Adult ADHD and Work
Adrian’s Story
What was your first job? How did it end?
My first job was working in McDonalds at the age of 19 whilst studying at University. It was a stressful environment with electronic buzzers and machines dictating your pace of work, orders shouted from the frontline, managers criticising your efforts, and hot kitchen temperatures. I wasn’t very coordinated. I panicked often and took impulsive decisions with disastrous consequences (like turning the conical sauce dispenser upside down to see what was blocking one of the nozzles….I overshot the sauce-to-burger ratio that shift). I felt a bit of a joke and a buffoon, I was embarrassed to say I was a Medical student. I just quit in the end, deciding a student loan debt was preferable.
What does your CV look like?
My CV is a long list of jobs lasting two to three years. I quickly realised the institutional environment of hospitals didn’t suit me. Also, I struggled with the medical exams required to be a consultant. I hated multiple choice questions and couldn’t understand the need to learn endless facts and statistics. I liked principles, concepts and ideas. I wanted to understand things, not learn them — there were books, journals and the internet for reference and research. Unsurprisingly, I failed the multiple choice exam for the Royal College of Medicine and couldn’t face another attempt.
I moved into General Practice believing it was a more dynamic, responsive and innovative organisational model to deliver Medicine. There was something authentic, earthy and real about Community Practice. General Practice in the medical profession doesn’t have the same perceived gravitas as a Consultant or Professorial role. Through the culture of medical school training and early hospital jobs, it is often thought to be chosen as a lifestyle preference, rather than a legitimate career path.
Unfortunately I was sued by a patient during my General Practice training. It deeply affected my confidence and was an experience I struggled to reconcile. The claim was relatively small, and the patient suffered no longterm complications, but it was deeply upsetting to think a medication I prescribed caused avoidable, unintended harm.
Dopamine and adrenaline are believed to be depleted agents people with ADHD seek in order to feel pleasure or focus on a task (Scassellati and Bonvicini, 2015). Hence, those of us with ADHD are often drawn to high risk and “thrill-seeking” activities, also sadly, towards chemical agents of addiction. I realise now, I would manufacture internal stress to pump my system with adrenaline. With my sympathetic nervous system fired-up I could focus, manage complex situations and demands. Unfortunately, it also meant tipping into feelings of panic and desperation. On odd occasions I had to excuse myself from a patient to manage an anxiety attack.
I tried various models of the profession: employed and self-employed, but none seemed to fit. Unbeknown to me at the time, and before my diagnosis, I often applied catastrophic, binary thinking when faced with an obstacle. My default position was to quit, rather than consider a number of potential alternatives.
I found it hard to join an organisation and just sit back, and observe. Despite previous experience and awareness, I kept repeating the same pattern of behaviour. Within weeks of joining a new team, I would be proposing system changes. Now, I realise my motivation came from fear for my own safety in the work environment. I needed systems to protect and support me. If I was feeling anxious and overwhelmed I could easily miss important steps in a process, and make rash intuitive decisions without clear reasoning.
Pre-diagnosis I had enough self-awareness to know what made me vulnerable at work. However, trying to change organisational systems is an incredibly exhausting and demanding process. I constantly underestimated the work involved, and would feel resentment over perceived work inequalities. I found it hard to delegate and form alliances within the team. I felt the archetypal disconnected, lone ranger. I was so wrapped up in my own internal turbulence, I had little time to build relationships or empathise with my peers.
I read endless books about effective change management. I believed any failing rested squarely on my shoulders. I recently took a “drivers” questionnaire (Brefi Group Ltd, 2018) and scored high across all domains: try harder, please others, hurry up, be perfect, and be strong. It is no surprise burnout was a common occurrence in my career, and especially within a Medical profession where no agreed threshold between professional responsibility and patient accountability exists.
A turning point came when I attended a careers seminar at the “School of Life” and from the various topics discussed, I mapped my work history. I documented the triggers for change, and realised they always came from a place of stress and negativity. I tended to be pushed away from situations, not attracted or drawn to them.
