GPSolo Magazine - October/November 2006
Lawyers with ADHD
Attention deficit hyperactivity disorder ( ADHD), often called attention deficit disorder (ADD), begins in childhood and can persist in adulthood. ADHD manifests as a chronic pattern of behavior that includes difficulty focusing and maintaining attention, chronic disorganization, impulsivity, and difficulty perceiving time. Hyperactivity may or may not be a part of the pattern. ADHD affects the executive functions of the brain, such as prioritizing, planning, executing and completing, and paying attention to detail. Although ADHD often runs in families, it is highly treatable, usually with a combination of medication, lifestyle changes, and adaptive skills that “work around” its symptoms.
The National Institute of Mental Health (www.nimh.nih.gov) estimates that 3 percent to 5 percent of all children have ADHD. Nearly 25 percent of those related to a child diagnosed with ADHD also have ADHD (compared with roughly 5 percent of the general public), which adds up to nearly 8 million people. Of these, 80 percent to 90 percent are undiagnosed and may be unaware that they have the condition.The ABA’s most current estimate (summer 2006) is that there are 1.1 million lawyers in the United States; thus, roughly 44,000 lawyers may have ADHD, the majority undiagnosed.
In lawyers, one of the most obvious manifestations of the condition is their ongoing attempts to “get organized”—which always end in only short-term success, if any. They report falling behind in their work or being fearful they missed something important, and frequently they feel that they are not living up to their potential. By this point in their lives, many lawyers have learned to work around the manifestations of their ADHD symptoms. They struggle to stay focused on boring tasks, have trouble managing their time, and often start projects enthusiastically but quickly lose their excitement and, with it, the desire to finish the project. They are usually aware of being facile and quickly grasping and building on concepts, but planning for the eventual goal is a problem. They often have low self-esteem because of their inability to be consistent, stay focused, and curb impulses, and frequently they struggle with relationships—partly because they miss or misunderstand the social cues people give one another. They question why things that seem easy for others can be such problems for them.
Unfortunately, once out in the professional world, they tend to continue these coping mechanisms—procrastinating, working in fits and starts. Lawyers with ADHD typically are well acquainted with regret, although they may have established firm defenses against recognizing it. They develop reputations for being chronically late, having messy offices, or performing excellently some of the time and abysmally at others. Like the general population with ADHD, these lawyers usually do not realize they have a defined problem until they seek treatment for a different condition or, often, for their children’s attention problems. Nearly half the people with undiagnosed ADHD have a coexisting condition—such as depression or substance abuse. Undiagnosed, and sometimes even when treated, ADHD is not easy to live with; rarely does a person with ADHD make it through life unmarked.
What’s Wrong with Me?
A diagnosis of attention deficit disorder often comes as an enormous relief—at last, the inconsistencies and spotty perform-ances have an explanation. Years of self-referential questions now have answers: How can I be so bright and not be able to do this simple task? Why am I always late when I try so hard to be on time? Why is my (office, car, desk, calendar) so disorganized? Where are my keys?
With diagnosis it seems the riddle is solved and all is well. Unfortunately, diagnosis is only the beginning of treatment. Appropriate medications may help by reducing some impulsive behaviors and concentration issues, but they most often simply quiet the background noise enough to allow the person to contemplate further changes.
If the above descriptions sound familiar and you think you or someone you care about may have ADHD, the following suggestions may help you or others manage it:
1. Don’t self-diagnose. That said, if you’ve suspected you might have ADHD, you probably have already done a preliminary self-diagnosis. Please get a medical evaluation, and stay open to other diagnoses as well.
2. See a doctor who is knowledgeable about ADHD. Use online resources, hospital recommendations, and referrals from friends and colleagues (yes, they’ve had to learn about it, too). The doctor will likely be a psychiatrist who works with both children and adults. Discuss other conditions that the physician may need to know about: depression, anxiety disorder, bipolar disorder, alcoholism, and drug addiction; their symptoms may have a lot in common with ADHD, and those conditions will need attention as well. Adults with ADHD often are in trouble not from the ADHD itself, but from the effects of any number of coexisting conditions. For example, nearly 50 percent of children with ADHD also have learning disabilities—take time to learn about such disabilities because you may have made adaptations to accommodate one years ago. Keep in mind that you’ve already finished law school and passed the bar—learning disabilities don’t mean you’re not smart.
3. Be patient with finding the right ADHD medication . One size does not fit all. What works for your friend may not work for you. Pay attention to how you feel and function on a medication; if you see no improvement, say so.
