10 Reasons Why ADHD People Burn-Out

Why Are People with ADHD at higher risk of burnout?

Despite its challenges, having ADHD is not synonymous with poor performance, nor is having a diagnosis of ADHD synonymous with having a disability. The prevalence of ADHD in medical schools for example is equal to, or even higher than the population prevalence (~5%), while in lawyers it is significantly higher than the population at 12.5%?[1]. Everyone knows that both med school and law school are notoriously academically competitive to get into, so ADHD has nothing to do with intelligence. Studies have also found higher rates of ADHD in elite athletes (7-8%)?[2] the military (9%)?[3] and the fire service (19.5%)?[4]?[2]. So, ADHD does not come with a lack of work ethic either.? Yet people with ADHD are more likely to underperform compared to their potential and they are at higher risk of burnout than those without ADHD?[5].

So why is this the case?

Before we get into the question of why people with ADHD are at higher risk of burnout, let’s clarify what burnout is.

The World Health Organization defines burnout as an occupational syndrome resulting from chronic workplace stress that has not been successfully managed?[6]. Yip, the WHO says burnout is a problem with the workplace, not a problem with you.

Burnout is not simply being tired or exhausted. There are three dimensions to burnout: emotional exhaustion; reduced professional efficacy and depersonalisation/cynicism. In other words, when you become burnt out, you are so exhausted you can’t do the work even when you try, and you don’t trust that the workplace will do anything about it. ?Burnout can lead to serious health problems including musculoskeletal injuries, and cardiovascular disease [6]. So, it is incredibly important that we do not normalise ‘burnout’ to the point of being no big deal. IT IS A BIG DEAL.

So, if the underlying cause of burnout is an unhealthy work environment, why are people with ADHD at higher risk of becoming burnt out?

Interactions between work factors and individual factors.

It is likely that certain groups of people are more vulnerable to becoming burnt-out. For example, in a Swedish study looking at long term sickness absence due to burnout, over 50% met the criteria for ‘possible ADHD’, and over 70% met the criteria for ‘possible PTSD’?[6].? So, of course that raises questions around underlying psychiatric reasons for burnout, however that doesn’t take the onus off the employer from creating a safe place to work. Let’s shine a little local light on this. It is hard to get an accurate number on adult ADHD diagnoses in NZ but estimates sit at around 1 in 20 (5%). It was reported in 2022, that 0.6% of the adult population in New Zealand was receiving treatment for ADHD?[8] . According to the NZ Health Survey, prevalence of ADHD in children is between 1.5%-3%.? However, recent research in New Zealand reported that 57% of workers reported experiencing symptoms of severe burn-out?[7]. So, it is highly unlikely that it is the ADHD that is causing the burnout, because there are significantly more people reporting burn-out than there are people with ADHD. Non-ADHD people are burnt out too. Half of us! It's the way that we are working that is not working! It’s possible if we improve the conditions for those with ADHD we might just improve working conditions for others as well.

Here are 10 reasons why people with ADHD are more vulnerable to become burnt out.

1.????? Problems with Executive Functioning

Adults with ADHD have more difficulty than others managing time, organizing work, prioritising tasks, following instructions, and regulating emotions. They often exert more energy and work harder just to do basic stuff?[5]. This doesn’t mean they are incapable, but it does mean they will burn through their fuel much quicker.

?2.????? Hyperfocus can lead to workaholism

Hyper-focus is a well-known ADHD trait, but if overused, can become problematic. People with ADHD are more likely to be workaholics?[11]. However, the ability to hyper-focus is not the only reason. People with ADHD often grow up being misunderstood as being lazy, irresponsible or dumb. This can cause them to push themselves to prove these misconceptions wrong, which can lead them to work even harder than neurotypical people. This can be particularly problematic in workplaces that praise and reward workaholic traits. ?

3.????? Inability to Relax

People with ADHD can sometimes thrive in busy high pressure, fast paced workplaces because the stress acts as a stimulant and keeps them going. However, the hyperactivity, inherent in ADHD, means it is often difficult for those with ADHD to relax?[11]. Brain studies have shown that people with ADHD have 138% more ‘background noise’ going on in their brain than non-ADHD people?[12]. Their restless thoughts and behaviours can drive them to continue to work even when they are exhausted, and they struggle to recover afterwards. This failure to relax is like having a hole in your fuel tank. Even when the car is parked, you will be losing fuel.

4.????? Compensatory Behaviours.

Adults with ADHD do a lot of compensating for their shortcomings. For example, they may spend evenings and weekends working to avoid distractions or simply to keep up with their colleagues?[5]. ?This might not be a problem if work environments and work schedules were designed in a way to allow people to do focused, undistracted work, and people felt they did not need to compete to get ahead.

5.????? Perfectionism

As paradoxical as it may seem, many people with ADHD are perfectionists. There are two kinds of perfectionism. The first kind is personal standards perfectionism, which involves setting high standards, and striving for ambitious goals, which can be a good thing. The second kind is self-critical perfectionism, which involves constant self-scrutiny and critical self-evaluation of behaviour, and this is rarely helpful?[7]. People with ADHD are much more likely to have the second kind. They judge themselves harshly when they fall short of their own standards. Yet because of their perfectionism tendencies may also deliver very high-quality work at times, at the expense of their own wellbeing.

