Running head: COACHING THE MISSING LINK IN TREATING ADHD

Coaching: The Missing Link in Treating ADHD

Debra Y. Graham Certification Candidate Life Coaching Certification

July 2012

Debra Y. Graham

Running head: COACHING THE MISSING LINK IN TREATING ADHD

Abstract

Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD) is a condition with a certain set of characteristics that in some settings causes impairment. Despite efforts at comprehensive care, ADD/ADHD is a very humbling set of conditions for clinicians to treat. In other words, clients get better, but dont get well. Discouragement is common because of the frequent noncompliant client who understands what needs to be done but fails to accomplish his goals or tasks effectively and completely. Life coaching can provide the missing link to available, well-rounded treatment and support, and is increasingly used by therapists who treat ADD/ADHD as part of their treatment plan.

Debra Y. Graham

Running head: COACHING THE MISSING LINK IN TREATING ADHD

Coaching: The Missing Link in Treating ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a common condition with tremendous consequences to affected individuals. According to Craig Garfield, a researcher at Northwestern University and lead author of a study published in March 2012 in Academic Pediatrics, more children in the United States are being diagnosed with ADHD than ever before 10.4 million in 2010 alone. Academic, social and personal issues arise from the disorders manifestations, hampering personal growth and accomplishment of goals. Frequently, individuals diagnosed with ADHD are labeled by teachers, parents, coworkers and bosses as irresponsible and unreliable. Over time, this leads to erosion of self-confidence in those who suffer from ADHD. Those individuals often blame themselves for their shortcomings, impairing their ability to reach their goals successfully. Life coaches believe clients are resourceful and whole, and work from a clients strengths, accessing positive emotions. At the same time, coaches encourage clients to accept responsibility for past actions and to develop solutions to live more effectively in the present and the future. The gifts and talents associated with ADHD have led to the success of businessmen, artists, entrepreneurs, doctors, scientists and others with extraordinary ADHD minds. Creative thinking, high energy, charismatic sense of humor, brilliance and the ability to hyper-focus on desirable activities are apparent in many who struggle with ADHD (Hallowell and Ratey, J. 2005). Research has traditionally focused on diagnosis and treatment but has frequently overlooked the need for comprehensive multimodal treatment because of the difficulties of evaluation. Despite efforts at comprehensive care, ADHD is a very humbling set of conditions and difficult for clinicians to treat. Clinicians experience much discouragement due to frequent noncompliance among patients, who generally understand what needs to be done but fail to follow through on the behaviors needed to accomplish their treatment goals. Realistic expectations are crucial to success, and coaching has been found to be effective in the treatment of ADHD individuals (Josephson, 2010). A coach acts, in effect, as an external frontal cortex Debra Y. Graham

Running head: COACHING THE MISSING LINK IN TREATING ADHD the executive functioning area helping the individual to maintain arousal and remember motivation to succeed (Ratey, 2008). The Missing Link. Coaching can provide the missing link to available, well-rounded treatment and is increasingly used by therapists who treat ADHD. The organization Children

and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) is the nations leading nonprofit organization serving individuals with ADHD and their families. CHADD has consistently supported the addition of coaching in a patients treatment plan. ADHD coaches help clients with the disorder develop and implement practical strategies that help them attain their specific goals in either the personal or professional life, or both. As a new and emerging field, coaching continues to develop the educational and professional standards that have long existed in fields such as medicine, psychology, social work and other helping professions (Hallowell and Ratey, N. 1994). The Personal and Professional Coaches Association defines coaching as an ongoing relationship that focuses on the client taking action toward the realization of their vision, goals and desires. An effective life coach will keep a patient on track and accountable for goals on a regular basis. A coach will help a client prioritize goals and discuss with them how to accomplish their goals one step at a time. A coach can help remove obstacles that are overwhelming a client and impeding action. The combination of medicine, psychotherapy and coaching can enhance an ADHD patients chances of long-term success (Josephson, 2010). Coaching helps the ADHD individual by creating and implementing the tools needed to increase focus, to follow through on tasks and to manage time effectively. Rather than trying to cure the disorder, a coach works with the client to cope with the disorder and to strategize behavioral changes. By introducing helpful tools and organizational standards for dealing with their often weakened executive function skills, a coach teaches structure and accountability, creating programs on how to organize, approach tasks, and discover appropriate ways to think through resources and allocation (Ratey, N. 2008). If ADHD individuals can hold on to motive, remember the consequences and keep the reward in mind, they can move forward toward completing tasks and meeting goals (Ratey, N. 2008). Executive Functions. Executive functions are the skills an individual of any age must master to deal with everyday life. They include a vast array of critically important abilities, including Debra Y. Graham

