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ADHD Medications and Treatments

ADHD affects an estimated 3% to 5% of children and adults in the U.S. Dr. Richard Sogn shares information and advice about attention deficit hyperactivity disorder, including its causes, diagnosis, and promising ADHD treatments

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Wednesday, September 20, 2006

ADHD Awareness Day: Careers
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Although ADHD is largely associated with children in school, many adults struggle with ADHD and in particular, struggle in their chosen careers. Since today is ADHD Awareness Day, I thought posting a question and answer from my message board concerning the possibility of ADHD creating career problems would be appropriate. The original question comes from a young lawyer, who writes:
I'm 29 and an attorney. In law school, I began to notice that I was extremely forgetful. I would forget conversations I had with people, things I had to do and places I had to go. I had a lot of difficulty studying and memorizing a lot of my subjects and things got progressively worse as I continued with my studies. However, I found workarounds for many of my "issues" and made it through law school and successfully passed the bar in three states.....

I do not know who to talk to or what to do. I am consistently surrounded by a sensation I can only describe as a "fog". I cannot focus on anything at any time. I lose interest in everything quickly. Things that made me exceptionally happy in the past-- no longer have the same affect. ...

Do any of these symptoms sound like anything that can be rolled into ADHD/ADD? If not-- does it sound like anything else? Who should I consult regarding whatever it is that is wrong with me?
My answer:

I see many lawyers with AD/HD. There are enough lawyers struggling with AD/HD in my state for the state bar to form a support and referral system for lawyers struggling with AD/HD issues in their practice.

Many bright lawyers succeed in law school, but struggle once in practice with the same issues that affect others with AD/HD: inattention and distractibility, planning, organization, time management, and follow through.

They have problems keeping track of billable hours, and might have to stay late at work because it takes them longer to do their work than others. They are stressed from the pressure to perform to make money for the firm, and with increased pressure, AD/HD symptoms increase. They feel overwhelmed and incapable of keeping up.

AD/HD is a lifelong problem, although someone might not have significant problems until the work load increases, such as in law school. When someone has not had lifelong symptoms of AD/HD and starts having them when under a great deal of stress, "pseudo ADD" must be ruled out--meaning symptoms due to stress of daily life. People who are depressed and/or anxious also cannot focus, are forgetful, and cannot keep up with their work load.

I recommend that you see someone who specializes in the evaluation and treatment of AD/HD, as they would be able to sort out possible AD/HD from stress, anxiety, depression, or other factors.

If your general physician doesn't have a referral, you could call the psychiatry department of the nearest medical school for a referral, or check for names of therapists on the CHADD site. In the meantime you might want to read (or listen to the audio tape in your car) either, "Driven to Distraction," or, "Delivered from Distraction," by Hallowell and Ratey.

Related Topics: Suffering in Silence: Women with Adult ADHD, Workplace May Overwhelm Adults with ADHD

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Posted by: Richard Sogn, MD at 4:18 AM

Tuesday, September 05, 2006

Bipolar Disorder: Challenges in the Workplace
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Work is a meaningful part of most of our lives. It not only provides income, but is part of our self-esteem and our self-image, and often provides social interactions and friendships. Work adds structure, routine, and life goals. Returning to work after a bipolar episode is often an extremely important part of recovery. Although most people with bipolar disorder can be successful in their career, and are willing and able to work, workplace challenges may arise because of the stigma of bipolar disorder, the response of employers and coworkers who don't understand, and difficulty balancing fluctuating moods with a stable work life.

The first goal of someone with a mood disorder is to maintain health and mood stability and to prevent future episodes. Staying consistent with medications and a sleep schedule and managing stress are important, but having some type of work allows someone to focus on something besides their problems and can help maintain mood stability. However, finding the right balance between levels of job stress, the number of working hours, job satisfaction, and working within a supportive environment are equally important.

Most people struggle with whether or not to inform their employer or their co-workers of their diagnosis. The standard advice from others with bipolar disorder is often "Don't do it!" However, some employers and co-workers will be empathetic and understand, and others will not and might use it against you. There is no single solution that is best for everyone.

What are the disadvantages of disclosing your diagnosis? A prospective employer might not hire you without telling you why you weren't hired. You might feel that you are being dishonest if you don't disclose your diagnosis when applying for a job, but there is no law that requires you to do so, and it's illegal for an employer to ask about the presence of a disability during a job interview.

Under the Americans with Disabilities Act (ADA), it is unlawful to discriminate against someone with a disability if they can perform the essential functions of their job (have the education, know-how, and ability to do the job), with or without reasonable accommodation. Bipolar disorder qualifies as a disability as it is "a physical or mental impairment that substantially limits one or more of the major life activities of such individual."

Although the law is on your side, proving that your disability was the primary reason you were not hired for a job can be difficult. Not everyone with bipolar disorder needs job accommodations, such as a modified work schedule, and disclosure might not be necessary. You have no way of knowing how a potential employer will react to disclosure of a diagnosis of bipolar disorder. It is up to you to decide whether or not to disclose your diagnosis of bipolar disorder during a job interview.

Other disadvantages of disclosing your diagnosis include dealing with the potential stigma at work, being fired, being demoted, not receiving a promotion, and a possible negative reaction from coworkers. Although many public figures have talked openly about their struggles with bipolar disorder, including Patty Duke, Ben Stiller, Jim Carrey, Robin Williams, and Jane Pauley, the stigma is still there and most employers don't realize the similarity of bipolar disorder to other medical disorders.

Some people who discuss their disorder with employers and coworkers receive empathy, support, and understanding, while others find insensitivity and even outright rejection. Again, you will have to decide whether disclosing or not disclosing your disorder is best for you. In general you should consider disclosing when you feel you'll receive a supportive reaction, or when you fear losing your job if you don't receive the accommodations you need. If you feel that your symptoms are significantly interfering with your ability to work, and if you would benefit from accommodations such as a modified work schedule, the ability to take time off from work to attend medical appointments, or being granted extended leaves of absence for treatment of a manic or depressive episode, it's probably best to discuss your disorder with your employer. A list of the types of workplace accommodations considered reasonable for people with bipolar disorder can be found at the Job Accommodations Network.

If you do decide to disclose your disorder, you'll need to document your disability (a letter from your physician) and describe your needs for particular accommodations. You do not need to disclose your personal medical information to everyone. Your employer is only allowed to disclose your difficulties to supervisors who must know about the accommodations that you require to perform your job. I recommend that you request needed accommodations in writing, including suggestions for alternative accommodations, and request that a meeting be scheduled to discuss your request.

A fact sheet that can help describe bipolar disorder to others can be found here. I also recommend the book, "The Bipolar Disorder Survival Guide: What You and Your Family Need to Know," by David J. Miklowitz, Ph.D.

Related Topics: Workplace Wellness, WebMD Video: Finding the Gene That Causes Depression

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Posted by: Richard Sogn, MD at 2:59 PM

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