If you’ve been more distracted, impulsive or fidgety lately, you’re not alone. The news at home and abroad is disturbing, stress levels are high, our mobile devices have become appendages, online shopping is always just a click away, and we’re suffering from information overload. Googling “Do I have ADHD?” reveals 914 million search results.
Chances are you’re also seeing ADHD (or ADHD-like) symptoms among your clients.
Although ADHD (short for attention-deficit/hyperactivity disorder) isn’t necessarily growing among adults, more cases are being diagnosed. [October is ADHD Awareness Month.] The American Psychiatric Association, which refers to ADHD as “a chronic and debilitating disorder,” says many adults don’t even know they have it. Meanwhile, the ADHD medication shortage that started a year ago persists.
But ADHD is also a superpower, say many successful individuals. And more financial advisors are realizing they need to find better ways to serve clients who exhibit signs of ADHD, even if they haven’t mentioned a diagnosis.
The ADHD-wealth link
ADHD and learning disabilities (LD), which often go hand in hand, are more prevalent among individuals with wealth, says Jim Grubman, PhD, a Boston-area family wealth psychological consultant who works with wealthy families and family enterprises. A clinical psychologist and clinical neuropsychologist by training, he started speaking with families about wealth while treating them in the healthcare system in the 1980s and 1990s. He knew the types of questions to ask, he says, because his father was a wealthy businessman.
Not only is ADHD a very real problem for adults, but it can also worsen as clients age, Grubman says.
“A relatively stable and mild pattern at 35 or 45 could start to look worse at age 55 and create problems,” says Grubman. [More on why in a bit.] “This, of course, is also the age where retirement planning and good financial management are important, so it would show up at a financial advisor’s office.”
I reached out to Grubman after learning about him through Abacus Planning Group. The South Carolina-based firm consulted with him for a decade on multiple aspects of wealth psychology and uses an article he co-authored, “Whirlwinds and Wealth: Entrepreneurs, ADHD and Wealth Management,” as part of its ADHD training module for its team. These days, Grubman spends less time advising clients and more time working with the UHNW Institute.
‘A stunning statistic’
His paper on ADHD, published by Wealth Manager magazine back in 2010, contains still relevant action points for advisors.
Research the paper cited, from London’s Cass (now Bayes) Business School, found that while ADHD/LD typically presents in approximately 5% of the global population, its incidence was 20% among British and American entrepreneurs. The researchers and Grubman mention Charles Schwab and Virgin Group’s Richard Branson, who’ve spoken publicly about struggling with dyslexia.
“It was a stunning statistic,” Grubman says. His observations were similar when he began working in financial services during the dot-com years:
“I began to realize, as I was looking around, that ADHD and learning disorders were just strewn throughout the client population of affluent, high-net-worth and ultra-high-net-worth families in a way that I did not realize and that no one else had really written about,” he says.
To Grubman’s knowledge, such research hasn’t been replicated and “it begs for somebody to take it on as a really good study.”
More research can be found on the wealth status of children with ADHD, but the findings are mixed. Some studies do show that children with milder cases are wealthier and that wealthier children are likely to be diagnosed and receive medication. Other studies have concluded that lower-income children receive more ADHD diagnoses.
The magic combination
Grubman is clear about this: Not everyone with ADHD/LD succeeds. Those who do succeed tend to have above-average intelligence with mild to moderate ADHD and learning disorders, he says.
Hardworking and creative, they typically join the ranks of wealth through entrepreneurial success, he says. “They say, ‘I couldn’t get along in a normal job, so I had to create my own company.’”
It’s not just wealth management clients who fit this constellation, says Grubman. “When I’ve talked about this [topic], so many advisors kind of sheepishly say, ‘Well, I actually have ADHD.’”
Grubman, who generally sees ADHD/LD among male entrepreneurs, has also seen how it impacts families.
Often “the wife is completely intact, but she runs the home and she’s exhausted. And she’s constantly dealing with the tangents and the chaos and disarray of life,” he says. “And you have to remember that if you have three kids, at least one of those kids is going to have it too.”
“It’s not Red Dye No. 4, it’s not whether you spend a lot of time on your phone, it’s an actual genetic disorder that runs in families,” he says.
