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It happens all the time. The father of a young girl I just diagnosed with ADHD, Inattentive Type, takes me aside and confides that he may have the same challenges as his daughter. He also has problems with executive function — getting organized and planning projects. He asks if he might meet with me to discuss what can be done about his executive function problems.
When one father — whom I will call Alex — and I met, he told me his story. Alex had an M.D. and a Ph.D. Medical school had been easier for him than his current job, because everything was organized and had specific timelines. However, it took him forever to finish his Ph.D. dissertation and to submit it. He now worked for a large pharmaceutical company, which he had been with for 12 years. Over the past three years, he has been passed over twice for a promotion.
"I have published over 100 articles in professional journals," Alex told me. "I speak at national meetings, and I was elected president of my national professional society. Yet I keep getting passed over for a promotion."
It wasn't just the title and recognition that was important to him. It was the salary increase that went along with the promotion. He felt stuck where he was, receiving only a cost-of-living increase for years. His three children were getting older, and family expenses were growing.
Alex explained that, each year when he was considered for advancement in his company, the professional qualifications board supported the promotion, but the administrative personnel voted no. They said that he never turned in his activity and expense reports with the necessary receipts. His time sheets weren't completed correctly either. They questioned whether he could handle the organizational tasks required of a chief of a section, and asked, "If he can't handle the responsibilities of his current job, how could he manage a more complex job?"
"I listened to you describe my daughter's symptoms and realized that she got her problems with organization and time planning from me," Alex said. Was there anything that could be done to help him? I put him in touch with an ADHD coach who worked on organization with adults. She helped him set up charts and timelines. They worked together, using time-management software, to monitor what needed to be done, when, and where it had to be routed. If he did not check "done" in a timely way, he was reminded to do it by his computer, his smartphone, and his coach. The coach went to his office to help him organize and set up similar programs for other tasks. She monitored his progress by calling him every day.
Alex saw the benefits of these efforts. But he could no longer afford to pay the coach. "She's great," he said, "but I can't afford her." I told him about Section 504 of the Americans with Disabilities Act (ADA). It states that if an individual is qualified for a job but has a disability that interferes with specific tasks required to be successful in the job, the employer is required to provide the necessary accommodations to enable the individual to succeed.
We agreed that Alex should request that the company pay his expenses for the coach under Section 504 of the ADA. You can guess what the company's response was: "No. What does the coach have to do with your job performance?" With the help of his coach, and guidance from an attorney familiar with disability law, he prepared a document that he submitted to his company's human resources department. After consideration (perhaps concern that the company might be sued), HR agreed that the coach's guidance was necessary and covered the cost.
Now, with the financial burden lifted off Alex's shoulders, the coach was able to visit his workplace, as well as his home office, to help him develop strategies for addressing his other challenges with organization and time management. Once these programs were in place and the coach's work was done, he called her only when he needed advice or ran into a new problem. The strategies were not complex. When he logged on to his computer each morning, he saw a list of tasks and timelines. Before he went to sleep each night, he checked his list of "things that were done" and updated the list of "things to be done." When he traveled, all pieces of paper were put in a large blue folder. When he got home, he sorted the items out and did his expense report.
Alex is doing much better at work. As he puts it, his professional work has always been excellent but now his "daily routines" and an organized paper trail made the administrative personnel happy. "They are happy with me. So I am happy with me," said Alex. He was recently promoted to chief of his research section.
At our last visit, his wife asked if we can work on his life at home next. He is always late. Sometimes he forgets to pick up the kids. He still leaves his clothes, newspapers, and dishes all over the house. He isn't reliable. I sighed and said, "Time to call in the coach for round two."
LARRY B. SILVER, M.D., senior medical advisor to ADDitude, is a child and adolescent psychiatrist in the Washington, D.C., area. His work has focused on the impact of neurologically based disorders on young lives.
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