Running head: COACHING THE MISSING LINK IN TREATING ADHD

handling frustration, starting and completing tasks, recalling and following multi-step directions, staying on track, planning, organizing and self-monitoring (Boorady, 2011). Common client problems include difficulty in initiating and completing tasks, disorganization, verbal or physical impulsiveness, time management, indecision, low tolerance of frustration and a cluttered work or living space. Purchasing a new planner or electronic organizer is in and of itself an ineffective solution to executive function issues. Clients need modeling, a routine, a planned work environment, instruction on breaking projects down into small tasks, support to organize steps and a system of rewards. A coach can help set realistic goals, set realistic consequences, and work on impulsive responses. A coach provides direct training in organization skills and task management, and instruction in breaking down large tasks into smaller and more manageable parts or sections. A coach teaches time management and awareness, using a timer and a set of exercises to enable the client to become more familiar and attuned to time. A coach will find the most effective way for a client to work with a planner, either paper or electronic. ADHD clients are frequently overwhelmed with tasks and consequently unable to complete them, and a coach will work with the client on prioritizing tasks, making daily goals attainable. Urgent deadlines with consequences are addressed first, and a list of important tasks is made that incorporates those activities and goals that will make the client feel good and successful. A coach will discuss both long-term and short-term goals with the client. This approach to designing individual strategies helps clients meet their responsibilities and goals. Clarifying goals and setting realistic expectations also helps a client with time structure. Breaking down strategies helps a client to feel less overwhelmed. Requiring accountability acts as a deadline and helps the client set and realize goals. A coach also helps a client find appropriate stimulus to focus on, which helps a client prioritize and sustain focus. Flash phone sessions help redirect the client back to focusing on tasks. Students with executive functioning deficits need coaching and feedback from professionals who understand an ADHD clients unique challenges and how best to teach the skills to address them (Eckerd, 2011). Coaching can help develop the skills that will lead to a positive outcome for the patient. The role of the coach fills the void by setting structure, prioritizing tasks and finding suitable ways to approach these tasks with evaluation. The coach and client work together to design and imprint upon the client the needed program for success. Debra Y. Graham

Running head: COACHING THE MISSING LINK IN TREATING ADHD

Motivational Training. Motivational training is important to the ADHD client, and a coach is crucial to cultivating motivation over a long period of time. Coaching can act as an external force in the executive functioning area to help the client maintain arousal and motivation to succeed in areas that were previously unattainable. Using coaching as a combined modality, often with pharmacology, will help the client focus. Cognitive Behavioral Therapy (CBT) or Acceptance Commitment Therapy (ACT) is often combined with a doctor prescribing medicine, when necessary, for ADHD patients. When the additional support of a life coach is added to the two strategies above, a higher rate of success is reported. Frequent contact with a warm and enthusiastic coach assists a patients motivation by looking clearly at the consequences of uncompleted tasks and responsibilities, and in establishing positive rewards for tasks completed. A supportive coach will help a client set goals while posing probing questions that unearth the roadblocks preventing success. A coach provides active listening and intelligent questioning, which helps clients tap into their own wisdom and holds a client accountable for his goals. Kevins Story. The story of Kevin, a young adult male in his early twenties, is a case study in the effectiveness of combining coaching with psychopharmacology and psychology in treating clients with ADHD. Kevin was enrolled in a well-known university in Washington, D.C. Kevin reported back to his family in New York City that all was going smoothly his first year away at school. He reported that his classes were interesting and doable. He was doing well socially and academically and was having a successful freshman year. During school breaks, Kevin would return home to New York City and accompany his family on vacations to destinations including Israel, Switzerland and the Hamptons. All seemed normal. During the summer months, Kevins father inquired about Kevins grades before paying the upcoming years tuition. At this point, his father discovered that Kevin had neither attended his classes, nor did any course work or took any exams. Needless to say, Kevin received no credit for his freshman year from the university. His parents told him that before he could return to that school, he needed to register for two classes at a local university and work in tandem with a coach to ensure success. If these requirements were not met, he would not be going back to the university in the fall. Kevin was immediately sent to a New York psychologist, Dr. Stephen Josephson, who diagnosed Kevin with ADHD. He sent Kevin to a psycho-pharmacologist, who prescribed medication to help lower his distractibility, and to a life coach specializing in clients with ADHD. The triad was in place. The life coach portion of the triad helped Kevin implement Debra Y. Graham

