Literature Review on "Interventions That Improve the Workplace"

Literature Review 20 pages (5597 words) Sources: 2

[EXCERPT] . . . .

1) Since adults in the workplace are under the expectations that they will function in an independent manner with little supervision "…ineffective self-management and organizational strategies create many problems with potentially serious consequences. Students encountering academic difficulties may have access to support in the form of tutoring, or buffers, such as an interesting course, a positive connection with a teacher, or participation in extracurricular activities, each of which may promote a sense of confidence and competence. Even when facing extreme educational difficulties, students with ADHD may take heart from the knowledge that, should all else fail, if they can just stick it out, they will eventually reach the end of the semester or school year and be able to start over with a new teacher and a clean slate." (Ramsay, 2010, p.1) However, for workers with ADHD "the consequences of impairment in the workplace can be particularly damaging. Although there is flexibility inasmuch as adults can choose to leave an unsatisfactory job for a better one, costs may be associated with starting over, such as loss of seniority, a cycle of being stuck in entry-level positions, and potential disruption in other aspects of life, such as loss of health care coverage and relocation costs." (Ramsay, 2010, p.1)

While students have support services that are accessible workers with ADHD do not have these types of support services and exacerbating the problem with that adult workers with ADHD "…have the added responsibility of organizing and managing personal affairs, including supporting their families. Thus, workplace impairments stemming from adult ADHD have significant ripple effects." (Ramsay, 2010, p.1) In addition, even though there is a great deal of new research that highlights the underperformance at work of adults with ADHD there is not any empirical guidance in relation to approaches for assisting adults with ADHD in their choice of occupations or interventions to improve their performance in the workplace. Interventions are however, presently being researched and reported. It is reported that commonly used non-pharmacologic interventions are those listed in the following table.

Figure 2: Evidence-Based Use of Nonpharmacologic ADHD Interventions in Specific Patient Groups

Intervention

ADHD Patient Group

Children

Adolescents

Adults

Psychoeducation1

Behavior modification

Cognitive behavioral therapy1

Coaching/skills training

School/workplace accommodations

Source: ADHD and You (2013)

Setting target goals involves setting personalized goals stated to begin with a "thorough interview process to understand which desired behaviors and outcomes each patient and his or her family value most." (ADHD and You, 2013, p.1) In children behavior modification is used however, in adults cognitive behavioral therapy is reported to work well in managing symptoms. The cognitive behavioral therapy program indicates the five components as necessary for addressing ADHD difficulties in adults:

(1) Neurocognitive skills: for example, learning strategies to improve attention control, memory, impulse control, and planning;

(2) Problem solving: for example, developing skilled thinking, problem identification, consequential thinking, managing conflict, and making choices;

(3) Emotional control: for example, managing feelings of anger and anxiety;

(4) Social skills: for example, recognizing the thoughts and feelings of others, empathy, negotiation skills, and conflict resolution; and (5) Critical reasoning: for example, evaluating options and developing effective behavioral skills ADHD Coaching. (ADHD and You, 2013, p.1)

Coaching

ADHD coaching is reported as "…an emerging field that seeks to address the daily challenges of living with the disorder. An ADHD coach helps patients learn how to manage the nuts and bolts of daily life (eg, paying bills on time) in an organized, goal-oriented, and timely fashion. A coach accomplishes this by teaching ADHD patients practical life skills and ways to initiate change in their daily lives." (ADHD and You, 2013, p.1) The provisions of coaching are those of encouragement, recommendations, and feedback, which serve to "teach practical techniques such as reminders, questions, and calendar monitoring…[and]…develop strategies to help patients address time management, eliminate clutter in the home or office, and become more effective in their personal and professional life." (ADHD and You, 2013, p.1)

Included among the life skills the individual may acquire through ADHD coaching are the following:

(1) How to maintain focus to achieve desired goals;

(2) How to translate abstract goals into concrete actions; and (3) How to build motivation and use rewards effectively. (ADHD and You, 2013, p.1)

