A Context for Normalizing Impulsiveness at Work for Adults with Attention Deficit/Hyperactivity Disorder (Combined Type)

Abstract

Impaired executive function and impulsiveness or intolerance to boredom in adult attention deficit/hyperactivity disorder (ADHD) are thought to compromise performance at work. Several task parameters help people with ADHD to perform better on computerized cognitive tasks, namely reduced response-to-stimulus interval, discriminative feedback, or a format resembling a videogame. However, still very little is known about how these contexts might be helpful in a real work environment. We developed a computerized task resembling a fast-paced videogame with no response-to-stimulus interval and constant and diverse discriminative error feedback. The task included several measurements of high-order executive function (planning, working memory, and prospective memory) formatted as a single multitask simulating occupational activities (SOA). We also administered the Continuous Performance Test-II (CPT-II), a very simple vigilance task without discriminative feedback and with long response-to-stimulus intervals. We tested 30 adults answering to DSM-IV criteria of ADHD (combined type) and 30 IQ-matched adults without ADHD. As has been reported many times, the ADHD participants made significantly more errors of commission than the control participants on the CPT-II, whereas the two groups made the same number of errors of commission on the SOA. The ADHD group also sought discriminative feedback significantly more actively on the SOA than the control group and performed at par with the control group in all respects. There was no speed/accuracy trade-off, nor was there any evidence of other costs of normalization on the SOA. Impulsiveness in adult ADHD is compensable on a task simulating the work environment.

ADHD in context: Young adults’ reports of the impact of occupational environment on the manifestation of ADHD

“…Delisle and Braun, 2011). Much like our subjects describe, situations that are particularly motivating—fast-paced, challenging, novel—have been shown in laboratory settings to improve performance and reduce symptoms in these individuals.…”

“…This model hypothesizes that, rather than a static “attention deficit” in all contexts, affected individuals have a higher threshold for “motivational salience,” becoming bored easily when performing uninteresting or menial tasks (Delisle and Braun, 2011, Sonuga-Barke, 2005). Thus, “ADHD is not characterized by an inability to sustain attention, but rather by the inability to appropriately regulate the application of attention to tasks that are not intrinsically rewarding and/or that require effort” (Kaufmann and Castellanos, 2000, p. 624).…”

“…Altering neuropsychological tasks to make them more stimulating can improve performance and decrease symptom severity in children and adults with ADHD, making them appear indistinguishable from controls (Delisle and Braun, 2011, Liddle et al, 2011, Slusarek et al, 2001, Bennett et al, 2006, Strand et al, 2012). For example, in one study (Delisle and Braun, 2011) adults with ADHD were tested on two computer-based cognitive tests. The first was a basic vigilance test; the second, a rapidly-paced simulation of work tasks with frequent performance feedback.…”

Return to Work in Mild Cognitive Disorders

“…Generally, most adults with ADHD will manage best in an environment that provides some fl exibility within the context of a clear structure and set of rules to follow (Barkley 2010 ). Clinical observations (Barkley 2010 ;Murphy 2005 ;Nadeau 1997 ) and results of a simulated workplace experience (Delisle and Braun 2011 ) have suggested that adults with ADHD perform best in occupations that have constant action demands rather than understimulating or repetitive work. The externally generated cues of a more lively setting can provide much-needed stimulation and also help to structure one's activities, thus reducing the need to organize and initiate activities independently.…”

“…At the same time, a balance is required to avoid overstimulation as clinical observations suggest that stress has the potential to worsen ADHD symptoms (Nadeau 1997 ). Also pertinent is having some clear means to evaluate work performance as adults with ADHD were more likely to seek out discriminative feedback in a workplace simulation experiment (Delisle and Braun 2011 ). Incentives and rewards may be particularly important to adults with ADHD; if not directly built into the job, it may be helpful to set up a feedback system, perhaps with a close mentor or supervisor, to provide such tangible rewards to help structure and prioritize their work.…”