Grubman also notes that males with ADHD tend to be a little more hyperactive and that females are more likely to have inattentive ADHD. “They’re highly distracted in their heads, but they don’t look so hyperactive so they tend to escape being diagnosed quite as much as the boys,” he says. And that means they may not get the help they need.
Signs to look for
Although ADHD and LD are different, “30% to 50% of people with one will have the other,” Grubman says.
Advisors may notice clients are highly distractible, go off on tangents very easily, and have trouble sticking to a topic for more than a few minutes, he says.
Individuals with the hyperactive component often talk at great lengths, interrupt, have trouble listening, and may have “pressurized speech,” says Grubman. This means that not only is it hard to get them to stop talking, they seem to have trouble stopping themselves.
And if clients are impulsive, especially if they’re always “chasing the next shiny object,” he says, they can be at risk for overspending and neglecting to manage their finances.
Beyond face-to-face interactions, advisors can also learn a lot about clients by how they communicate in emails, he says.
Communication dos and don’ts
Adapting communication styles is especially critical when clients have ADHD or learning disabilities, says Grubman.
First, you have to figure out how to converse and work with someone “who is mentally bouncing around and talking,” he says. Next, “you have to shift gears and change how you explain things.”
For example, it’s not useful to show five or six pages of dense type to clients with ADHD, he says. Someone with ADHD or a verbal learning disorder like dyslexia requires a lot more diagrams and pictures. “On the other hand, if they have non-verbal learning disorders, where they don’t understand pictures and graphs so well, they need it all in words,” he says.
Aging with ADHD
As a clinician, the oldest person that Grubman diagnosed with ADHD was 65. In his practice, he saw ADHD worsen with age and occasionally that was a patient’s impetus for getting diagnosed.
“Anything that can cause cognitive symptoms like mild memory impairment reduced attention, or fuzzy ‘executive functions’ — sequencing, following multi-step instructions or planning complicated tasks — would exacerbate an underlying ADHD problem and cause more problems,” he says.
This can include entering menopause or andropause (sometimes referred to as male menopause), as well as having a mild concussion or another medical syndrome with cognitive effects, such as thyroid disease or low vitamin B12 levels, he explains.
Grubman’s patients experiencing stepped-up ADHD problems were often scared that they were developing dementia or a similar cognitive issue. But while there’s no established link between ADHD and different kinds of dementia, “many common extra problems with ADHD do increase the risk of dementia in later life,” he says.
For example, individuals with ADHD frequently have (or have had) substance abuse problems, he says. “They also tend to be at risk for falls, head injuries, motor vehicle accidents, bar fights and other incidents that cause cognitive problems.”
A study published this month by Columbia University Mailman School of Health found that older drivers with ADHD are twice as likely to be involved in car crashes and traffic-ticket events compared with their non-ADHD counterparts.
One reason it’s difficult to diagnose and treat adults with ADHD is the lack of guidelines, says the American Professional Society of ADHD and Related Disorders (APSARD), a member organization for physicians, psychologists and allied mental health partners. It’s presently developing such guidelines and targets a mid-2024 release date.
Alex Chastain, CFP, the chief planning officer and a partner with Abacus Planning Group, says she has observed that clients aging with ADHD fall into two groups. Group 1 tends to improve with age thanks to proper diagnosis, ongoing treatment and management. Group 2’s symptoms get worse due to life events that are stressors — divorce, death, menopause or illness.
Abacus had been working with Grubman for several years before he published his paper on ADHD. “Since our niche is closely held businesses and family business, it was a natural area for us as practitioners to spend some time,” says Chastain.
Chastain teaches and trains her colleagues on the ADHD module. In addition to sharing Grubman’s article, she plays a video during training that depicts the “typical” ADHD brain. “Many were surprised how chaotic the ADHD brain can be,” she says.
“I also have an ADHD/LD diagnosis,” she says. “So, naturally, I have added some personal anecdotes and suggestions that have been successful for me personally and working with ADHD clients,” she says.
Chastain also emphasizes altering presentations for a client with ADHD. Her advice: Talk in headlines, keep the information to the point. tackle three items at most and don’t forget to “manage the meeting” because people with ADHD tend to get “off track.”
When she plans a meeting for these clients, she tends to create a custom deliverable that makes the information more visual instead of text heavy. She also likes to send the meeting package in advance so clients with ADHD have time to review the content at their own pace.
