Adults with attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) often face significant challenges in obtaining and maintaining sustainable employment.
Cognitive difficulties, such as executive function impairments, and sensory sensitivities can make it difficult for them to manage work tasks and adapt to the work environment. Additionally, rigid societal norms and lack of understanding and flexibility in the workplace can create barriers to success.
As a result, individuals with ADHD/ASD are at a higher risk of experiencing chronic stress and autistic burnout/ADHD burnout, which can further impact their ability to sustain long-term employment.
Högstedt, E., Igelström, K., Korhonen, L., Käcker, P., Marteinsdottir, I., & Björk, M. (2023). ‘It’s like it is designed to keep me stressed’—Working sustainably with ADHD or autism. Scandinavian Journal of Occupational Therapy, 30(8), 1280-1291. https://doi.org/10.1080/11038128.2022.2143420
Key Points
- The study identified three main themes related to sustainable work for adults with ADHD or ASD: one’s own cognitive abilities and challenges, enablement by flexibility and acceptance in the work environment, and accumulated stress that makes the work situation unsustainable over time.
- Factors like executive function challenges, sensory sensitivities, social acceptance, well-defined tasks, flexibility in work practices, and long-term stability of support measures significantly affect the ability of individuals with ADHD/ASD to find and maintain sustainable employment.
- The research, while enlightening, has certain limitations, such as selection bias from recruiting only through psychiatry clinics and the heterogeneity introduced by including both ADHD and ASD.
- Understanding the challenges and support needs of adults with ADHD/ASD in the workplace is crucial for promoting inclusive employment practices and individual well-being.
Rationale
Adults with attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) often struggle to achieve a sustainable work situation (Högstedt et al., 2023).
Previous research has shown that about 70% of Swedish adults with ADHD and/or ASD rated their ability to work as reduced (Statistics Sweden, 2021), and more than a third receive sickness compensation compared to 2.4% in the general population (The National Board of Health and Welfare, 2019).
While some studies have investigated the challenges and support needs of this population in the workplace (Scott et al., 2019; Anderson et al., 2021; Schreuer & Dorot, 2017), there is a lack of research addressing the needs of individuals with ADHD/ASD concerning their ability to work sustainably over time, especially in those with clinically confirmed diagnoses (Young et al., 2016; Bennett & Goodall, 2021).
The current study aimed to fill this gap by identifying and describing how adults with ADHD and/or ASD experience their ability to work and what conditions affect their ability to work sustainably.
Method
This qualitative study used individual in-depth interviews with 20 purposively sampled participants with ADHD/ASD.
The interviews were conducted using a 2×2 matrix covering four areas: the person’s view of their own ability to work, their past, present, and future work situation, experiences of previously received support, and desired support for a sustainable work situation.
Data were analyzed using reflexive thematic analysis with an inductive, latent, constructionist approach.
Sample
Participants were recruited through five psychiatric outpatient clinics in south-eastern Sweden.
Inclusion criteria were being 25-40 years old, having a diagnosis of ADHD and/or ASD according to medical records, and no psychosis, ongoing eating disorders, substance use disorder, or intellectual disability.
The mean age was 32 years, and the mean time since diagnosis was 5.5 years.
Several participants had comorbid psychiatric conditions.
Results
Three main themes were identified:
1. One’s own cognitive abilities and challenges
This included subthemes of having the ability to create structure at work, understanding one’s own support needs, and hypersensitivity to sensory impressions.
One participant described: “I have a weekly schedule … the problem is I don’t follow it.” (Participant 14)
2. Enablement by flexibility and acceptance in the work environment
This came with subthemes of being seen, understood, and accepted, having clearly defined tasks and instructions, and permission to choose when, where, and how to work.
“Most important for me is to work from home, given that it costs me so much energy just to transport myself to work and be there physically … open office plans, many people … they want everyone on-site.” (Participant 9)
3. Accumulated stress makes the work situation unsustainable over time
This encompassed subthemes of battling with the system over time and juggling everyday life in a sustainable way.
“It is like it’s designed to keep me stressed and tired, and then it continues when I pick up the kids, and when I get home, and then I go to bed and feel that I am still stressed, and then I know that there’s a new day and it just keeps going like that … ” (Participant 4)
Insight and Depth
This study is particularly informative because it captures the complex interplay between individual challenges, environmental factors, and the accumulation of stress over time that affects the ability of adults with ADHD/ASD to find and maintain sustainable employment.
The findings highlight the importance of individually tailored, flexible, and long-term support measures that consider both work-related and non-work-related factors.
The study also sheds light on the detrimental effects of rigid systems and lack of continuity in support, which can exacerbate stress and lead to burnout in this population.