I realised my passions were in creating, aesthetics, values and principles. I am an academic by nature but believed this to be something nerdy and uncool. I had learned by fear through Medical training, so to rediscover learning from curiosity and interest was a revelation. Unfortunately, re-directing such a vocational career has not been easy. In the early months of leaving my profession I went through an existential crisis. Also, I thought limitless unstructured time would be restorative and healing, only to realise I could not independently manage and prioritise my activities.
How long is the longest you have been in a job?
Over the last four years I have provided appraisals to my General Practice colleagues and it has been my longest job role since University. I am now 44 years old! I work independently and the meetings are agreed between myself and the doctor. The time it takes can be relatively flexible according to the need of the individual, and I enjoy the process of written reflection. There are some mandatory boxes to tick and hoops to jump, but the engagement with colleagues is generally rewarding when I see their personal growth emerging.
There are three principles we often seek in work for satisfaction: autonomy, competence, and relatedness (Reis et al. 2000). I see the value in the work I offer because my colleagues continue to serve the General Public despite sometimes facing hostility, suspicion and mistrust both within the NHS and from patients. I probably spend more time than necessary over the process, but it is my way of “giving back” within a role I am currently able to manage and sustain.
What would be your ideal job/career?
My ideal job/career would be portfolio based. I now want to be an independent contractor. I recognise I do not fit well into corporate machines and office-based environments. I enjoy helping people discover themselves and learn new strategies to manage their lives.
I spent two years at Art College and attended evening classes. Every time I entered the building I would feel a wave of emotion. It was if I was experiencing the sensation of returning home. I felt safe and accepted, the old building breathed patience, experience and understanding. It was worn and damaged, but felt loved all the same. Judgements were relaxed (they never truly dissipate) and mistakes managed as opportunities, not with shame.
Sadly, art is not present in my life at the moment. Childhood values, and upbringing sabotage my attempts; I feel it too indulgent, and I hate having to interrupt and break-off from creative flow. Hyper-focus is not very family-friendly. I still can’t quite manage the risk of feeling guilty and then resentful for breaching pre-arranged plans and time limits, so better to avoid altogether….I’ll leave you to consider how that is working out! I have a strong “Obliger”trait (Rubin, 2017) and need to find an accountability vehicle to make artistic expression a validated exercise.
Have you received any reasonable adjustments?
Since diagnosis I have not been in a work situation where I would require reasonable adjustments. I left my clinical medical career just over two years ago with another episode of burnout and the realisation I couldn’t face another cycle again. It happened before my diagnosis.
I am not sure how a small business such as General Practice would accommodate my condition. In an ideal world I wouldn’t be required to provide an on-call/duty doctor role. This is where a person is assigned to manage unexpected and urgent issues for the day, but often alongside routine, scheduled work. People with ADHD can be good at managing emergencies but in General Practice it is often about prioritising work that can arrive simultaneously such as: an important medication not dispensed, a serious blood test result, a late afternoon home visit, a hospital investigation needing action……and don’t forget the waiting room full of people because you are running late.
I would require more catch-up time between appointments to accommodate a certain level of disorganisation and time management issues. With my inability to say “no”, and constant curiosity for innovation and change, I would need a firm colleague to supervise my work. Although quite an experienced doctor, I was corroded with years of uncertainty and self doubt by undiagnosed ADHD. I needed a lot of reassurance and feedback on my clinical performance that is not part of established culture due to time pressures and workload.
I think with all the adjustments, I would not feel like an equal member of the team. My ADHD would make me conscious I was working with a disability, and not a strength. I would worry I might become a burden and liability, rather than an asset. I would also need to reduce my earnings to accommodate the additional time requirements; unless I was experiencing a lot of pleasure and reward from the work, I don’t think it would prove worthwhile after deductions for tax, pension, medical defence fees, and professional registrations.
