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In Adult ADHD, Abigail Levrini and Frances Prevatt demonstrate and discuss their approach to ADHD coaching with adults.
ADHD coaching derives from the model used in executive coaching and athletics to help improve performance. Unlike most traditional psychotherapeutic approaches, this is an active and results-oriented modality that focusses on giving clients realistic and proven strategies they can start using immediately. The approach involves helping clients deal with aspects of ADHD that interfere with work or academic performance such as procrastination, lack of concentration, and poor planning. Useful strategies include teaching organizational, time management, and study skills, and helping to establish goals.
The video begins with a general explanation of ADHD coaching. Then, Dr. Levrini works with a man in his 20s, recently diagnosed with ADHD, who seeks assistance in overcoming distractions and managing his time better. After the demonstration, she and Dr. Prevatt sit with a roundtable of graduate students to discuss and expand on the strategies and techniques used in the coaching session.
ADHD coaching helps the individual to problem-solve various manifestations of their disability (Quinn, Ratey, & Maitland, 2000) and a growing amount of research suggests its utility. ADHD coaching derives from the coaching model used in executive coaching and athletics, the latter which has also been the impetus for life skills coaching (Quinn et al., 2000).
ADHD coaching involves two primary theories, cognitive-behavioral therapy and psychoeducation, using the principles of the former and the strategies of the later to target areas of impairment that interfere with academic performance and coping with difficulties such as procrastination, lack of concentration, ineffective self-regulation, poor planning, anxiety, social incompetence, or time management. Useful strategies for adults with ADHD to learn include organizational skills, time-management, goal setting, and specific study skills (Finn, 1998; Willis, Hoben, & Myette, 1995).
As opposed to traditional counseling and psychotherapeutic methods, ADHD coaching puts the clients' needs and interests at the center, fitting the program to the student rather than fitting the student to the system, extending to all aspects of ADHD individuals' life (McCormick, 1998).
According to Jaska & Ratey (1999), the ADHD coach and client have a structured, goal-driven, strategy-oriented relationship. Goal completion and strategy building are the most important aspects of the coaching process (Jaska & Ratey, 1999).
The focus is on developing strategies and skills to become more effective in everyday life. Each client receives very individualized help. Different clients may require help in different areas of life (e.g. school, work, nutrition, exercise, stress management, relationships, etc.).
For each of these areas, the client and coach both agree on set strategies. It is the coach's job to help the client understand how ADHD impacts their behavior and then encourage the client's motivation and active involvement in making changes to this behavior. The coach also elicits creative strategies to serve the needs of the client.
An important starting point in the treatment process is education about ADHD. Learning about ADHD is especially important at the outset of treatment but should be viewed as having ongoing value as the disorder plays out over time and across situations. The more patients know about the disorder and how it specifically affects them, the better they will be able to devise individualized treatments targeting their highest-priority goals.
The pervasive impact of ADHD needs to be explained explicitly to patients as a way of helping them to understand the disorder. A sound knowledge base can help patients, spouses, parents, and family members cope more effectively, help patients make sense of what has been impairing them, and assist them in setting realistic treatment goals.
As part of the educational process, patients also need to understand that they are a potent force in their treatment and that what they do from here on out will have a significant influence on their outcome. It is very much a collaborative give-and-take process between therapists and patients.
The initial meeting between the coach and each participant is used to explain the processes of coaching and cognitive training, discuss confidentiality, discuss the participant's needs and goals, and establish guidelines for the coach-client relationship. The initial meeting also establishes frequency, duration, and methods of contact between the coach and participants.
Unless special circumstances are needed, clients meet with the coach once per week for one hour, in order to establish some consistency. In accordance with the coaching philosophy, the client determines the details of communication, which can include phone calls, and/or emails as reminders and encouragement to complete goals.
Also within the first meeting, rewards and consequences are established for the attainment or lack of attainment of weekly objectives and long-term goals, which are written down and signed by both coach and participant. Two to three long-term goals are established as overall indicators of the participant's performance during the coaching process, and tangible possible achievements for the participant. This amount has proven to be the most effective (Swartz et al., 2005), as more than three goals tends to be difficult to manage, especially for those clients who have a hard time planning and structuring.
These goals, as well as short term goals, are required to be measurable, observable, specific, reasonable, and motivating to the participant (Swartz et al., 2005). Furthermore, the long term goals are designed to extend past the eight weeks of coaching.
Weekly sessions involve strategizing about the client's behaviors, including discussion of obstacles, problem-solving solutions for overcoming areas of difficulty, modifying consequences, cognitive training sessions, and utilizing each week's events as a stimulus for future actions. Weekly goals are established, beginning with the initial meeting, and each meeting thereafter.
These objectives serve as smaller, more attainable steps toward achieving a more long term goal. Examples of these types of goals include passing an upcoming quiz or not going out to dinner in order to save money. Progress on weekly objectives can be charted for visual representation of goal achievement.
Feedback given by the coach is carefully tailored depending on its effect on the client. Often, especially at the beginning of the coaching process, positive reinforcement is necessary to help foster self-esteem and motivate individuals with ADHD (Fiore, Becker, & Nero, 1993). The coaches questioning format models cognitive prompts that participants should ideally internalize and independently use to compensate for their deficits in executive functioning. Ultimately, the intervention is designed to transfer responsibility for change to the participants.
