personality and to "read the room" so they don't make embarrassing mistakes.

They may be the employee who lands the company's biggest account in history or comes up with a revolutionary idea that completely transforms a company. In fact, we know there are plenty of successful business owners and CEOs with ADHD.

The difference, Progressive's partners say, is they are "consistently inconsistent." They may write an awe-inspiring annual report one week and botch up a simple spreadsheet the next. If they're interested in the project, they will laser in and work tirelessly, Grove says. But if a task is boring or of little interest, they'll struggle to even finish it.

"Someone may be undiagnosed and not have any idea that these series of problems they're having are basically ADHD related. But they certainly can tell," Grove says. "They'll say, 'This and this and this are not working. I don't know why. But there's a series of things not working. I can't seem to do my life like this person does. Why is that?"

The National Institute of Mental Health reports the estimated lifetime prevalence of ADHD in adults aged 18 to 44 (meaning they've been diagnosed at some time in their life) is 8.1%.

Even so, providers like Kama Jensen, a licensed professional clinical counselor with Conscious Living Counseling and Education Center in Fargo, believes the disorder is often overlooked, especially in girls and women.

“This population that is supposedly overdiagnosed is undertreated," she says.

Jensen believes this is partly because women's complex hormonal systems can mask or compound ADHD symptoms — especially at key points such as puberty, child birth, perimenopause and menopause.

And ADHD is complex, so isn't so readily diagnosed with one quick trip to a doctor, Jensen says. A thorough history and evaluation should be taken and those close to the client should also be surveyed so the diagnosis doesn't rest entirely on the patient's self-reporting.

Finally, ADHD often is overlooked in girls in the first place, as it tends to manifest in female children as a dreamy, inattentive type vs. the type of rowdy, jump-on-the-desk type that is more common to boys, Hedstrom and Grove say.

"It just presents differently, right?" Grove says. "Not less. It's the inattentive, gapped-out little girl in the classroom. it might be the inattentive, struggling young lady in college who doesn't say anything until she lashes out because she's frustrated. It doesn't mean that the symptom evaporated. It just morphed over time."

In general, that often means the outward "hyperactivity" and fidgeting have disappeared as the adult adopts the socially acceptable "grown-up" demeanor at work.

But that doesn't mean the hyperactivity has stopped, Jensen says.

Instead, the overactivity has gone underground, creating someone who may look outwardly calm but whose brain never stops obsessing over ideas, fears, half-finished to-do lists, relationships and whatever else their brain's meaning-making mechanisms can concoct.

After Horner's diagnosis, her healthcare provider prescribed Adderall, a combination of two central nervous stimulants that sharpen focus and reduce impulsivity by boosting dopamine and norepinephrine levels in the brain.
The medication helped, but Horner still had work to do.

Several months later, she accepted a job at a tech company that morphed into an account manager job.

Suddenly, Horner found herself in familiar but uncomfortable shoes. She now needed to maintain a portfolio of 75 customers — calling them regularly and cultivating a relationship.

"Everyone else on my team has come from that background so they know how to set up their day, their week, their month. You have to do all these things. So, you know, my manager has been kind enough to pull me along as we go," she says. "But my biggest issue was what about these people that I reached out to a while ago, and then I was supposed to do something for them and I didn't."

At this point, Horner knew she needed ADHD coaching to help her stay organized and motivated. She began working with Hedstrom, who taught her how to take a seemingly insurmountable task — such as calling 35 customers every Friday — and break it into more manageable, less anxiety-inducing increments, such as making five phone calls a day throughout the week.

Horner also learned about the importance of using a planner — she relies on the digital, fully searchable Rocketbook — as well as Microsoft's To Do app to continually remind her of tasks.

Hedstrom helped Horner recognize how emotions could hijack motion: Getting tangled up in fear about calling customers, for instance, would keep her from taking the first step and doing it.

"She helped me understand that motivation actually follows action," Horner says. "If it gets you over that hump, whatever it is, that's good. Or just do 5 minutes and let's just break the task down into smaller pieces and just do one piece."

Often, Horner would find that once she started, she was able to work beyond that 5 minutes or beyond that first step. She just needed to make that first tentative step.

"It's been life-changing," Horner says today. "Because not only do I understand why I do things, but she helps me walk through a problem. What can I do to kind of counteract things and what have I been doing that's detrimental. Like saying, 'Oh, I'm so overwhelmed, I'm just going to ignore it.' And she'll say: 'So is that working for you?'"

A self test, like one on Additude magazine's website , can give you an idea. Be sure to also talk to your healthcare provider, and don't be afraid to advocate if they readily dismiss it, Jensen says.

Progressive Therapy also offers numerous tips for helping someone with attention-deficit feel more productive. Here's a sample of them:

• Find a planner that works for you, and make it your constant companion.
• Get a Time-Timer : This clever tool helps those with time-blindness by creating a visual timekeeper which makes the passage of time immediately visible and more concrete. The 60-minute timer starts out by showing a whole, red “pie” shape to clock an hour of time. As each minute passes, the white “slice” of time that's passed grows bigger while the available red “pie” of time left gets slimmer.
• Check out “The Pomodoro Technique”: This productivity-enhancing technique, first devised by business consultant Francesco Cirillo, requires allocating 25-minute chunks of time into focused, uninterrupted “task time,” punctuated by 5-minute breaks. After four Pomodoro “cycles,” the worker takes a longer, 20 to 30-minute break. This method works by breaking big tasks into smaller, more managed time blocks to align with the brain’s natural attention span. It can keep our ADHD brains from procrastinating with the shiny promise that we need only work for 25 minutes before getting a break. However, the time chunks may need to be longer for people who have trouble shifting into focus mode or struggle with leaving a task once they start. “The trick is identifying when your attention usually starts to wane and setting the timer to stop just before that point,” writes Dr. Jeffrey Ditzell, a New York City psychiatrist with ADHD on Psychcentral.com.
• Stick to SMART goals: The ADHD brain can turn procrastination into an art form, especially if a task is vague and unscheduled. We get better results with a SMART (Specific, Measurable, Achievable, Relevant and Time-Bound) approach. It’s safe to say a nebulous promise to “get more organized someday” probably won’t happen. But a promise to “declutter my desk by May 15” — with smaller tasks toward that end in your planner — probably will. 
• Wondering if you should tell your boss if you have ADHD? Check out this article to hear an expert's advice:
  https://www.additudemag.com/should-you-tell-your-boss-about-your-adhd/

Tammy Swift is a business reporter at The Forum and was diagnosed with ADHD in 2016. She can be reached at tswift@forumcomm.com.