What was your worst work experience and why?
As part of my research into ADHD there are associated issues people can face with the condition. These include: Oppositional Defiant Disorder (ODD) and Rejection Sensitivity Dysphoria (RSD). I have come to accept the many contradictions of ADHD. For example, I can be impulsive, suffer strong emotions, and hence risk saying something hurtful or thoughtless. However, I am also extremely sensitive. I absorb emotions expressed from others, and sometimes risk losing myself in their moment.
Working with sensitive colleagues was my worst experience, but also aided my self-awareness. Low self-worth and self-esteem can be dangerous in a work environment. Your belief that what you say is unimportant, unheard and dismissed can lead to reckless comments and behaviour. I was unnerved that someone valued my thoughts and opinions to such an extent that it actually caused them personal distress.
However, it is difficult navigating the terrain of a sensitive individual. I likened it to “emotional censorship”. The effort of vetting and double-checking every opinion and idea for a potential negative response is exhausting and frustrating. I value authenticity, and grew-up in a family environment where true meaning was gleaned through sub-text and nonverbal leakage. Living in an environment of constant second-guessing, doubt, and uncertainty brought back challenging memories.
What positive things do you bring to the work place?
If I manage myself well with “healthy” stress, and keep feelings of overwhelm in perspective, I can bring ideas and solutions to complex problems. I am autonomous and self-motivated in the early stages of a project, and can get a large amount done in a short space of time, but usually need assistance to see things through to completion. My sensitivity is both a strength and an Achilles heel. In the right environment I can be thoughtful and compassionate towards colleagues, but under stress tend to withdraw and become critical.
What is the most important advice you could give someone with ADHD about work?
Know your condition inside-out. Insight is not a common strength for people with ADHD (Meaux, et al. 2009). Can you name your emotions when they happen? How much influence do your feelings have on your decision making? Can you separate facts from that internal voice? Building self-awareness will help determine what is in your power to change, and what needs to be present in your environment to keep you safe, satisfied, and connected with colleagues.
I find regular alarms, although irritating, keep me checking-in with time and where I am supposed to be. Reducing interruptions, and distractions makes a big difference. This includes: turning off mobile devices, using ear-plugs (either noise reducing, or noise cancelling), and having visual prompts/reminders to keep on-track.
Hyper-focus is unforgettable, and if work can tap into my ability to move into this zone, I get a lot more satisfaction.
Celebrate success. ADHD people can be very dismissive of achievements. I found it was usually because I had already moved on to something else, or I considered it a twist of fate. It doesn’t feel culturally comfortable to make a noise about achievements (we all like humility and self-deprecation), but a celebration could involve something private and personal. I became so accustomed to my short comings, and negative thinking, I felt uncomfortable to say “Well done, Adrian”. It’s risky to seek external praise for validation, but if it comes unsolicited your way — make sure to embrace it, rather than dismissing with embarrassment.
What is your story? Please share with us what you have learned on your ADHD journey.
References
Brefi Group Limited. 2018. [Online] Available at: https://www.brefigroup.co.uk/acrobat/drivers.pdf. [Accessed 3 Feb 2019].
Meaux, J.B., Green, A. and Broussard, L., 2009. ADHD in the college student: A block in the road. Journal of psychiatric and mental health nursing, 16(3), pp.248–256.
Reis, H. T. et al. 2000. Daily Well-Being: The Role of Autonomy, Competence, and Relatedness. Personality and Social Psychology Bulletin, 26(4), pp. 419–435.
Rubin, G. 2017. The Four Tendencies. Two Roads, London.
Scassellati, C. and Bonvicini, C., 2015. Role of dopaminergic and noradrenergic systems as potential biomarkers in ADHD diagnosis and treatment. ADHD-New Directions in Diagnosis and Treatment. InTech.
The School of Life London. 2019. Home. [online] Available at: https://www.theschooloflife.com/london [Accessed 3 Feb. 2019].
