Attention deficit hyperactivity disorder (ADHD) has huge organizational and individual costs. For employers, it means workers who are mentally exhausted, have difficulty functioning, are constantly procrastinating and need the stress of last-minute deadlines to complete tasks. For individuals, it means underperforming, errors, lots of sick days and job losses.
“ADHD is an area where pharmatherapy is extremely important,” said Dr. Martin A. Katzman, clinical director, START (Stress, Trauma, Anxiety, Rehabilitation and Treatment); assistant professor at the University of Toronto and the Northern Ontario School of Medicine; as well as an adjunct professor in the Department of Psychology at Lakehead University and at the Adler School of Psychology in Toronto. “When people suffering with ADHD take the right medication, they do better.”
Dr. Don Duncan, clinical director at BC Interior ADHD Clinic, agrees. “Individuals with ADHD typically report lower productivity because of their ADHD in the workplace,” Duncan said.
“In fact, two-thirds of them felt that they weren’t living up to capacity in the workplace. Only about five per cent thought that they were fully functioning in the workplace and that’s of course individuals on, versus off, medication,” said Duncan, referring to the Benefits Canada 2013 study of ADHD in the workplace.
However, while many are prescribed the right medication by their physicians, some pharmacists are switching patients to a cheaper generic version that may not be cost-effective in the long run. Health Canada allows a medication to be switched with an available bioequivalent—or a generic version, said Katzman. He explained that, in some cases, generic versions do not work as well as the name brand, and this is especially true with the leading ADHD medication. “When you get medications that do not work as well, you get poorer returns to work or people who return but don’t stay,” he said. So, the cost to the individual is also a cost to the company in missed time and reduced productivity.
Katzman is now conducting an in-depth mental health survey that includes questions regarding medication switches. One of the early findings is that only 42.15% of respondents said their symptoms stabilized after switching back to the originally prescribed medication, suggesting there are long-term consequences when patients are switched to the generic, which is described as bioequivalent but may not be therapeutically equivalent.
“Bioequivalence is not the same as clinical equivalence,” said Duncan.
But treating employees with ADHD is not just about medication, he said. It’s also about accommodation. For example, letting the employee work in a quieter space. “Companies love to put people in cubicles to encourage a ‘cross-pollination of ideas,’” said Katzman. “But if you have an attention problem, that shuts you down completely. So you have to take work home or work in the coffee shop, and that’s not a good idea.”
Cognitive behavioural therapy and coaching can also be extremely helpful, he added, but access to these services can be limited, even for employees with a health plan. “Often, they either aren’t covered or are covered for say $200 over six sessions. But a psychologist may charge upwards of $200 for a single session. “
As a result, organizations are handicapping themselves in not getting the patients on disability the best treatments. Even if the patients return back to the workforce, he concluded, their performance may not be at what it could. Ultimately, Katzman suggested, “…these illnesses destroy people’s lives, destroy the workplace and destroy the economy, and we all end up paying for it.”
Katzman presented on this topic at the Toronto Mental Health Summit on Nov. 12, 2015, and Duncan presented on it at the Vancouver Mental Health Summit on Dec. 8, 2015.
All the articles from the event can be found in our special section: 2015 Mental Health Summit Coverage.