I watched with both interest and concern the episode of Insight which aired on SBS TV on Tuesday 16 March 2021(1), in which guests described their experiences of living with Attention Deficit Hyperactivity Disorder (ADHD) as adults or of being newly diagnosed with the condition as adults.       

 I am not an ADHD expert by any means and respectfully refer to and draw on the wisdom of those who are. I am a Certified Occupational Health and Safety (OHS) Professional, and I suspect I’m not alone when I state that through the course of my career, I can count on one hand the number of times I have knowingly dealt with a worker with this condition.  

It’s simply not been on my radar when investigating incidents, assessing and managing risks or providing advice about return to work following injury. I say knowingly because with the wisdom of hindsight I can think of many workers who had red flags to which I was not attuned at that time.  

 The Insight episode reinforced the view that was forming in my mind following a period of research that adult ADHD is under-diagnosed, misunderstood and under-treated, and presents a significant risk for employers and workers if workers with ADHD are not recognised, understood, supported, and managed effectively.  

 This is not to say that workers with ADHD create a hazard that employers need to control, but rather, the employer’s risk management processes must adapt to accommodate the unique needs of the ADHD worker if they are to ensure that worker’s safety and productivity.  

So, do we have an ADHD blind spot in our OHS Management Systems?  

What is Adult ADHD? 


For the sceptics who maintain that ADHD is not a real condition, it has been recognized as such by the Centre for Disease Control and Prevention(2) and the World Health Organisation(3), and its diagnostic criteria have been defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)(4) 

 Whilst technically classified as a mental health disorder that includes a combination of persistent problems such as inattention, distractibility, hyperactivity, and impulsivity, it is perhaps better described as related to neuro-development or a form of neurodiversity. Whilst creating significant challenges, it also produces traits that can be highly advantageous, such as, the ability to hyper-focus on topics of interest, creativity, entrepreneurship, innovation, empathy, spontaneity, and energy.  

 ADHD is known to be about 70 – 80% heritable(5), though there are other environmental, socioeconomic, and pregnancy/early childhood risk factors as contributors.  

 Like many, I had long held the belief that ADHD was a childhood condition that mainly affected boys and which they usually grew out of as they matured – I was wrong. Studies demonstrate that ADHD affects people of every age and gender, and up to 65% of those diagnosed as children will continue to show significant symptoms into adulthood(6) 

 The presentation is very often different between girls and boys and between women and men, and symptoms can vary and fluctuate over time with hormonal influences and life stressors, which makes it a problematic condition to identify and diagnose.  

 To further complicate diagnosis, individuals with ADHD may also have comorbidities such as dyslexia, obsessive-compulsive disorder, opposition-defiance disorder, depression, and/or anxiety. In adults, it is often misdiagnosed as major depressive disorder, treatment-resistant depression, anxiety disorder, or bipolar disorder.  

How prevalent is ADHD in the adult population in Australia? 


A 2019 study undertaken by Deloitte Access Economics(7) estimated that ADHD affects 281,200 children and adolescents (aged 0 – 19) and more than 518,800 adults (aged 20+) in Australia with an economic impact in 2019 of AUS$20.42 billion.  

 Professor David Coghill (Chair of Developmental Mental Health at the University of Melbourne) provided an interpretation in NewsGP(8) of a large, international study by Raman, Man, Bahmanyar, Berard, Bilder, and Boukhris (2018)(9) in which he opined that the data suggested both children and adults are under-diagnosed in Australia, and in fact, in the worldwide adult population whilst around 2.5% of adults have the condition, in Australia only 0.2% are being treated.  

 In other words, the data suggests that only one in 10 adults with ADHD are currently detected and treated. So that begs the question: What is happening with the nine out of 10 adults that have not been diagnosed and are not receiving treatment?  

 When left untreated, ADHD can have serious and far-reaching consequences for adults. Those who are diagnosed with ADHD in adulthood, where it hasn’t been diagnosed in childhood, have a four times higher rate of mortality than those without ADHD. Adults with ADHD that are untreated are much more likely to have problems with substance misuse, they are more likely to smoke and drink as well as take illegal drugs. They are much more likely to be involved in accidents, either as pedestrians or as a driver of a vehicle, because of their impulsive behaviour. (Coghill, 2018)  

Is it a Human Resource issue or an OHS issue? 