It is reported that an important part of the ADHD coaching process is regular meetings whether these occur in person, via the phone or email. This type of interaction enables the coach to learn how ADHD symptoms influence the individuals' daily life and enables the coach in tailoring their "encouragement, recommendations, feedback, and practical techniques to address specific challenges faced by the patient." (ADHD and You, 2013, p.1)

It is shown in research that ADHD coaching is beneficial for adults. Individuals who are "mature…[and]…motivated…[and]…who are ready, willing, and able to spend the time and energy necessary to create strategies for improving their behavior and who steadfastly adhere to those strategies may benefit from coaching." (ADHD and You, 2013, p.1) It is reported that patient who are giving consideration to coaching "…should be informed of the following caveat: Coaching is not therapy. Coaches address the challenges of daily life -- they focus on what, when, and how, not why. They are not trained to address psychiatric, emotional, or interpersonal challenges; these issues fall under the purview of mental health professionals." (ADHD and You, 2013, p.1)

ADHD symptoms in the workplace should be addressed with the following strategies:

(1) Take steps to decrease distractibility: The patient may consider requesting a private office or quiet cubicle, or he or she may find it helpful to take work home or work when others are not in the office. Another key strategy is to perform only one task at a time; another task should not be started until the current one is done.

(2) Learn how to limit impulsivity: Adults with ADHD who struggle with impulsivity or temper outbursts in the workplace may benefit from learning how to anticipate problems that regularly trigger impulsive reactions and develop routines for coping with these situations. Practicing relaxation and meditation techniques may also help.

(3) Channel hyperactivity: A patient with ADHD may find it helpful to take intermittent breaks to move around, exercise, or take a walk. During meetings, taking notes may help to prevent restlessness.

(4) Outsmart a poor memory: To counteract forgetfulness, adults with ADHD can try writing checklists for complicated tasks; using a day planner, smart phone, or other PDA device to keep track of tasks and events; setting up reminder announcements on the computer; and writing notes on sticky pads and putting them in highly visible places.

(5) Avoid the opportunity for procrastination: Having a firm deadline in place can help prevent a patient from continuously delaying completion of a project. Tasks can be broken into smaller pieces, with small rewards along the way (eg, a walk to the coffee shop). The patient may also want to consider working on a team with a coworker who manages time well. (ADHD and You, 2013, p.1)

Another publication states the following strategies for the adult with ADHD in the workplace:

(1) Set aside daily time for organization: Set aside ten to fifteen minutes each day to clear ones' desk and organize ones' paperwork. Experiment with storing things inside ones' desk in bins so that the desk is not cluttered and the workspace is not filled with storing things inside your desk or in bins so that they don't clutter your workspace as unnecessary distractions;

(2) Use colors and lists: Color-coding can be very useful to people with ADD/ADHD. Manage forgetfulness by writing everything down;

(3) Prioritize: More important and least favorite tasks should be done first. Set deadlines for everything even if they are self-imposed;

(4) Let your workmates know you need to concentrate, and try the following techniques to minimize distractions.

(5) Where one works matter: If one does not have their own office, they may be able to take your work to an empty office or conference room. If one is in a lecture hall or conference, they should try sitting close to the speaker and away from people who chat mid-meeting;

(6) Immunize external commotion: Face your desk towards a wall and keep workplace free of clutter. Discourage interruptions by hanging a do not disturb sign and let voicemail pick up phone calls to be returned later;

(7) Save big ideas for later: write ideas on paper for consideration later on. (All One Health, 2013)

Suggestions that are stated for coping with the symptoms or impairments of ADHD in the workplace include the following:

(1) Distractibility -- This is one of the biggest challenges in the workplace and such that can be addressed with the following strategies:

(a) Request a private office or quiet cubicle, or take work home or work when others are not in the office.

(b) Use "white noise" earphones, classical music or other sounds to drown out office noises.

(c) Work in unused space, such as a conference room, where distractions are few.

(d) Route phone… READ MORE

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