6.????? Procrastination

Procrastination is common in ADHD, but it is not laziness, nor is it about hyperactivity, impulsiveness, or lack of urgency. However, forgetfulness may play a role. Research has shown that those with ADHD have reduced prospective memory when it comes to follow through on real life intentions, but not in a controlled environment like a laboratory experiment. E.g. in real life they genuinely may forget what they intended to do, but when it’s laid out in front of them in a lab, they do ok?[13]. It seems the primary driver of procrastination in ADHD appears to be inattention?[5]. They are more easily distracted. So, what’s distracting them? It's not always squirrels (as in the ADHD meme “Hey! – look there is a squirrel!”) or social media, it is possibly fear of failure. People with ADHD may learn to avoid activities where the conditions are not perfectly right to enable them to succeed in order to avoid disappointing themselves, so they put things off as a coping mechanism?[12].

7.????? Time Blindness and Taking on More Than They Can Handle

Due to their impulsiveness, people with ADHD may take on more tasks than they can handle. They say yes to things on impulse, but seem to have time blindness regarding how long things might take?[5]. But not on all types of tasks. On routine tasks, those with ADHD often lose track of time and can be wildly inaccurate in predicting how much time has passed?[15]. However, people with ADHD seem to be more accurate at predicting time in situations that are emotionally charged?[6]. ADHD are highly driven by emotions and outperform Non-ADHD people in emotionally charged situations. That’s why you hear that people with ADHD are good in a crisis. Time blindness is not only an ADHD issue. Workplaces constantly make inaccurate judgements on how long things will take. Improving that overall might also help ADHD people get a better handle on timelines.

8. Excessive Life Admin

All the things described above, don’t simply have consequences in the workplace, but in all life domains. Symptoms of ADHD are associated with increased risk of stressful life events such as relationship issues, financial problems, legal troubles and challenges with addiction. All these things create a lot of life admin. At times people with ADHD will seem to have more on their plate than they can handle, it might be because they actually do have more on their plate than they can handle?[5].

9. Chronic Fatigue

Coping with the symptoms of ADHD is mentally exhausting. It takes considerable mental effort to ignore environmental distractors, sustain attention, control impulsive urges and manage internal restlessness. One study found that 62% of people with ADHD met the medical criteria for chronic fatigue, compared to 26% in the healthy control group?[16]. Research has shown that adults with ADHD experience greater fatigue after cognitively demanding tasks, such as driving. Driving simulation studies show that under a low level of fatigue, drivers with ADHD appear as capable as non-ADHD controls, however with increasing fatigue, those with ADHD are at more risk of accidents?[16]. However, ADHD medication seems to decrease the risk of accidents and injuries?[18].

10. Co-morbid Psychiatric Problems

Most adults with ADHD meet the criteria for at least one comorbid psychiatric diagnosis?[5]. Substance abuse, mood disorders and anxiety disorders are all common in ADHD. In a 2022 prevalence study on anxiety in ADHD, 56% had some sort of comorbid anxiety – which includes conditions such as PTSD, social phobia and panic disorder. Low self-esteem and low self-efficacy are also common in adults with ADHD. Many have experienced chronic underachievement and continuous negative feedback from others due to the difficulties they have. ?[17]. Being described as “unfocused”, “careless”, “forgetful”, “lazy”, “disorganised” and “messy” takes its toll?[17]. The stigma from ADHD can prevent people disclosing their struggles, so many people don’t recognise their ADHD until their mental health deteriorates to a level that is hard to disguise?[1]. ?

WHAT WORKPLACES CAN DO?

So, what do reasonable accommodations look like for people with ADHD?

Reasonable accommodations for people with ADHD are actually no more than what would be considered good conditions to enable good performance in neurotypical people as well. ADHD people are not asking for additional perks, they simply want reasonable conditions of work. If engineers designed an environment for peak human performance, there is no way it would resemble the traditional open plan, hot-desking set up that has become common place. For people with ADHD who can by hypersensitive to noise and distractions it is a nightmare. Very few people have their best ideas at work because work is rarely designed in a way to allow that to happen.

Here are some things workplaces can do.

1.????? Develop Compassionate Leadership.

Compassionate leadership is not a personality trait. It is a set of behaviours, and it is important whether you have people with ADHD in your team or not, because compassionate leadership protects people from burn-out?[21].

Compassionate leadership includes 4 behaviours. Being present and paying attention to those in your team and noticing when they are struggling. Understanding what is causing distress in your team through regular conversations. Empathising with your team without being overwhelmed by the emotions. Taking thoughtful, skilled, and appropriate action to help relieve their stress of help them cope more effectively?[21].

?2.????? Meaningful Work

Meaningful activities are essential for motivation, and this may be even more important in workers with ADHD. Where possible limit unnecessary tasks or redesign the task so that it becomes more meaningful.