Throughout the coaching and cognitive training process, a system of rewards and consequences is used to help participants regularly attend sessions, successfully achieve weekly objectives, and likewise, their long term goals. As with the development of goals, rewards and consequences are set up by the participants themselves, with little help from the coach. Consequences may include anything from having to drink a glass of milk for a milk despising client, to not allowing time to relax and watch television.
Individuals with ADHD perform best with clear expectations and immediate feedback (Fiore, Becker, & Nero, 1993). Generally, the more structure and routine incorporated into one's life, the better. It helps to have explicitly stated goals, specific methods for accomplishing goals, and specific time frames for meeting goals. Implementing behavioral strategies targeting the most impairing problems can help clients gain better control over their life, reduce anxiety, and improve productivity.
As stated earlier, the ultimate objective in coaching is to help adults who have ADHD to take charge and initiate change in their life, learn to set realistic goals, and learn to follow through and stay the course until tasks are completed (Ratay, 2002).
For example, teaching a college student time management and organizational strategies should not be viewed as providing a short-term solution to achieve a grade, pass a test, or otherwise complete some immediate task. Instead, it should be taught in the context of life training.
These are skills and habits that when put into practice regularly as part of a daily routine will serve the person well in all aspects of life, including home, work, social, and daily adaptive functioning.
- Finn, J.D. (1998). Parental Engagement That Makes a Difference. Educational Leadership 55(8), 20–24.
- Fiore, T., Becker, E. A., & Nero, R. C. (1993). Educational interventions for students with attention deficit disorder. Exceptional Children, 60, 163–173.
- Jaska, P. & Ratey, N. (1999). Therapy and ADD coaching: Similarities, differences, and collaboration. FOCUS Archives. Retrieved from http://www.add.org.
- McCormick, A. (1998). Retention interventions for college students with AD/HD. In P.O. Quinn & A. McCormick (Eds.), Rethinking ADD/HD: A Guide to Fostering Success in Students with AD/HD at the College Level (pp. 48–63). Bethesda, MD: Advantage Books.
- Quinn, P. O., Ratey, N. A., & Maitland, T. L. (2000). Coaching college students with AD/HD: Issues and answers. Silver Spring, MD: Advantage Books.
- Ratey, N. A. (2002). Life coaching for adult ADHD. In S. Goldstein & A. Teeter Ellison (Eds.), Clinician's guide to adult ADHD: Assessment and intervention. San Diego: Academic Press.
- Swartz, S., Prevatt, F., & Proctor, B.E. (2005). A coaching intervention for college students with Attention Deficit/Hyperactivity Disorder. Psychology in the Schools, 42, 647–655.
- Willis, C., Hoben, S., & Myette, P. (1995). Devising a supportive climate based on clinical vignettes of college students with Attention Deficit Disorder. The Association on Higher Education and Disability - Journal of Postsecondary Learning Disability,11(2–3), 1–33.
Abigail Levrini, PhD, is a licensed clinical psychologist and ADHD specialist with nearly a decade of experience as an ADHD Coach and counselor.
Dr. Levrini has published numerous scientific articles on ADHD and presented her coaching model in professional settings throughout the country.
Dr. Levrini was a featured speaker at the 2009 International CHADD Convention in Cleveland, Ohio (Children and Adults with ADHD). She served as the Board President for the Northern Virginia/DC Chapter of CHADD, and is the author of the self-help book Succeeding With Adult ADHD: Daily Strategies to Help You Achieve Your Goals and Manage Your Life (APA, 2012).
Frances Prevatt, PhD, is a professor in the Department of Educational Psychology and Learning Systems at Florida State University and the Executive Director of the Adult Learning Evaluation Center (ALEC). ALEC provides assessments and interventions to college students and young adults with ADHD, provides training to graduate students, and is the setting for many research projects dealing with ADHD. She was on the faculty at Texas A&M University for 15 years before moving to Florida State University.
Dr. Prevatt has authored over 70 publications in the field of educational psychology.
Further information about Dr. Prevatt and ALEC can be found on the Adult Learning Evaluation Center Website.
- Attitude: Living Well with Attention Deficit. Goal setting for ADHD adults. Retrieved from http://www.additudemag.com/adhdblogs/3/4166.html
- Barkley, R. (1997). ADHD and the nature of self-control. New York: Guilford Press.
- Dawson, P. & Guare, R. (2000). Coaching the ADHD student. North Tonawanda, NY: Multi Health Systems, Inc.
- Kolberg, J., & Nadeau, K. (2002). ADD-friendly ways to organize your life. New York: Brunner-Routledge.
- Prevatt, F., & Lee, J. (2009). Challenges in conducting ADHD coaching with college students: A case study. The ADHD Report, 17(4), 4–8.
- Prevatt, F., Lampropoulos, G. K., Bowles, V., & Garrett, L. (2011). The use of between session assignments in ADHD coaching with college students. Journal of Attention Disorders, 15, 18–27.
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