More than half of adults with attention deficit hyperactivity disorder (ADHD) find their symptoms change depending on their environment, new findings show.
“Many noticed that while certain environments amplified difficulties, others seemed to make them disappear,” wrote Arielle K. Lasky, of the University of California at Los Angeles, and her colleagues in the journal Social Science & Medicine. “This led them to believe that their symptoms could be mitigated by selecting environments that were a good ‘fit.’ In contrast to childhood, adulthood offered increased opportunity to select environments that better suited their dispositions.”
The researchers conducted open-ended interviews in 2010-11 with 125 young adults who had been diagnosed with ADHD as children. The participants, 90% white and 24% women, enrolled in a longitudinal study between ages 7-9, and follow-up occurred at 2-year intervals up to 16 years after enrollment.
Of the sample, 55% described their ADHD symptoms as context-dependent. They had trouble focusing on tasks that bored them, but highly engaging or interesting work lessened their symptoms. Many preferred highly stimulating work environments, such as those involving high-stress deadlines or requiring high energy levels.
“Believing the problem lay in their environments rather than solely in themselves helped individuals allay feelings of inadequacy: characterizing ADHD as a personality trait rather than a disorder, they saw themselves as different rather than defective,” the researchers reported. “Viewing their symptoms as contextual shifted some individuals’ conceptualizations of ADHD in another way: rather than seeing it as an overall attention deficit, they characterized the disorder as an issue of interest or motivation.”
Another common theme was an attraction to highly stressful or challenging work, which also alleviated symptoms. Busy, fast-paced jobs, those requiring multi-tasking and frequent new tasks, physically demanding jobs, and jobs with hands-on learning also appeared helpful. “Stressful situations, they explained, forced them to pay attention, overcoming their propensity to become distracted,” the authors wrote. Those individuals describing more difficult environments, however, often found their work did not require enough energy or was simply boring to them.
“It is striking how well these young adults’ accounts align with empirical neuropsychological research demonstrating the influence of context on ADHD,” the authors wrote. “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.”
The findings indicate that assisting adults diagnosed with ADHD find occupations that suit them well could be used as a treatment supplement. “Providing adult patients alternative or adjunctive non-pharmacological interventions is especially relevant in light of the ongoing debate about efficacy of stimulant medication, the typical first-line treatment for ADHD,” the researchers concluded.
Lasky AK, Weisner TS, Jensen PS, et al. ADHD in context: Young adult’s reports of the impact of occupational environment on the manifestation of ADHD. Soc Sci Med. 2016;161:160-168.