Running head: COACHING THE MISSING LINK IN TREATING ADHD

the necessary tools to enhance his executive functioning abilities, encourage him to keep on task, and realize that his goals were attainable. With Kevins medication in place, he met weekly with his psychologist to discuss shame, resistance, blame and entitlement. Kevin also began meeting weekly with his coach. Together they planned out detailed routines, created working strategies, broke down tasks into organized steps and set realistic goals. The weekly meetings were supported by two or three additional weekly flash session meetings, conducted by phone. The flash sessions were set up to ensure Kevins accountability and to determine if he were meeting his goals. What tools could be used to accomplish his goals? What was contributing to his distraction? If Kevin had a difficult time starting and completing his homework, his coach used a timer to keep him on task. Set for just 30 minutes, the timer required Kevin to stay immersed in his work. When he became frustrated, his coach would encourage him and together they would set smaller goals. When those were accomplished, bigger goals were added until they were met without anxiety and failure. The continued impact of positive encouragement, implementation of tools, routine, breaking down tasks, creating strategies, organizing steps and rewards were all part of the coachs work with the client. After an initial period of success, Kevin again fell behind and it became difficult for him to keep up with his work. The coach increased the number of flash sessions and offered encouragement until Kevin was back into the rhythm and routine that had proven successful before. After one-and-one-half years of coaching, Kevin was able to manage the process on his own. He is now a college graduate and owner of a successful business. The guidance and encouragement of coaching, coupled with the tools he needed, led to Kevins success. Conclusion. The missing link in treatment of ADHD has been coaching, which is now being integrated as part of the triad of support for clients. Coaching starts a client on the path of accomplishment that previously was unattainable without stress and anxiety. Working with a coach teaches the client how to organize and approach tasks and time, and how to allocate resources and use tools effectively. The ability to consistently apply strategies and programs taught by a coach will result in a clients success throughout his career and personal relationships.

Debra Y. Graham

Running head: COACHING THE MISSING LINK IN TREATING ADHD

References Albano, A., & Pimentel, S. S. (2010, November). ABCT Annual Convention. Retrieved from www.anxietytreatment.org doi: www.anxietytreatment.org Barkley, R. A. (2006). Attention-deficit hyperactivity disorder [Pamphlet]. The Guilford Press. Beck, M. (2010, April 6) ADHD: Why more adults are being diagnosed. The Wall Street Journal. Boorady, R. (2011, Spring). Executive Function Deficits in Children. ADDitude Magazine. Eckerd, M. (2011, Spring). Executive Function Deficits in Children. ADDitude Magazine. Hartman, T. (1998). Healing ADD. Underwood-Miller. Hallowell, E.M. & Ratey. N. (1994). Living with ADHD: A lifespan disorder: Coaching for adults with ADHD. www.help4adhd.org/en/living/coaching/WWK18. Hallowell, E.M. & Ratey. J. (2005) Delivered from Distraction. Random House. Josephson, S. (2010). Comprehensive Treatment of Three Patients with Comorbid OCPD and ADHD [Personal interview]. Kelly, K., & Ramundo, P. (2006). You Mean I'm Not Lazy, Stupid, or Crazy? Simon & Schuster. Kolberg, J., & Nadeau, K. (2002). ADD - Friendly Ways to Organize Your Life. BrunnerRoutledge. Nadeau, K. (1996). Adventures in Fast Forward. Brunner/Mazel. Neenan, M. (2002). Life Coaching: A Cognitive Approach. Routeledge. Novotini, M., & Whiteman, T. (2003). Adult AD/HD Revised and Updated. Pinon Press. Ratey, N. A. (2008). The disorganized mind: Coaching your ADHD brain to take control of your time, tasks, and talents. New York: St. Martin's Griffin. Solanto, M. V. (2011). Cognitive-Behavioral Therapy for Adult ADHD. The Guilford Press.

Debra Y. Graham

Running head: COACHING THE MISSING LINK IN TREATING ADHD

Appendix: Josephson Interview 2010 How long have you been in practice? What is your speciality? Do you treat both adults and children? What percentage of your patients are ADD/ADHD? Are most of your patients who are ADD/ADHD on medication? Are you ADD/ADHD? Please describe ADD/ADHD and their differences? What are their strengths? What are their weaknesses? Can people who are ADD/ADHD learn to cope with their weaknesses? Do you treat both children and adults with ADD/ADHD? What is your method of treating your patients with ADD/ADHD? What is CBT therapy? What is ACT therapy? What is the most difficult thing to get across to your patients? Have you been successful treating these patients? What do you wish for these patients? Do you use coaches in your practice to help support the work you are doing with your patients? How has it been beneficial to your patients? How can coaches help support your patients? Do you think that coaching ADD/ADHD id the missing link in helping them reach their full potential?

Debra Y. Graham

Running head: COACHING THE MISSING LINK IN TREATING ADHD

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Debra Y. Graham