 Whilst ADHD is classified as a disability under the Disability Discrimination Act (1992), which brings into play the requirement for employers to make reasonable adjustments to facilitate the equitable employment of people with a disability such as ADHD, the highly individual presentation of the condition, which can span several domains including mental, intellectual, sensory, neurological and learning impairments, creates challenges for employers to know precisely what adjustments to make.  

 Further, the object of this regime is to ensure that employment discrimination does not occur rather than to ensure worker safety.  

 Australian Regulators are increasingly placing a high priority on managing the mental health risks associated with work, and rightly so. Likewise, AS/NZS ISO 45001: 2018 Occupational health and safety management systems – Requirements with guidance for use provides an opportunity for employers to factor in the promotion of the mental health of workers into their occupational health and safety management systems. Many employers have designed and implemented mental health programs to educate, destigmatise and support workers with mental health conditions, and these are usually directed to the big ones, depression, anxiety, PTSD, etc.  

 From my observation, employers tend to view workers with ADHD as an employment equity or anti-discrimination problem for Human Resources to manage under anti-discrimination policies, rather than as individuals who may have an increased risk of physical and psychological injury because of their neurodiversity.  

 If a worker is being treated with one of the common stimulant medications such as methylphenidate (Ritalin) or dexamphetamine, these may be detectable on a drug screen and so act as a disincentive for disclosure by the worker if the employer’s policy is not well communicated or understood.  

 This was the case for a young worker with which I recently became involved, who had come off the medication that had effectively managed his symptoms since childhood because he feared losing his job for failing a drug test, under a new Drug and Alcohol Policy implemented by his employer which mandated random drug and alcohol screening. As a result, as his ability to focus declined, so did his work performance and as his impulsivity and restlessness increased, so did his risk of injury.   

 If a worker is newly diagnosed and has just commenced treatment, the initial adjustment to stimulant medication can result in a temporary increase in risk-taking behaviour and impulsivity of which the employer must be made aware, especially if the worker is engaged in high-risk work, so that those risks can be controlled effectively. 

 Anecdotal evidence indicates that when workers know they have ADHD, whether or not they are receiving treatment for it, the general misinformation that exists in the community (and sadly amongst some clinicians) and fear of stigma and discrimination is creating a barrier to the disclosure of the condition to their employer. 

 Further, based on the statistics identified by Raman et al. (2018), if an employer is aware of one worker who is known to have ADHD, there may very well be up to nine others who remain undetected, undiagnosed, and untreated and therefore exposed to a higher level of risk.  

 It was explained in Insight that whilst the diagnosis, treatment, and support of children with ADHD has improved and there are now good resources available in the education system to facilitate their learning, adults with ADHD are exclusively treated within the private health system, and this can be a barrier to diagnosis and treatment where an individual does not have the financial means for private health care. There are no resources available to treat adults with ADHD in the public health system.  

Red flags of undiagnosed ADHD in adults. 

 If nine out of 10 adults with ADHD are potentially undiagnosed and untreated, how is the employer meant to know who is at risk and who needs support?  

 A diagnosis of ADHD can only be made by a psychiatrist or clinical psychologist with specialist skills and training in this area. There are some helpful self-assessment screening tools that are readily and freely available online, such as the Adult ADHD Self-Report Scale (ASRS-V1.1) Symptom Checklist(10). 

 Whilst it would not be appropriate for employers to require workers to complete a screening test for no reason, where work performance and safety behaviour is identified as an issue for a worker, a supportive conversation with the worker would be warranted, as one would in any other case where there are concerns for a worker’s mental health.  

 There are some red-flag indicators11 that would make you consider the possibility that your worker has ADHD and prompt you to encourage them to consult with their treating medical practitioner in the first instance for assessment and support.  

 The obvious red flags: 

  • They have a child or children with diagnosed ADHD

    – Since the condition is 70 – 80% heritable, if a child has ADHD there is a high probability that it was inherited from one of their parents. Often, the first time an adult becomes aware that they have ADHD is when their child is diagnosed, and they see many of the same traits that led to them seeking a diagnosis for their child, in themselves.  

  • Other known mental health conditions

    – ADHD is often misdiagnosed as depression and anxiety or it can be missed with an individual diagnosed with treatment-resistant major depressive disorder when they fail to respond to antidepressant medication.  It can also exist as a comorbid condition with other diagnosed mental health conditions.  

  • Attention regulation

    – Frequently losing things, forgetting to complete tasks, easily distracted. 

  • Hyperactivity

    – Fidgeting, restlessness, talking too much, doing too much at once. 

