There are a couple in every battalion, maybe even under your direct command: the co-workers you love, but hate. He's the hard-working firefighter who runs circles around those in other companies, but repeatedly gets written up for freelancing at fire scenes and verbal altercations with co-workers at the station. Or she's the top-notch paramedic, renowned for creative solutions in the field, who's often in trouble for yelling at patients and hospital personnel.

These are "high-maintenance" employees, but not necessarily bad ones. More likely, they may be displaying classic signs of attention deficit hyperactivity disorder.

During the 1990s, adhd has received a great deal of coverage within the medical and educational communities, as well as in the popular media. Researchers have estimated that between 3% and 5% of American children live with this neurological syndrome, which is characterized by distractibility, impulsivity and restlessness. (Footnote: "Adult attention deficit hyperactivity disorder." Lanham, Md., 1997: Children and Adults with Attention Deficit Disorder Inc.) (See "Signs of adhd" sidebar.)

Traditionally seen as a pediatric condition, adhd was only recently recognized as an adult disability. Ten years ago, doctors and educators assumed that children who exhibited symptoms would grow out of it by puberty. In reality, researchers now estimate that up to 60-70% of those affected as children will continue to experience symptoms.

Individuals typically exhibit short (but sometimes extraordinarily intense) attention spans, have difficulty getting along with others, and incur high rates of divorce, traffic accidents and substance abuse (perhaps from a misguided attempt to "self-medicate" with stimulants or other drugs).

adhd can be treated with medication, therapy or a combination of these. Studies show that bimodal or combination therapy yields the best results. (Footnote: Dodson, B., "Update on attention deficit disorder in adults." Paper presented at the Southern Physicians Association Annual Meeting, New Orleans, Sept. 26, 1996.) The main medications used to treat adhd are stimulants (Ritalin, Dexedrine or Adderall) and anti-depressants (Prozac, Paxil, Zoloft, Wellbutrin or tricyclic anti-depressants). Although many of these medications have received a bad rap from the media and special-interest groups, current studies have shown them to be safe when their use is monitored by a qualified provider. (Footnote: Murphy, K.R. and S. LeVert, "Out of the fog: Treatment options and coping strategies for adult attention deficit disorder." Skylight Press: New York, 1995.)

The addiction potential for the stimulants normally occurs at doses much higher than those prescribed for adhd, so fire service personnel who take these medications should be able to perform all their assigned duties. Furthermore, federal law requires that physicians closely monitor the use of these medications, and prescriptions for stimulants must be personally handed to the patient. Phone, fax or mail-in refill orders aren't acceptable.

ADHD in the fire service There's little data concerning adhd in the fire/ems community, which is particularly unfortunate since preliminary research indicates that this condition might be three times more common among firefighters than among the general populace.

This lack of information spells potential trouble for fire departments. First, left untreated, affected individuals could compromise their job performance and personal safety. Second, departments may be losing good firefighters who, if properly assessed, could realize their full potential and become outstanding employees.

There's a third reason, too. The intense, fast-paced world of the fire service is practically tailor-made for someone who craves, for example, constant change and adrenaline-producing situations. In turn, people with adhd often naturally exhibit the personality characteristics - such as creativity, risk-taking and quick decision-making - that are required of the best firefighters and emts. That "made for each other" theory is an interesting one, observes Lisa Weyandt, one of the nation's leading researchers in adhd. It goes hand-in-hand with those seeking to explore the benefits of a neurological condition long seen as mostly problem-filled.

"People are saying, 'If you can just channel that, if you can find a career to fit their symptoms, it can be an advantage,'" says Weyandt, a professor of psychology at Central Washington University, Ellensburg, Wash. "What we don't know is if there are certain careers that people [with this condition] are drawn to and are doing really well in. That hasn't been looked at."

Over the years, researchers have made some findings about the types of work to which adults with adhd tend to be attracted. They include high-intensity work environments, manual-labor jobs and self-employment, reasonable choices for those who commonly exhibit restlessness, an aversion to boredom and difficulty working with others. (Footnote: Mannuzza, S., et al, "Educational and Occupational Outcome of Hyperactive Boys Grown Up." Journal of the American Academy of Child & Adolescent Psychiatry, 36: 1222-1227.)

The fire service provides several avenues to put the disorder's positive characteristics to good use. Both firefighting and ems work demand the ability to make rapid decisions, shift seamlessly from call to call, and monitor or perform activities on several fronts. They also require the courage to put oneself in stressful, even dangerous, situations and the physical and/or intellectual strength needed to perform difficult tasks or intensive interaction with another person.

For individuals with adhd who have difficulty "staying on task" and managing their time effectively, a fire department's paramilitary structure provides a much-needed organizational framework and optimizes their chances of experiencing success. Structure is provided in many ways. Everyone dresses in much the same way. There are daily maintenance and operation checklists and protocols to adhere to. The ranked power structure is clearly defined and consistent. Rank-and-file firefighters get close, almost individualized supervision, enhancing the possibility that unproductive work habits will be noted, and corrected, quickly.

For a person who has difficulty following directions (as well as starting and completing long-term projects) frequent oversight helps keep him or her on track and performing effectively. Clearly defined, short-term goals presented by the call-by-call nature of the work present repeated opportunities for success. Unfortunately, any theories about whether public safety work attracts an inordinate number of adults with adhd, and whether their symptoms can function to their (and the profession's) advantage, must remain, for now, conjecture.

"There has not been a study done, as far as I know, on career choice," says Dr. Michael Camfield, a neuropsychologist with Boulder, Colo.-based Neuropsychological Consultants. "When I think of the ideal job for someone with adhd, it would be one with a lot of change, a chance to work independently, and a lot of latitude. Someone who travels a lot, meets a lot of people."

