ADD/ADHD And Caregiver Productivity
By: Erin Dick & Denise Balch
ADD/ADHD may have as significant an impact on employee health and productivity as asthma has. Erin Dick and Denise Balch, of Connex Health Consulting, examine the findings of their study which also emphasizes the importance of medication compliance among all ADD/ADHD sufferers.
Attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and asthma are serious medical conditions that frequently affect children and, in many cases, continue into adulthood. However, a review of the literature reveals no previous investigations of the work implications of ADD/ADHD and the extent to which employee health and productivity are impacted by ADD/ADHD. While several studies have investigated the link between other chronic illnesses – such as asthma and productivity (Burton et. al., 2001; Burton et. al., 2002; IHPM et. al., 2000; Wang et. al., 2003) – these studies have focused primarily on the effects of personal illness on workers themselves. There is much less empirical evidence regarding the impact on employees who are caregivers of children with chronic illness.
Connex Health Consulting, with the financial support of Janssen Ortho Inc., a provider of pharmaceutical solutions for ADD/ADHD patients, began exploring the extent of this in 2003. Its study found that there are significant workplace absenteeism and productivity costs for those caring for children with ADD/ADHD. This study identifies non-compliance to medication as one of the primary issues; an issue that can be addressed through several strategies that may include once a day therapy and workplace education solutions.
ADD/ADHD is known to have a prevalence rate of four to 12 per cent in the population and is characterized by inattention, impulsivity, and, in some cases, hyperactivity. Asthma was selected because of its similar incidence rate to ADD/ADHD and similar reported non-compliance issues. In order to assess the complete productivity implications of these conditions, the study examined the impact of ADD/ADHD and asthma on employees diagnosed with these conditions as well as those caring for dependents diagnosed with these conditions.
The objective of the study was to assess several aspects of these conditions including medication compliance, absence from work, productivity, and career effects. Results of the study confirm that ADD/ADHD has a significant impact on employee health and productivity. It also emphasizes the importance of medication compliance among all ADD/ADHD sufferers. From the results, we can conclude that there is a significant opportunity for improvement in health and productivity which can be supported in the workplace through awareness, education, and support related to ADD/ADHD.
Outcome measures are crucial to workplace health initiatives and the only way to assess whether they improve the bottom line. Successful wellness strategies have adopted a more outcome-focused approach than the more traditional, softer ‘lunch-nlearn’ approach. Sustainable health programs require consistent measurement of outcomes such as absenteeism and productivity. “Workplace productivity has become a critical factor in the strength and sustainability of a company’s overall business performance” (Koopman et. al., 2002), however, the productivity of knowledge workers is more difficult to calculate than for repetitive task workers where output can be clearly counted or tracked.
Employers struggle to track intangible measures of productivity, particularly for knowledge workers, limiting their ability to assess the full economic burden of illness in their workforce. In addition to productivity, these costs include the tangible measurements of health, the majority of which is made up of drug costs, employee assistance, and all absences, including long-term disability.
In recent years, several industry researchers have developed methods to assess productivity for workers performing cognitive tasks in the workplace. Both electronic database and self-report methods have been implemented. Self-report methods are more common when assessing the productivity of knowledge workers. While employers often express doubts about the validity of self-report data due to limitations such as recall period, ability to make causal inferences, and the use of a linear scale i.e. 0-10 (Greenberg et. al., 2001), research indicates that this method can play a meaningful role in assessment.
In fact, self-reported data is often conservative with employees underestimating the impact of their health conditions (Wang et. al., 2003). Its credibility can be enhanced with the support of other quantitative measures such as diagnostic test results (Greenberg et. all, 2001 and Simon et. al., 2001 as stated in Koopman et. al., 2002).
The ADD/ADHD asthma survey used expert methodologists who have worked extensively in the measurement of productivity, particularly among knowledge workers. The confidential survey was administered both in hard copy and online. Measurement of employees was based on a two-week recall period. It inquired about the respondent’s own, or their school-aged dependent’s, diagnosis of ADD/ADHD and asthma using items in the following categories:
- Symptom control and medication compliance
- Absence from work
- Career effects
The survey was administered to employees of four employers. Approximately 2,500 employees had access to the survey, of which 269 responded. The survey inquired about ADD/ADHD and asthma with identical questions. Of those who responded, more than half (63 per cent) had school-aged children between the ages of four and 18, representing 272 children. Almost one quarter (21 per cent) reported that they had a child with ADD/ADHD and a similar number (22 per cent) reported they were caring for a child with asthma. Over half of those caring for children with ADD/ADHD completed the relevant questions in the survey and one quarter of those caring for children with asthma responded. Response rates are based on the actual number of responses for each question. For the purpose of brevity, data relating to employees’ own diagnosis has been excluded.