4. Educate yourself. Getting a diagnosis is the beginning of a learning curve; ADHD is not a mystery illness. Magazine articles, TV shows, and books galore exist to help you. Of particular use may be Robert M. Tedesco’s website, www.addcopingskills.com. Tedesco is a practicing attorney diagnosed with ADD who currently sits on the board of Children and Adults with ADHD (CHADD) and was on the board of the Attention Deficit Disorder Association (ADDA). Both organizations’ websites feature a variety of articles and other material. Part of your job is to learn about the condition and discover what steps you can take to manage it more effectively. Take small steps to implement changes based on what you learn—at a minimum, start exercising regularly, eating well, and spending time at play (play is a great way to slow down a struggling brain).
5. Manage coexisting conditions . Although not everyone diagnosed with ADHD also has a concurrent medical disorder, as mentioned previously, about half do. People with ADHD are more susceptible to developing substance abuse disorders (drugs, alcohol, food), anxiety, depression, bipolar disorder, and other conditions. These conditions must be treated concurrently with the ADHD. Some lawyers who have struggled with these disorders for years find they make real progress only when they also address the ADHD. With younger lawyers, treating the ADHD actually seems to reduce their chances of later developing a substance abuse disorder. Keep in mind that your doctor must have all physically related facts about you, including past or current drug or alcohol abuse, in order to treat you.
6. Don’t make excuses . Although a diagnosis of ADHD may be a life-changing explanation for you, it is not an excuse in the real world. The real world requires behavior change, not behavior explanation. People in that world set timetables, make plans, and carry out tasks on schedule. You can make your life easier by accepting this truth early on.
7. Decide how much to disclose and to whom . Unfortunately, especially in the professional world, you cannot predict how others view ADHD and related disorders, so be discreet. The last thing you need is to have your newfound “solution” be seen as a limitation or stigma. Be selective about whom you tell, and where or when.
8. But be excited. The more interested and excited you are about understanding your ADHD, the more you will benefit. The more you know, the more you can make reasonable changes that enhance your personal performance.
9. Continue to get professional help . After you are diagnosed, many other professionals may be able to help with your recovery: psychiatrists, counselors, coaches, nutritionists, trainers, and organizers. Many people who have been recently diagnosed experience an initial “honeymoon” period in which understanding the disorder seems to solve all problems, but they soon feel deflated or burdened with the plans and changes yet to be made. Lawyer assistance programs, doctors or other treatment providers, and support groups and organizations such as CHADD can provide referrals.
What’s Wrong with My Practice?
Lawyers with ADHD are often in solo or small group practice, for good or ill. Many like the adventure and independence—being the boss and escaping the constraints of larger firms. Yes, large firm practice offers top-of-the line software, a staffed law library, administrative assistants, law clerks, and paralegals. Paid vacations. Colleagues to watch your back and catch your mistakes. But lawyers as a group tend to be risk takers, and lawyers with ADHD even more so. Being in solo practice is a gamble, a bit like being on the high wire without a net. You love the excitement of the fat years, but how will you handle the lean?
Of course, a solo practice has some inherent drawbacks that can be particularly unmanageable for those with ADHD. Solo practice comes with every aspect of big firm practice, but there is only one person to do it all. Will you be able to handle the office upkeep—filing, billing, answering phones, etc.? Can you afford to hire a secretary? Whom will you discuss cases or conflicts of interest with, or debate ideas for the right way to proceed? Will your impulsivity be a blessing or a curse?
For the most part, lawyers with ADHD get into trouble with the bar for the same reasons other lawyers do: They fail to communicate with their clients, don’t release files quickly enough, let something slide, or miss a deadline. To protect your practice from a complaint, you may need to incorporate new protocols to keep things on track. They need not be complicated; in fact, they’re better when kept simple. Some people swear by their electronics—personal organizers, Palm Pilots, and BlackBerries are very helpful when used properly. The test is whether you, the lawyer, are able to use them effectively. Examples of changes to consider follow—do yourself a favor and don’t try to implement the entire list at once.