Strengths
The study had several methodological strengths, including:
- Purposive sampling to ensure a diverse range of experiences
- Confirmation of ADHD/ASD diagnoses through medical records
- Use of a structured interview guide to ensure consistency across interviews
- Rigorous data analysis using reflexive thematic analysis with an inductive, latent, constructionist approach
- Member checking to confirm the relevance of the results
Limitations
The study had some limitations, including:
- Selection bias from recruiting only through psychiatry clinics, which may have excluded individuals not in contact with psychiatric care
- Heterogeneity introduced by including both ADHD and ASD, although this also allowed for a broader range of experiences
- Potential impact of the COVID-19 pandemic on data collection, as some interviews had to be conducted remotely
These limitations may affect the transferability of the findings to the broader population of adults with ADHD/ASD.
Implications
The results of this study have significant implications for supporting adults with ADHD/ASD in the workplace.
The findings suggest that occupational therapists, healthcare providers, employers, and support agencies should focus on providing individually tailored, flexible, and long-term support measures that address both work-related and non-work-related factors.
The study also highlights the need for greater understanding and acceptance of neurodiversity in the workplace and the importance of challenging rigid systems and norms that can create barriers for individuals with ADHD/ASD.
By implementing these changes, we can promote more inclusive employment practices and improve the well-being of adults with ADHD/ASD.
Conclusion
This study underscores the importance of understanding the complex challenges and support needs of adults with ADHD/ASD in the workplace.
The findings reveal the intricate interplay between individual factors, environmental factors, and the accumulation of stress over time that can make it difficult for this population to find and maintain sustainable employment.
While the study provides valuable insights, further research is needed to explore effective interventions and support strategies that can promote long-term success and well-being for adults with ADHD/ASD in the workplace.
It is crucial to acknowledge the sensitivity and complexity of this topic and to approach it with empathy, understanding, and a commitment to creating inclusive and supportive environments for all individuals.
References
Primary reference
Högstedt, E., Igelström, K., Korhonen, L., Käcker, P., Marteinsdottir, I., & Björk, M. (2023). ‘It’s like it is designed to keep me stressed’—Working sustainably with ADHD or autism. Scandinavian Journal of Occupational Therapy, 30(8), 1280-1291. https://doi.org/10.1080/11038128.2022.2143420
Other references
Anderson, C., Butt, C., & Sarsony, C. (2021). Young adults on the autism spectrum and early employment-related experiences: Aspirations and obstacles. Journal of autism and developmental disorders, 51(1), 88-105. https://doi.org/10.1007/s10803-020-04513-4
Bennett, M., & Goodall, E. (2021). Employment of Persons with Autism: A Scoping Review.
Schreuer, N., & Dorot, R. (2017). Experiences of employed women with attention deficit hyperactive disorder: A phenomenological study. Work, 56(3), 429-441.
Scott, M., Milbourn, B., Falkmer, M., Black, M., Bolte, S., Halladay, A., Lerner, M., Taylor, J. L., & Girdler, S. (2019). Factors impacting employment for people with autism spectrum disorder: A scoping review. Autism, 23(4), 869-901. https://doi.org/10.1177/13623613187877
Statistics Sweden. (2021). The labour market situation for people with disabilities 2020. Information about education and labour market (IAM), 2.
The National Board of Health and Welfare. (2019). Konsekvenser för vuxna med diagnosen ADHD: En kartläggning och analys.
Young, S., Adamou, M., Asherson, P., Coghill, D., Colley, B., Gudjonsson, G., Hollis, C., McCarthy, J., Muller, U., Paul, M., Pitts, M., & Arif, M. (2016). Recommendations for the transition of patients with ADHD from child to adult healthcare services: a consensus statement from the UK adult ADHD network. BMC psychiatry, 16, 1-10. https://doi.org/10.1186/s12888-016-1013-4
Keep learning
Below are some suggested Socratic questions for a college class:
- How do the individual challenges experienced by adults with ADHD/ASD, such as executive function difficulties and sensory sensitivities, impact their ability to find and maintain sustainable employment?
- In what ways can the work environment, including social acceptance, task clarity, and flexibility, enable or hinder the success of employees with ADHD/ASD?
- Why is the accumulation of stress over time a significant barrier to sustainable work for adults with ADHD/ASD, and how can this be addressed through support measures and interventions?
- What are the limitations of current support systems and societal norms in accommodating the needs of adults with ADHD/ASD in the workplace, and how can these be challenged to promote greater inclusion and understanding?
- Based on the findings of this study, what recommendations would you make to occupational therapists, healthcare providers, employers, and support agencies to better support the long-term success and well-being of adults with ADHD/ASD in the workplace?