"There is a tremendous amount about adult adhd that we don't know," adds Weyandt. "That's why you're hearing these different theories."

An initial study It's one thing to have these anecdotal reports, however, and it's another thing to prove something scientifically. Quite simply, more research must be done. As part of a National Fire Academy Executive Fire Officer Applied Research Project, I tried to determine if the rate of adhd might be higher among fire service personnel than among the general population. As a control, 12 published adhd works were reviewed and a mean percentage was obtained. While not precise, it was appropriate for beginning research.

One hundred and twenty-eight fire service personnel completed a 20-question survey based on the Hallowell and Ratey 20 Traits of Adult add. (Footnote: Hallowell, E.M. and J.J. Ratey, "Driven to Distraction." Pantheon Books: New York, 1994.) Both the responders and survey proctors were blinded to the subject matter; all were told this was an inventory of personality characteristics. Responders who identified 12 or more traits were considered to possibly meet the criteria for adhd given in the dsm-iv ("Diagnostic and Statistical Manual of Mental Disorders," 4th ed., published by the American Psychiatric Association).

The literature revealed a mean of 5.6% for the adult population, while the fire service sample revealed that 18.5% of responders answered yes to 12 or more of the traits (one sample t-test, p

Another interesting finding was the scores for female participants. Of 39 women who participated, three (7.67%) answered yes for 12 or more traits. which revealed a 2.5 to 1 male/female ratio. Although estimates in the literature of the male/female ratio have gone as high as 9 to 1, the National Institute of Mental Health suggests 2 to 1 or 3 to 1. This finding, therefore, although not statistically significant, is in line with current adhd research. (Footnote: Solden, S., "Women with attention deficit disorder." Underwood Books: Grass Valley, Calif., 1995.), (Footnote: Cohen, H.C., "Is there a Prevalence of Attention Deficit/Hyperactivity Disorder among ems/Fire Service Personnel?" Emmitsburg, Md.: National Fire Academy Executive Fire Officer Program Applied Research Project, 1997.)

More than 50% of those surveyed indicated that they identified with eight or more traits. The highest self-reported traits included:

* a frequent search for stimulation;

* a tendency to be creative, intuitive and highly intelligent;

* impatience, with low tolerance for frustration;

* an inability to gauge the impact they have on others; and

* other family members who exhibit similar behaviors.

These results have led me to continue this research as part of my doctoral studies. This study is comparing fire service professionals to non-public safety professionals. The results of this research should be available this fall.

Responding to ADHD Of course, how fire departments eventually respond to personnel with adhd is an emotional, economic and legal issue. Departments that refuse to address the issue of an employee with possible attention deficit hyperactivity disorder risk damage, perhaps resulting from substance abuse, to department property or injury to personnel. Those who fire a "problem" employee without exploring the reasons behind his or her unacceptable behavior risk losing an otherwise talented, dedicated firefighter.

And departments that refuse to reasonably accommodate an employee with such a disability risk costly litigation, because adhd is protected under the Americans with Disabilities Act. Since many departments have training facilities, they must be able to accommodate the academic challenges presented by a firefighter with adhd internally, or be able to find the means to do it elsewhere in the community.

Identifying firefighters and emts who may have adhd, and working with them to identify and eliminate negative behaviors, will take more time than simply writing them up for misbehavior or inconsistent work performance. But identification leads to education about treatments and behavior modification, and that, in turn, may lead to happier, healthier, more productive employees. It's the proverbial win-win situation.

A major confounding issue is using adhd as an excuse for poor performance or behavior. adhd care providers and coaches agree that adhd may be a condition, but it isn't an excuse. Those with adhd must still meet all standards of performance and behavior required by their department. Knowing that they have adhd may motivate employees to seek out the technologies needed to effect change.6 As noted, the traditional structure and supervision that are part of the fire service may themselves be therapeutic.

Further research would benefit not only departments, but, perhaps most importantly, rank-and-file firefighters and emts who've unknowingly been struggling with this frustrating, troublesome, but very treatable, disability. "It could help them better understand themselves, their symptoms, some of the problems they've been having," says Weyandt, enabling them "to gain control over a life that has been out of control."

People with adhd may show a number of classic symptoms, including:

* Difficulty concentrating.

* Trouble getting along with others.

* Difficulty with impulse control.

* Sleep disorders.

* Poor performance in school.

* High divorce rates.

* Depression and mood swings.

* Acting without considering the consequences.

* Explosive temper.

* Risk-taking, including risky sexual behavior.

* Physical restlessness.

* Marked creativity.

* Difficulty finishing long-term projects.

* High rates of substance abuse.

* Chronic traffic mishaps.

adhd can be diagnosed and treated by:

* Psychiatrists

* Pediatricians (some treat adhd adults)

* Family physicians

* Psychologists

* Family counselors

* Social workers

A number of treatments have been found to be effective for adhd:

* Medications (stimulants, anti-depressants)

* Psychological (cognitive, group or family therapy, counseling)

* Non-medical (vitamin supplements, diet, eeg biofeedback )

* Personal coaching (organizational, career and work skill-building)

* A combination of the above

* The National Institute of Mental Health publishes a free booklet titled "Attention Deficit Hyperactivity Disorder," nih Publication No. 96-3572. To request a copy, call 301-443-4513. It can also be downloaded from .

* A National Institutes of Health report from a November 1998 conference on adhd diagnosis and treatment can be downloaded from .

* Children and Adults with Attention Deficit/Hyperactivity Disorder, 8181 Professional Place, Suite 201, Landover, Md. 20785, 301-306-7070, .

* Kelly, K. and P. Ramundo, "You mean I'm not lazy, stupid or crazy?" Scribner: New York, 1995.