3.????? Positive Feedback and Recognition

Regular positive feedback is important to all people. However, regular feedback can help people with ADHD stay on task. ADHD people appear to be motivated more by immediate reward than non-ADHD people and they are demotivated by delayed rewards?[21]. It is thought this is due, not to personality or preference, but to differences in the activation of reward-recognizing circuits in the?brain?[21].

4.????? A Sense of Belonging

People with ADHD are hypersensitive to social rejection and yearn for a sense of belonging?[19]. Research has shown in brain studies that those with ADHD are more triggered by feeling rejected, and experience greater activation in the emotional parts of the brain?[23]. It’s important for all people to feel seen, understood, and accepted. These are the underpinnings of psychological safety, and psychological safety protects people from burnout, and not just those with ADHD?[26].

5.????? Recognition of Strengths not just Deficits

There is no ‘cure’ for ADHD. While therapy and medication can help. It is unlikely that any amount of performance management will fix the inherent executive functioning deficits in ADHD?[20]. High functioning adults with ADHD, tend to be able to tap into their unique strengths to support and compensate their deficits. People with ADHD have many strengths. Creativity, curiosity, innovation, empathy, energy, proactiveness, flexibility?[20]. No one can do all things well. That’s why we need teams. The mark of a great leader is how they positively influence the success of the whole team, not the few that are easy to manage.

6.????? Role Clarity

It is important to ensure tasks and instructions are clearly defined to prevent people with ADHD going off on a tangent. However, having clear roles and objectives is helpful for protecting all people from burnout?[27]. Poor role clarity is a psychosocial hazard that can lead to burnout whether you have ADHD or not. ?The best thing you can do to help your people feel motivated is to help them feel capable and successful. The best way to do that is set them up for success. Let them know what good looks like. Make sure they get good feedback to keep them on track.

7.????? Realistic expectations around timeframes

Excessive time pressure is a well-known precursor to burnout?[28]. While people with ADHD are vulnerable to time blindness, workplaces constantly make inaccurate judgements on how long things will take. Leaders need to understand their business well and understand their people so they can understand how long things actually take and the pressure it actually puts on people.

8.????? Flexible working

Allowing flexibility regarding when, where, and how they carry out their work is important to allow people with ADHD to find ways to work that bring out their best. This may include taking additional breaks to exercise, eat well, decompress or switch tasks and flexibility to work somewhere where they can focus without excessive distractions.

9.????? Structure and Discipline

People with ADHD will flounder in chaotic workplaces. But they are (paradoxically) great in a crisis. People with ADHD often thrive in workplaces that have a balance of structure and discipline, with frequent novelty and challenge. For example, the military, firefighting, emergency management, medicine and law. In a study in the military, leaders with ADHD were found to succeed in their decision-making, and even exceed the performance of leaders without ADHD when given accommodations. These included having a quiet area to make decisions, and being able to talk through their decision face to face with someone, rather than as a written report?[29].

10. Decrease Stigma and Raise Awareness around Mental Health

Research suggests that understanding the behaviours of someone with ADHD encourages more supportive behaviour in colleagues and reduces criticism?[16] which could be helpful in preventing burnout. Most people with ADHD have other psychiatric conditions, but many people with ADHD don’t get diagnosed until they burnout. Being more aware of signs that someone is struggling can help people feel open to speak out when they are struggling so they get the additional support they need.

?11. Managing Unreasonable Stress

People with ADHD may require more buffers in their workday and work week to manage everything, but they will repay that with greater quality work. So will neurotypical people, because humans perform best in periods of work and rest. It’s important to recognise that chronic stress makes the work situation unsustainable over time whether you have ADHD or not. Its normal to have a stressful day, its normal to have a stressful week. It’s not healthy if every day or every week is stressful.? If your people perceive their job as very stressful or extremely stressful for more than a month that is a problem with your work, not a problem with them. In that regard your organisation is failing in its obligations under the Health and Safety at Work Act (2015).

12. Stop Rewarding Over-working.

Burnt-out leaders build burnt-out teams. If people observe leaders overworking they are learning that to get ahead I must need to overwork too. Leaders can talk all they want about mental health mattering, but if what they show their team is an exhausted, burnt-out version of themselves, no one wins because it becomes a vicious cycle. ?Self-compassion is an important tool for decreasing the risk of burnout, and it is an important skill for leaders to learn to remind them that their wellbeing matters too?[22].

Psychiatrist Ed Hallowell famously describes ADHD as like having a Ferrari brain with bicycle breaks?[30]. If this is the case, then it would be unsurprising that people with ADHD have trouble to maintain balance in stressful settings. By improving conditions for those with ADHD and other neurodiverse people, we have the potential to improve the conditions for all New Zealanders. The Dunedin study famously found that half of new diagnoses of mental illness in young working adults was attributable to work related stress?[30]. If we want to deal with the mental health crisis in this country, we have to deal with work stress. Resilience courses are not going to cut it, EAP is not going to cut it. It’s time to design workplaces to enable people to thrive, whatever their neuro-type.

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