Symptom Control and Medication Compliance Results indicate symptom control and medication compliance for ADD/ADHD is achieved less frequently than for those children with asthma. This appears to be primarily due to scheduling of medication, which is frequently required during school hours or at times when the child is not under adult supervision.
Over half (65 per cent) of children with ADD/ADHD were taking medication to control their symptoms. Almost one dose per child taking medication was missed in the two weeks prior to completing the survey (see Figure 1).
The results for children with asthma were very different. Almost all children with asthma either take daily medication or medication as required to control their symptoms. Most doses are taken in the morning or the evening. Just one caregiver reported that their child had missed a dose of medication in the two weeks prior to the survey. In this case, the caregiver reported forgetting the dose and did not link it to scheduling.
Absence from Work
This results of this study show that workers caring for children with ADD/ADHD have more time absent from work to care for their children than those who have children with asthma.
In the two-week period prior to the survey, over one third of caregivers of ADD/ADHD children reported missing time from work due to the illness, most frequently for school issues. This compares with under 10 per cent for those caregivers of children with asthma.
While those dealing with both ADD/ADHD and asthma missed time from work in the prior two week period, only those caring for ADD/ADHD missed more than 10 hours (see Figure 2).
Employees report negative productivity impacts from their caregiving of ADD/ADHD children to a greater extent than for those caregiving for children with asthma.
Almost half of those caring for ADD/ADHD children reported their productivity at work declined as a direct result of the illness compared to 14 per cent of asthma caregivers. Using a scale of 0-10 where 0 equals ‘no effect’ and 10 equals ‘productivity is always effected,’ the average for ADD/ADHD caregivers was 3.1 and 2.5 for asthma (see Figure 3).
The negative career impact reported by employees when they are caregivers for children with ADD/ADHD are also greater than when they are caring for children with asthma.
Almost half of caregivers with ADD/ADHD children reported not pursuing opportunities at work due to their responsibilities, compared with 20 per cent for asthma. Using a scale of 0-10 where 0 equals ‘no effect’ and 10 equals ‘unable to pursue opportunities at work,’ the average was 3.0 for ADD/ADHD and 2.3 for asthma (see Figure 4).
While ADD/ADHD and asthma have a similar incidence in the survey population, this study provides evidence that caregivers of children with ADD/ADHD experience greater problems – compliance issues and negative impact in the workplace – than caregivers of children with asthma. Despite the small number of respondents, several results were quite compelling.
The majority of compliance issues in this survey revolve around daytime administration of ADD/ADHD medication when there is no parental control or supervision, particularly during lunchtime school hours. Comparatively, asthma medication is often taken only morning and night when parental supervision is available.
The survey documents the negative impact that ADD/ADHD and asthma have in the workplace including excess absence, lost productivity, and difficulty pursuing opportunities for advancement. ADD/ADHD is consistently more severe. While asthma is generally recognized for its negative impact both personally and in the workplace, we believe that this is the first time that similar measures have been made for ADD/ADHD.
The evidence suggests that ADD/ ADHD related outcomes may be due at least in part to non-compliance. If symptom recurrence, largely from non-compliance, produces some of the cost of ADD/ADHD in the workplace, then one strategy for improvement is to improve compliance and decrease the impact in the workplace. Workplace based solutions could include the following:
- Caregiver education on compliance.
- Implementing a compliance program.
- Creating educational resources for school time caregivers to increase awareness.
- Inviting support resources in the workplace.
- Encouraging caregivers to access local community resource groups.
If non-compliance is a contributor to work loss, one tactic for improving compliance is to administer medication in the form of a once-per-day form. If compliance could be improved by approximately 79 per cent, the resulting savings per employee caring for an ADD/ADHD child is calculated as $2,705.09 including the increased cost of once daily medication. A once daily medication is taken in the morning while under parental supervision. If compliance were improved by any less, the resulting savings would be less than calculated here.
The enhancement of business operations will likely continue to be a pressing economic concern in the immediate future (McCunney, 2001). The workplace health and productivity movement can support this enhancement through targeted and measured programming. In order to target programming, it is essential that general health risk and productivity assessment surveys and more targeted surveys such as this one be administered. These benchmarks will identify opportunities for intervention and provide measurement tools to calculate the value proposition for business. In return, employers will realize the financial and organizational benefits of improved employee health and productivity.
Erin Dick is workplace health specialist and Denise Balch is president of Connex Health Consulting.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -