Job Accommodation Network

Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Attention Deficit-Hyperactivity Disorder (AD/HD)

What is AD/HD?

Attention deficit-hyperactivity disorder (AD/HD) is a neurobiological disorder that affects three to five percent of American children and adults. AD/HD is usually diagnosed in childhood, and the condition can continue into the adult years. Many individuals with AD/HD are undiagnosed until adulthood (NINDS, 2006).

The common characteristics of AD/HD are impulsivity, inattention, and/or over-activity (DSM-IV, 1994). Although individuals may have both inattention and hyperactivity symptoms, many individuals predominantly display one symptom more than another. Therefore, the DSM-IV identifies three subtypes that can be diagnosed:

AD/HD predominantly hyperactive-impulsive type: The major characteristics are fidgeting, talking excessively, interrupting others when talking, and impatience.

AD/HD predominantly inattentive type: The major characteristics are distractibility, organization problems, problems giving attention to details, and problems following through with instructions.

AD/HD combined type: The individual with combined type meets the criteria for both hyperactive-impulsive and inattentive type.

What causes AD/HD?

Many studies have linked AD/HD to genetics; other studies have suggested that prenatal problems and low birth weight may also be factors (NIMH, 2003).

How is AD/HD treated?

Many adults are prescribed the same medications as children with AD/HD. Examples of medication include stimulant medications such as Strattera, and antidepressants such as Effexor and Wellbutrin (NIMH, 2003).

Most experts agree that treatment for ADHD not be limited solely to the use of medications (NINDS, 2006). Treatment can include behavioral therapy, which can address time management, self-discipline, goal-setting, and decision-making (NINDS, 2006).

AD/HD and the Americans with Disabilities Act

Is AD/HD a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with AD/HD will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such impairment, or is regarded as having such impairment (EEOC, 1992). To be a disability covered by the ADA, the impairment must substantially limit one or more major life activities. These are activities that an average person can perform with little or no difficulty. Examples are: walking, seeing, speaking, hearing, breathing, learning, performing manual tasks, caring for oneself, and working. These are examples only. Other activities such as sitting, standing, lifting, or reading are also major life activities (EEOC, 1992).

Most courts have agreed with the activities listed by the EEOC. For example, in Brown v. Cox Medical Centers, 286 F.3d 1040 (8th Cir. 2002), the court noted that the "ability to perform cognitive functions" is a major life activity. In Gagliardo v. Connaught Laboratories, Inc., 311 F.3d 565 (3d Cir. 2002), the court held that "concentrating and remembering (more generally, cognitive function)" are major life activities (Fram, 2004).

For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with AD/HD

(Note: People with AD/HD may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with learning disabilities will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with AD/HD experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with AD/HD been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with AD/HD to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding AD/HD?

Accommodation Ideas:

Time Management: Individuals with AD/HD may experience difficulty managing time, which can affect their ability to mark time as it passes incrementally by minutes and hours. It can also affect their ability to gauge the proper amount of time to set aside for certain tasks. It may be difficult to prepare for, or to remember, work activities that occur later in the week, month, or year.

Divide large assignments into several small tasks
Set a timer to make an alarm after assigning ample time to complete a task
Provide a checklist of assignments
Supply an electronic or handheld organizer, and train on how to use effectively
Use wall calendar to emphasize due dates

Develop a color-coded system (each color represents a task, or event, or level of importance)
Allow co-worker or supervisor to add entries on the calendar, or to double-check entries added by the employee with AD/HD

Memory: Individuals with AD/HD may experience memory deficits, which can affect their ability to complete tasks, remember job duties, or recall daily actions or activities.

Provide written instructions
Allow additional training time for new tasks
Offer training refreshers
Use flow-chart to indicate steps in a task
Provide verbal or pictorial cues
Use post-it notes as reminders of important dates or tasks

Concentration: Individuals with AD/HD may experience decreased concentration, which can be attributed to auditory distractions (that can be heard) and/or visual distractions (that can be seen). People with AD/HD report distractions such as office traffic and employee chatter, opening and closing of elevator doors, and common office noises such as fax tones and photocopying.

To reduce auditory distractions:

Purchase a noise canceling headset
Hang sound absorption panels
Provide a white noise machine
Relocate employee's office space away from audible distractions
Redesign employee's office space to minimize audible distractions

To reduce visual distractions:

Install space enclosures (cubicle walls)
Reduce clutter in the employee's work environment
Redesign employee's office space to minimize visual distractions
Relocate employee's office space away from visual distractions

Organization and Prioritization: Individuals with AD/HD may have difficulty getting or staying organized, or have difficulty prioritizing tasks at work.

Develop color-code system for files, projects, or activities
Use weekly chart to identify daily work activities
Use the services of a professional organizer
Use a job coach to teach/reinforce organization skills
Assign a mentor to help employee
Allow supervisor to assign prioritization of tasks
Assign new project only when previous project is complete, when possible
Provide a "cheat sheet" of high-priority activities, projects, people, etc.

