Diagnostic Challenge 3 - Part II

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

Poor work habits & lack of organization

help me sign on desk Poor work habits and a lack of organization are more difficult to assess. These are traits that are usually observed throughout someone's life, including childhood. Rarely does someone suddenly become disorganized and scattered in their approach to work-related tasks (except after a stroke or other brain injury). Organizational skills, and a systematic, orderly approach to work completion, are fundamental components of human functioning and life success. However, does everyone who lacks these fundamental skills have a disorder? Of course not! There is large variation among individuals in this regard. One way to consider the topic is to examine the impact of disorganization on an individual's life. The term "pack rat" refers to many people who have difficulty throwing things away. Where does it become a problem? One consideration would be to examine a person's history. Have they always been that way? The sudden onset of such symptoms could possibly indicate a developing problem and trigger an evaluation. This would not include an ADHD evaluation because the symptoms are required to be present from childhood.

Another way to consider the topic would be to examine the impact of people's behavior on their lives. Are there functional impairments that interfere with someone's ability to successfully complete various life tasks? If poor work habits and lack of organization result in repeated job losses and the inability to complete taxes on time, there would be evidence of impairment. If combined with the lifelong history of such problems, it could be indicative of the inattention symptom cluster in ADHD. LINK Therefore, an adult with such a profile would likely benefit from an ADHD evaluation.

During such an evaluation, a clinician would first determine if symptoms from the Inattention subtype cluster are present. If not, the disorganization and poor work habits may simply represent normal human variation. If so, further assessment for ADHD is warranted. The clinician would focus on the criteria necessary for ADHD, inattentive type. To be diagnosed with ADHD, the adult needs to meet five of the inattention criteria LINK. If the clinician finds they meet five criteria of Inattention, s/he will next determine whether these symptoms impair functioning (social, academic, or occupational functioning) Remember my friend with the dental 'phobia'? She would not receive a diagnosis at this juncture because her symptoms did not create any dysfunction.

It is important to recognize that given the rate of adult ADHD in the population (2.5%), it is far more likely that poor work habits and a lack of organization represent a normal variation. One final note: these symptoms could be part of another disorder. LINK The experienced clinician will continue to evaluate until all diagnostic possibilities have been considered and ruled out.

Social ineptitude (poor social skills)

Social ineptitude, or awkwardness, can make it difficult to form and maintain relationships. It can also cause problems at work or school. In some cases, inadequate social skills represent a normal variation among humans. In other cases, it may be indicative of a mental health concern (such as ADHD).

Social skills come easily to some folks, but are very difficult for many others. Even in the non-clinical population, the difficulty with smooth and easy social engagement is fairly common. Nonetheless, poor social skills are also a diagnostic indicator for many psychiatric disorders, including ADHD. An experienced clinician will first consider whether poor social skills are creating dysfunction (losing a job, not having any friends). If poor social skills are creating dysfunction, the clinician will begin to evaluate a long list of diagnostic possibilities, including ADHD.

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Diagnostic Challenge 3: ADHD Symptoms

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Diagnostic Challenge 4: A Concealed Disorder

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