Abacus schedules meetings for clients with ADHD (or those they suspect have ADHD) in rooms with fewer distractions, she says. “No window, no diplomas on the walls, etc.”
Saving a marriage?
Accomplishing goals with one particular client couple was impossible, although the client team enjoyed spending time with the couple, says Chastain. But once she started implementing Grubman’s strategies, by making the meeting manageable and concise, she and the couple were able to get things done, she says.
“The spouse was thankful that they didn’t have to take on responsibility of managing their spouse in the meeting. Instead of being the ‘handler,’ they could experience being a client,” says Chastain.
Meeting them on their turf
Abacus doesn’t publicize that it works well with ADHD clients, says Stephen Maggard, CFP, a financial advisor at the firm. “But we do talk to potential clients about our deep expertise working with complex family dynamics,” he says — which include many personalities. “Working with ADHD clients is just one piece of that puzzle.”
The ADHD module also fits the firm’s approach to training. “We strongly believe that learning the soft skills is equally as important as the technical skills,” he says.
Discretion is also important when working with clients.
Regarding ADHD, “very few clients will tell us if they have a diagnosis and we rarely discuss it with them directly,” says Maggard. “Initially we will often notice the symptoms and discuss internally as a team.” Or sometimes a spouse will mention it if the individual is not in earshot.
“We will then document this in our client-management system saying something like, ‘When Dr. Jones comes in for meetings, seat him in a room facing a blank wall,’” says Maggard.
Staying on task and on time
Monica Dwyer, a wealth advisor with Harvest Financial Advisors near Cincinnati, thinks she figured out she had ADHD when her kids were diagnosed, “probably in my mid-to-late 30s,” she says.
“My biggest challenge is twofold: I go down rabbit holes because I love gathering information. I have to watch myself so that I don’t spend too much time on something that is irrelevant,” she says.
Second, “I have absolutely no sense of time” — a problem that’s plagued her for years. But, “I don’t ever like to be late for an appointment because I feel it is a sign of disrespect for the client I am meeting with.” So, she relies on simple technology to keep her on track.
Mornings and meetings
Dwyer sets alarms on her phone five minutes before meeting start times. Her receptionist also puts a sticky note on the glass door to the conference room when Dwyer is 10 minutes out from her next meeting. On weekday mornings, Dwyer sets three alarms at home — the third one gives her a 15-minute warning before she has to get in her car.
She also rarely schedules a meeting before 10 a.m. because she wants to answer all her emails and “have everything off my plate before I see my first client,” she says. “Part of this is just knowing my limitations and who I am.” But she often works late and appreciates this flexibility.
Using a pre-printed to-do-list pad also “makes me feel like I have had a good day and I am being productive,” Dwyer says. She prioritizes tasks further by labeling them A (must be done today), B (must be completed in a couple of days) or C (can be put off for a week or more), and also numbers the As.
“That way I don’t feel overwhelmed; I just do the task that’s the highest priority,” she says.
Keeping it simple for clients
One of Dwyer’s clients had to stop taking her ADHD medications after she had a mild heart attack. Now retired, she tells Dwyer that being off the meds makes it difficult for her to stay motivated for certain tasks. Dwyer hadn’t noticed because her client, who is also a friend, is as engaged as ever in their lengthy conversations on many topics.
So, it’s not always easy to tell who has ADHD, Dwyer emphasizes.
From a planning perspective, Dwyer keeps things very simple for her client, which she says has helped her client.
“She takes out a budgeted amount of money every month and that seems to meet her needs. She doesn’t live an extravagant life,” says Dwyer. She doesn’t update her frequently on the markets but they have periodic conversations about strategies. For example, she helped the client refinance her mortgage on her condo before interest rates rose. The client is happy with her very low rate, lower payment and shorter mortgage term of 15 years, Dwyer says.
The power of positive thinking
Despite the added efforts required to manage ADHD, Dwyer focuses on the positives.
“Everyone says I have an abundance of energy, and I tend to really enjoy diving into certain projects. I can hyperfocus on work and most of my days fly by quickly. I am very gregarious and enjoy the company of my family, friends and clients. I have many, many interests and I can talk to anyone about just about anything,” she says.
“People with ADHD tend to have ideas that are more outside of the box and we can be creative thinkers,” says Dwyer. “Some people see it as a superpower.”
Jerilyn Klein is editorial director of Rethinking65.