Social Skills: Individuals with AD/HD may have limitations in adaptive skills, such as communicating with others, or exhibiting appropriate social skills. This might manifest itself as interrupting others when working or talking, demonstrating poor listening skills, not making eye contact when communicating, or inability to correctly read body language or understand innuendo.

Provide a job coach to help understand different social cues
Identify areas of improvement for employee in a fair and consistent manner
Make attendance at social activities optional
Use training videos to demonstrate appropriate behavior in workplace
Encourage employees to minimize personal conversation, or move personal conversation away from work areas
Provide sensitivity training (disability awareness) to all employees
Encourage all employees to model appropriate social skills
Adjust the supervisory method to better fit the employee's needs
Allow the employee to work from home
Adjust method of communication to best suit the employee's needs
Use role-play scenarios to demonstrate appropriate behavior in workplace

Hyperactivity/Impulsivity: Individuals with AD/HD Hyperactivity-Impulsive type may exhibit over-activity or impulsive behavior. This could be disruptive to the work environment or could inhibit efficient and effective work performance.

Provide structured breaks to create an outlet for physical activity
Utilize a job coach to teach/reinforce techniques to control impulsivity
Allow the employee to work from home
Review conduct policy with employee
Adjust method of supervision to better prepare employee for feedback, disciplinary action, and other communication about job performance
Use services of EAP
Provide private workspace where employee will not disturb others by tapping, humming, or fidgeting

Multi-tasking: Individuals with AD/HD may experience difficulty performing many tasks at one time. This difficulty could occur regardless of the similarity of tasks or the frequency of performing the tasks.

Separate tasks so that each can be completed one at a time
Create a flow-chart of tasks that must be performed at the same time, carefully labeling or color-coding each task in sequential or preferential order
Provide individualized/specialized training to help employee learn techniques for multi-tasking (e.g., typing on computer while talking on phone)
Identify tasks that must be performed simultaneously and tasks that can be performed individually
Provide specific feedback to help employee target areas of improvement
Remove or reduce distractions from work area
Supply ergonomic equipment to facilitate multi-tasking
Clearly represent performance standards such as completion time or accuracy rates

Paperwork: Individuals with AD/HD may experience difficulty completing paperwork efficiently and effectively. This is due in part to workplace distractions and difficulty with time management, disorganization, or prioritization.

When possible, automate paperwork by creating electronic files
Use speech recognition software to enter text or data into electronic files
Save time filling out paper forms by completing information in advance, using pre-filled forms, or adhering pre-printed stickers
Use checklists in place of writing text
Supply large quantities of regularly-used forms
Color-code forms for easy identification
Re-design commonly used forms

Use large font
Double space or triple space
Provide adequate space for hand-written response

Situations and Solutions:

A journalist with AD/HD experienced sensitivity to visual and auditory distractions. The employer provided the individual with a private, high-wall cubicle workspace in a low-traffic area. The employer added an environmental sound machine to mask office noise.

A social worker with AD/HD had difficulty completing handwritten paperwork in a neat and timely fashion. The employer created electronic forms for the employee, which allowed him to type responses. The employer arranged computer files labeled by month to help the employee prioritize open cases. The employer also sent email reminders of deadlines.

An office worker with AD/HD experienced impulsivity and often interrupted co-workers by entering offices without knocking. The employer helped identify appropriate techniques for approaching co-workers, such as keeping a daily list of tasks to discuss with others, then emailing or calling to set aside time to talk about work-related projects.

A retail employee with AD/HD often forgot the closing and cash-out procedures, which resulted in missed printouts of daily sale reports. The employer created a numbered checklist that identified each step for proper closing procedures and identified which reports to run from cash registers. This accommodation benefited all employees.

A delivery person with AD/HD had difficulty with time management. She spent excessive time making deliveries and would forget to return to the warehouse between daily runs. The employer provided a personal organizer watch that could be programmed to beep and display a written message many times throughout the day. This auditory and written prompt helped the employee move quicker from task to task, and helped remind her to return to the warehouse to gather her next load.

A teacher with AD/HD experienced disorganization in her classroom due to clutter from many years of teaching. The employer provided a job coach to help the teacher learn organization techniques, to help separate and store items, and to dispose of previous student work and projects from yesteryear.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC.

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved October 28, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

Fram, David. (2004). Resolving ADA workplace questions: How courts and agencies are dealing with employment issues. National Employment Law Institute Publication, 17th edition.

National Institute of Mental Health (NIMH). (2003). Attention deficit hyperactivity disorder. Retrieved February 20, 2006, from http://www.nimh.nih.gov

National Institute on Neurological Disorders and Stroke (NINDS) (2006). NINDS attention deficit-hyperactivity disorder information page. Retrieved August 23, 2006 from http://www.ninds.nih.gov/disorders/adhd/adhd.htm