Adult ADHD - Attention Deficit Hyperactivity Disorder at work

ADHD (Attention Deficit Hyperactivity Disorder) is thought to be a childhood disorder. However ADHD persists in adults in up to 50% of children diagnosed with the disorder. Hyperactivity, impulsivity and inattention; the hallmark symptoms of Attention Deficit Disorder in childhood have been described earlier. In Adult ADHD, symptoms change to reflect the child's development into adulthood. The symptoms related to hyperactivity gradually disappear by adulthood; however, those related to inattention persist. Adults with attention deficit disorder (ADD) are often distracted, and avoid tasks requiring sustained mental effort. This impairs functioning at home and at work.

Adult ADHD at work

Adults with ADHD experience employment impairments at every level; from the initial job search, to the interview and then during the employment itself. People with Attention Deficit Disorder are more likely to be have poor job performance, lower occupational status, less job stability and absenteeism. Men and women with attention deficit disorder earn less money, and are more likely to be unemployed.

Attention Deficit Disorder (ADD) has at times been portrayed as advantageous from a work perspective, as in the Economist, "in praise of misfits". This may be so in certain sectors where

• Hyperactivity and distractability find an outlet in the need to multi-task with multiple apps at a time.
• Impulsivity manifests as risk taking and an apparent fearlessness. 

This works for Attention Deficit Hyperactivity Disorder adults at the entry level of the IT industry. The physical, social and cultural environment help overcome functional limitations of adult ADD. However, the lack of focus, disorganisation and procrastination become evident when they are promoted in the organisation. It is at this mid-career stage that the adult with Attention Deficit Disorder seeks our help.

ADHD friendly workplace adjustments

Symptom	Adjustment
Inattention and impulsivity	Quieter room/positioning in office Flexi-time arrangement Headphones to reduce distractions Regular supervision to maintain course Buddy system to maintain stimulation
Hyperactivity/ restlessness	Allow productive movements at work Encourage activity Structure breaks in long meetings
Disorganisation, procrastination, and forgetfulness	Provide beepers/alarms, structured notes Regular supervision with feedback, mentoring Delegate tedious tasks Incentive/reward systems Regularly introduce change Break down targets and goals Supplement verbal information with written material

Adult ADHD is a treatable medical condition. Medication to correct the underlying neurochemical imbalance is the cornerstone of treatment for ADHD adults. The adverse impact of adult ADHD is experienced by the employee and the organisation. At the organisational level, workplace adjustments can provide a safe nidus for the ADHD adult to function effectively. At the individual level treatment can help reduce the associated emotional problems and absenteeism of adult ADHD.

References

1. Marios Adamou and colleagues. Occupational issues of ADHD adults. BMC Psychiatry 2013, 13:59 doi:10.1186/1471-244X-13-59
2. Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000 May;157(5):816-8.
3. de Graaf R, et al: The prevalence and effects of Adult Attention-Deficit/hyperactivity Disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med. 2008.
   
4. Jane L. Ebeje, Sarah E. Medland, Julius van der Werf, Cedric Gondro, Anjali K. Henders, Michael Lynskey, Nicholas G. Martin, and David L. Duffy. Attention Deficit Hyperactivity Disorder in Australian Adults: Prevalence, Persistence, Conduct Problems and Disadvantage. PLoS One. 2012; 7(10): e47404. Published online 2012 October 10. doi: 10.1371/journal.pone.0047404
5. Schultz S, Schkade JK. Occupational adaptation: toward a holistic approach for contemporary practice, Part 2. Am J Occup Ther. 1992 Oct;46(10):917-25.

Tattoos - true love will never fade

What is the motivation or psychology behind obtaining a tattoo? Tattooing as a form of decorative body art has moved out of the realm of cults and organisations into mainstream society. It is increasingly common to see patients sporting a new tattoo. "Just like that, doctor. My friends were getting one". The Pune magazines reflect this new found art form through full page articles every other week. Driving through the some parts of Pune takes you past at least three studios specialising in the art of tattooing.

Here we are concerned with the psychological aspects of tattooing. As compared to body-piercing, a tattoo is relatively permanent and more deliberate operation. For the moment set aside doubts over hygiene, HIV, and hepatitis.

10 reasons people get a tattoo

1. Beauty, art, and fashion. Tattoos are a means of decorating the body with a permanent fashion accessory. Many tattooed individuals refer to their tattoos as a piece of art. 
2. Individuality. A tattoo fulfils the desire to create a distinct self-identity. The symbols or words embellishing the skin creates a special message that distinguishes the person from others. The individual gains a sense of control over their appearance and identity. We see this especially in teenagers brought in by their parents.
3. Personal narrative. Women recovering from abuse create a new understanding of the injured part of the body. They reclaim possession through the deliberate and painful procedure of body modification. Tattoos have a self-healing effect in this reclamation of the body. 
4. Physical endurance. For some tattoos are a statement about testing their threshold for pain endurance.  
5. Group affiliations and commitment. Body ornaments are a permanent sign of love and commitment. The wish to belong to a certain community or to show affiliation to a particular group is a common reason for getting a tattoo. 
6. Resistance. Tattoos are a provocative protest against parents and society, especially in college students. Body modification has long been associated with subcultural movements and criminal tendencies. Until recently most studies on tattooing were done on prison populations.
7. Spirituality and cultural tradition. Body modifications emphasise personal affiliation to cultures and their spirituality. Esoteric symbols that convey special meaning are tattooed as a permanent reminder.
8. Addiction. Tattoos and piercings possess an addictive character through the release of endorphins. These substances are released in brain areas in association with painful penetration of the body.
9. Sexual motivation. Tattooing is a form of expressing sexual affectations and of emphasising ones own sexuality. 
10. No specific reason. A tattoo may be obtained impulsively on the spur of the moment. Some individuals may be under the influence of alcohol or drugs while acquiring their piece of body art.

Reasons people have a tattoo removed

People are mostly satisfied with the actual design of their tattoo.

Most want their tattoo removed for personal reasons. This occurs when the quest for uniqueness turns into stigma, negative comments, and clothes problems. Poor decision making and subsequent personal regret seem to be frequent motivations for tattoo removal.

An improved sense of self and maturity is another factor. Especially for those who obtained their tattoos for internal expectations of self-identity at an early age. Many are still trying to dissociate from the past and improve self-identity. More than 40% of persons who choose a tattoo to feel unique are disillusioned when their unique product loses its luster and excitement.

Professional/social reasons account for another third of those motivated for tattoo removal. A new job or career is a major motivation. Negative workplace attitudes toward tattoos and perceived interference for a tattooed individual’s achievement is common. There is a perception of lowered credibility, competence, and sociability that diminishes the image of tattoo wearer in the workplace.

The possession risks are more for women than for men. More than two thirds of those seeking tattoo removal are women. Society support for women with tattoos is not as strong as for men. Strong tattoo support from significant others and friends is counterbalanced by negative remarks about the tattoos from fathers, physicians, and the public. Negative responses are also documented among career-oriented women with tattoos. Women still need to deliberately think about controlling the body placement of their tattoos to avoid the possession risks and to increase their own psychological comfort.

References

1. Armstrong ML, Roberts AE, Koch JR, Saunders JC, Owen DC, Anderson RR. Motivation for contemporary tattoo removal: a shift in identity. Arch Dermatol. 2008 Jul;144(7):879-84.
2. Silke Wohlrab, Jutta Stahl, Peter M. Kappeler. Modifying the body: Motivations for getting tattooed and pierced. Body Image 4 (2007) 87–95.