  • Impulsivity

    – Interrupting others, making impulsive decisions, being reckless and not considering consequences, and interpersonal conflict. 

  • Executive functioning

    Difficulty prioritising work tasks, disorganisation, procrastination. 

  • Emotional regulation

    – Overreacting, emotional outbursts, hypersensitivity to criticism. 

Risk Management 

 Anyone who studied OHS at any level will know the basic principles of risk management. There are any number of Standards, Codes and Regulations that spell this out, along with the primary duty of care owed by the person conducting a business or undertaking (PCBU) to eliminate risks in the workplace, or that is not practicable, minimise the risks so far as is reasonably practicable12 and the requirement to consult with workers in the process. 

 However, how do the well-known elements of the risk management process (identify hazards, assess risks, implement and review controls) apply to workers with ADHD or any other form of neurodiversity for that matter? 

 I’m not suggesting that workers with ADHD are the hazard that must be identified and controlled. Far from it.  

 At every stage of the risk management process, there is a need to consider the human factors, meaning the interaction between the workers, with their individual characteristics, and the work systems, processes, environment and equipment. We already know this.  

 What I am contesting is that when identifying hazards, assessing risk and deciding on controls, it’s not sufficient to look at the work systems, processes, environment and equipment through a single neurotypical lens, because the systems, processes, environment and equipment that may not present as a hazard to a neurotypical worker, may be a significant risk factor to the worker with ADHD, because of their unique characteristics.  

 Unless the hazard, risk assessment and controls are viewed through the eyes of the worker with ADHD/neurodiversity in that environment as well as the neurotypical worker then the risk management process is only half complete and will have reduced effectiveness and impact.  

 If employers are to genuinely consult and collaborate with their workforce in managing risk, as required under the relevant WHS legislation, it is my contention that this process would not be complete without input from workers who are or might be neurodiverse as well as neurotypical workers. Further, the inclusion of individuals with ADHD in problem-solving around risk management is more likely to yield creative and innovative solutions. 

Take home messages 


The inclusion of workers with ADHD, and other forms of neurodiversity in the consultation process necessary to effectively manage workplace risks is likely to yield a more complete, robust, and innovative solution than if they were not included. Without this, not only is the consultation and risk management process deficient because it neglects a proportion of the workforce but subsequently there will be a blind spot in the OHS management system that leaves both workers and employers exposed.  

 ADHD is a real condition. It is far more prevalent in the adult population than previously thought, and nine out of 10 adults with ADHD are not aware that they have it. If left undiagnosed and untreated it can create real as well as serious risks to worker health and safety.   

 ADHD is not the result of bad parenting, a lack of self-discipline, laziness or a low IQ. It is a lifelong condition, and whilst about 35% of the children diagnosed will successfully learn to manage their symptoms to the extent that it does not present any significant impairment in adulthood, the remaining 65% will continue to experience the effects of the disorder well into adulthood.  

 ADHD can be managed though not cured. Treatment can include medication, psychological counselling and coaching with ADHD Coaching to develop executive functioning skills.  

 OHS and Human Resources Professionals can increase their own awareness, challenge preconceived notions, educate others and remain alert to the red flag indicators that a worker may have ADHD, even if they have not yet been diagnosed, and handle this sensitively, seriously and supportively and provide systems to ensure the worker’s safety that accommodate the unique challenges of their condition. 

 As illustrated in Insight, many adults with ADHD describe their unique brain wiring as their superpower. They know they can be highly intelligent, entrepreneurial, creative, innovative, artistic, energetic and high achievers, even though they may have many challenges.  

Where to find more information and resources 

  1. ADHD Australia – https://www.adhdaustralia.org.au/ 
  2. Health Direct – https://www.healthdirect.gov.au/attention-deficit-disorder-add-or-adhd  
  3. ADHD Support Australia – https://www.adhdsupportaustralia.com.au/  
  4. Australian ADHD Professionals Association – https://aadpa.com.au/ 
  5. ADDitude Inside the ADHD Mind (online magazine) – https://www.additudemag.com/ 
  6. Centre for ADHD Awareness, Canada – https://www.caddra.ca/public-information/adults/resources-and-links/ 
  7. Children and Adults with ADHD (CHADD) – https://chadd.org/ 
  8. Do-IT Solutions – https://doitprofiler.com/ 
  9. Extensive works of Dr Russell A. Barkley PhD at  http://www.russellbarkley.org/index.html 
  10. ADHD Institute – https://adhd-institute.com/ 

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