1. Structure your time. Structure works for ADHD. Once you have a system in place and use it enough so it’s becoming routine, the chaos that results from making constant choices recedes. A “system” may be an object or a procedure. Use a book-type calendar as a memory aid—a bound volume in which you jot notes to yourself, keep lists, and maintain all deadlines and appointments (writing seems to be an important tool for ADHD people to use, possibly because it involves both hand and eye coordination). Next, plan specific times of the day for checking e-mails and returning phone calls—and follow that plan. Both of these suggestions will seem awkward and cumbersome at first, but they are relatively straightforward and can “set you up for success” in trying out additional systems. Although much infor-mation on organizational systems is available online, limiting the amount of time you spend surfing may be another protocol you’ll want to implement; fortunately, all these organizers write books, too. Definitely ask a friend or a professional for help with this stage so you’re not overwhelmed by the choices available. But keep it simple.
2. Clean up the office . The trick to getting through an office cleanup is to make going through the papers manageable for you. Your system may come from a book and/or might be pretty rudimentary, but you must use one—the simpler for you, the better. One lawyer decided to start with sorting his paper clutter into four boxes: Current Criminal, Current Civil, Past Criminal, and Past Civil. (This box system has merit: It immediately reduces obvious clutter, is portable, and prevents stacks of paper from toppling.) Once he had the papers corralled, he went through each box again, sorting the papers into a few relevant subcategories. At the start of the second sorting, he found it easier to stay focused because he didn’t have to make so many decisions about each paper right off the bat; by then, most fit into a smaller category. Be sure to undertake projects like this in small doses, or your ADHD brain will zone out; if it does, take a break. Your goal is not surgical precision—go for “organized enough.” Repeat when necessary. Knowing what is in the office and prioritizing the various matters is a giant step toward preventing bar complaints based on neglect.
3. Hire someone part-time to do the billing and maintain files. You are looking not for a paralegal or law clerk here but for a “manager.” Be sure your contract covers the relevant ethics and confidentiality requirements, then let him or her manage. (Until you have some history with this person, however, review all transactions monthly.)
4. Experiment with tools to find what works for you. Explore the various things that reportedly help with concentration—timers, rearranging your office, maybe even Mozart (many ADHD people find background music helps their concentration). Stick to your established timetable for e-mail and phone replies, or adapt them if they’re not working.
5. Carry a small notebook for recording billable hours. One of the most common complaints from lawyers with ADHD is difficulty with time reporting. Firms generally nag you to report billable hours; in solo or small group practice, the onus is on you. Keeping a notebook in your briefcase or suit pocket turns out to be considerably more efficient than later reconstructing time from cell phone and landline bills, e-mail folders, case notes, and so on. Jotting down things as you go along frees those hours for other things.
6. Recognize the limits of your attention span. Generally, people vary considerably in how long they can concentrate; some reach their limits after 45 minutes, others can double that before tiring. People with ADHD are often at or below the lower figure. Once you recognize your signs of drifting off, you can develop strategies to bring yourself back: setting a timer with a loud ring, planning a stretching break after a certain time, using deep breathing exercises. Some people play games or compete with themselves: “I can do anything for 15 minutes—I’ll stop when the timer rings.” It is not that people with ADHD cannot pay attention; it’s just more difficult for them to sustain it.
7. Get copies of your jurisdiction’s rules and consult them often. If you have them on hand, you’ll feel less pressured by the need to keep them all in your head. Contact the bars and associations you belong to for additional materials such as practice management guides. Surprise yourself and actually attend one of their meetings.
8. Enjoy yourself. Remember that you like the law, or at least did at one point. If you have lost sight of that, try to figure out when and why. Nothing makes work easier than liking what you do. Having alternative outlets such as music, sports, art, or hobbies also helps you enjoy your work more.
9. Take care of your physical plant. Your physical plant is your body and mind. Exercise is an excellent remedy for the stresses created by ADHD. Leave the excessive caffeine and alcohol use to others—you cannot afford the resulting biochemical changes that may upset the positive effects of your medication or other adaptations. Eat right and get adequate rest (sleeping is not a waste of time).
ADHD is treatable and manageable. If you’ve tried making changes before and given up, if you think (or know) you have a coexisting problem, please contact your state lawyer assistance program (LAP) or go to www.abanet.org/legalservices/colap/lapdirectory.html for more information. LAPs vary from state to state, but all have a variety of resources to offer. If you have already been diagnosed with ADHD, be sure to let the LAP know this, so the coordinator can refer you to a program or treatment professional who understands and has a successful track record with ADHD clients. Most of all, remember that a conservative estimate is that nearly 44,000 colleagues throughout the country are dealing with or suffering from ADHD and its wide-ranging impact. You are not alone.
Lynn Phillips, MS, LPC, is past director of the D.C. Bar Lawyer Counseling Program and a licensed professional counselor in the District of Columbia.