Kevin Antshel, PhD, ADHD in AdultsOccupational impairments are one of the most common outcomes for adults with ADHD. As a function of ADHD symptoms and associated problems such as psychiatric comorbidities and executive function impairments, adults with ADHD often experience difficulties finding and maintaining jobs and are at increased risk for being unemployed or underemployed. Given the variety of outcomes that are associated with occupational functioning (e.g., quality of life, socioeconomic status and subsequent healthcare access, etc.), efforts to understand ADHD in the occupational setting represent a clinically significant topic. Despite being an environment in which adults with ADHD spend considerable time, very few existing studies have considered how the occupational environment impacts ADHD.

A very recently published paper1 fills this void and examines how young adults with ADHD perceive their occupational environment and the extent to which this environment influences their ADHD symptoms. Using a qualitative research design, one of the primary research questions that the authors investigated was the extent to which certain occupational settings are a better fit for young adults with ADHD. The participants in this study all were young adults with well defined ADHD that was diagnosed in childhood. All participants were ascertained from the Multimodal Treatment Study of ADHD (MTA)2 and were approximately 24 years of age at the time of their qualitative interview.

The majority of young adults with ADHD reported a connection between occupational environments and ADHD symptoms. While certain work environments intensified ADHD symptoms, other work environments ameliorated symptoms. The importance of the “goodness of fit” between occupational environment and person was a consistent theme that emerged from the qualitative interviews. A view that problems were environmental, not personal, helped to reduce feelings of inadequacy. The young adults with ADHD commonly reported that a highly stimulating environment provided the best person-environment fit. A highly stimulating environment was further operationalized as consisting of some of these elements: stressful work that is novel and requires multitasking, working in a busy and fast-paced environment, completing work that is physically demanding or hands-on in nature, and/or working on tasks that are intrinsically interesting.

The authors concluded that ADHD symptoms are occupationally context-dependent; work environments may either increase or decrease ADHD symptoms dependent upon the “goodness of fit”1. The authors further assert that future research should consider the effectiveness of occupational “fit” as a potential intervention. In my own clinical experiences, I can relate that person-environment fit indeed has a salient impact upon symptom and functioning levels. As I commonly tell parents of children with ADHD, “there is no better intervention than a great teacher who understands your child”. These recently published data suggest that the same principles may hold for young adults, albeit with a different environmental context. This paper is important and reinforces the notion that context “matters”. Rather than ADHD being static, it is more accurate to view ADHD as dynamic and an interaction between the person and the environment.

Similar research has been published in outlets that are likely not familiar to mental health professionals. In the entrepreneur literature, several recent papers have been published on the association between entrepreneurship and having an ADHD diagnosis3 or elevated ADHD symptoms4,5. These research groups have demonstrated positive relationships between ADHD and entrepreneurial intentions (commitment to performing a behavior that is necessary to start a business venture) and the link between ADHD and entrepreneurial orientation (generally considered to be the level of innovation, creativity, proactiveness and risk-taking that an individual possesses). These three studies as well as a case study6 suggest that it is hyperactivity-impulsivity symptoms, not inattention symptoms, that are positively linked to entrepreneurship. Similar to the MTA ADHD researchers described above, these entrepreneurship investigators also concluded that the functional outcomes associated with ADHD are dynamic and context-dependent.

While these entrepreneur data are interesting, much research remains to be done regarding the association between ADHD and entrepreneurship. For example, the existing studies have methodological constraints (e.g., the variance of entrepreneurial orientation explained by ADHD symptoms is low, common method bias [relying exclusively on self-report], etc.). Likewise, these entrepreneurship papers have considered entrepreneurial orientation and intention, not entrepreneurial success. Thus, future work should consider the extent to which individuals with ADHD experience successful outcomes as entrepreneurs. For example, in which industry and contexts/situations (e.g., managing finances, developing a new product, marketing, etc.) might individuals with ADHD experience entrepreneurial success? My suspicion is that there will be no, “one size fits all” conclusions. In other words, the entrepreneurship success is context-dependent and varies widely among adults with ADHD. The exciting part of this line of investigation, however, is the seismic shift in focus: conventional workplace liabilities associated with ADHD may emerge as abilities in an entrepreneurship context.
 

References
1. Lasky AK, Weisner TS, Jensen PS, et al. ADHD in context: Young adults’ reports of the impact of occupational environment on the manifestation of ADHD. Social science & medicine. 2016;161:160-168.
2. MTA Collaborative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Archives of general psychiatry. 1999;56(12):1073-1086.
3. Dimic N, Orlov V. Entrepreneurial Tendencies Among People with ADHD. International Review of Entrepreneurship. 2014;13:187-204.
4. Thurik R, Khedhaouria A, Torrès O, Verheul I. ADHD symptoms and entrepreneurial orientation of small firm owners. Applied Psychology: An International Review. 2016;65:568-586.
5. Verheul I, Block J, Burmeister-Lamp K, Thurik R, Tiemeier H, Turturea R. ADHD-like behavior and entrepreneurial intentions. Small Business Economics. 2015;45:85-101.
6. Wiklund J, Patzelt H, Dimov D. Entrepreneurship and psychological disorders. Frontiers of Entrepreneurship Research. 2014;34:50-59.

Kevin Antshel, PhD

About Kevin Antshel, PhD

Kevin Antshel, PhD is the Director of the Clinical Psychology Program and ADHD Lifespan Treatment, Education, and Research Program at Syracuse State University. He is also Associate Professor of Psychology at Syracuse State University, and Adjunct Associate Professor in Psychiatry at SUNY Upstate Medical University.