Does ADHD Coaching Work?

There are three things to know about coaching.

First, if you read Russell Barkley, scholar and researcher on ADHD, the idea of coaching makes sense.  Barkley argues that what you need with ADHD is something external to guide your behavior right at the moment that the behavior’s needed.

Imagine you need to study for a job interview you have the next day and you are about to surf online.  Right at that moment, with your fingers poised to tap the keyboard, you need something external to stop you (or to guide you toward stopping).  This something will then need to remind you of your interview and reinforce studying over surfing.  This is ideally what a coach does…guides your behavior at the moment it most matters, which is when you play the game…of job-seeking or whatever it is.

A coach guides your action as it is happening.

baseball-1536097_1920Second thing to know is that the reality of ADHD coaching appears to approximate this at best.

You can get a coach working with you multiple times a week and the work can center around where you most struggle.  But, at best, it’s like having a coach available by phone some of the times you play the game.  It’s just unrealistic to have the ideal kind of coaching…unless you’re wealthy and want to pay someone to be with you, guiding your behavior at various points of the day, as needed.  Perhaps one day, we’ll have robots do this for us, should we choose…hmm.

The third thing to know is that the research on what makes for an effective ADHD coach is sorely lacking.  Only a few exploratory kind of studies, primarily focused on college students, seem to look at this, with the recommendation for future larger scale, more rigorous research.  So while you can find folks credentialed to be an ADHD coach, there’s no real research showing coaching clearly works and under what circumstances.

This leaves us all figuring out for ourselves, if we pursue coaching, whether it’s working. Actually, even if research clearly said it’s likely to be effective for most, we’d still have to figure out whether it was effective for us.

Fidgeting: Spin vs. Science

My local Memorial weekend festival had fidget spinners for sale, ranging from $12 to over $20, advertised to help with ADHD, anxiety and more.  It left me wondering what we know about their effectiveness.  It turns out very little.  On my go-to research source, pubmed, I could find no single study on fidget spinners or their kin (cubes, etc.).  But NPR published two articles exactly two years apart, one on fidget spinners and one on fidgeting.  ball-1023984_1920

On May 14, 2017, NPR published an article on fidget spinners.  Essentially, the article quotes a Duke professor suggesting to stick with what’s known to work.

The professor points out that there’s no evidence that fidget spinners work.  Though it’s said, what seems perhaps buried or likely to be easily overlooked is that the reason there’s no evidence is that there’s actually no trustworthy research on them.  See here.

Meanwhile, two years earlier, on May 14, 2015, NPR published an article describing a small study that shows that children with ADHD performed better on tasks requiring concentration when they fidgeted.  Specifically, the children worked while on a swivel chair that they, of course, spun and moved.

Overall, more movement meant better performance for these kids (kids without ADHD, on the other hand, did worse with movement).  The lead author, however, cautioned against both too little and too much movement.  See here.

Perhaps fidget spinners would fall into too much movement or the wrong kind (attracting eyes as well as fingers), but it’d be interesting to see some real research on them.  (Real added for my teenage son, who wanted me to buy a fidget spinner at the carnival.)

Medication Metaphor

A few weeks ago, I asked my teenage son what he noticed after trying Concerta for three days.  In true form, he answered with a metaphor.

He asked me to imagine him inside a room.led-lighting-1846929_1920

Off the medication, he can look down many tunnels.

On it, walls go up over all but one of the tunnels, the one he’s looking down at the moment.

He can switch which tunnel he looks down, but he’s forced to see only one tunnel at a time.  And he knows he’s forced because he wants to see down the other tunnels but is unable.

Me:  “Do you know what you’re describing?”

Son:  “What?”

Me:  “The rest of us, without ADHD.  How our brains work…or at least mine.”

Son:  “How can you live like that?”

I then mentioned that, when he sees all the tunnels, he goes down the ones that look more exciting to him and stays away from ones he needs to go down, such as a “homework tunnel.”

He said yeah, he stays away from ones with “obstacles.”  Then he shared that actually the medication has made it no easier to start down a tunnel with obstacles.  Instead, once he starts down one of the tunnels with obstacles, the medication makes it harder to leave.

This was after only a three-day trial.  We’re unsure what his experience would have been after a longer period.

Something Fishy

ADHD comes with omega-3 and omega-6 fatty acid deficiencies.

But upping your omega-3 and omega-6 fatty acids may have little effect on your ADHD symptoms.  What gives? Recent research reveals that it’s all about the ratio.

ADHD means low levels of both but overall higher levels of omega-6 to omega-3.

So now you may say, well, I just need to increase my omega-3 levels, right? Oh, how I wish it were so simple.  Researchers have tried this with only some succesfish-2207845_1920s.  A supplement heavier on the omega-3 than omega-6 side may be better, as indicated by a study that found benefit from giving participants an omega-3/6 supplement containing mostly EPA and DHA (omega-3), with only 60mg of LA (omega-6).

Still, it seems you’re best off knowing your ratio.  And then knowing how much omega-3 (EPA and DHA, specifically) and omega-6 (LA or AA, specifically) you need to optimize it.

See here.

It’s nothing personal.

This is for the loved ones of those with ADHD.

Yesterday, I sat with my husband and tried to just talk.  We are so busy doing things, we hardly ever just talk.  Ten minutes into it, I could tell his mind was elsewhere.  I let him know it looked like he was somewhere else mentally.  He said he was.  I asked what was going on, and he said he was “bored.”  “Ouch,” I said.

Then I remembered something.  It’s nothing personal.  I know hong-kong-1990268_1920what I tried to share with him would be quite fascinating to another psychology-lover.  But my husband has ADHD and becomes easily bored with things less exciting than a book such as The Martian.

He also prefers action to talk.  It’s hard to keep his attention.

As Thom Hartmann points out (The Edison Gene), those with ADHD constantly monitor the environment for what’s of high stimulation, with a swift ability to turn to these things.  If this high stimulation or need to act is lacking, they may shut down on you.  Kind of like your computer going into sleep mode.  When this happens, breathe and begin breakdancing or relax and remind yourself it’s nothing personal.  Really.  Their brains are just tuned to a different frequency.

 

Medicating Children

As the mother of a teenager with ADHD soon entering high school, I want to know the pros and cons of medication.  If you are a parenpill-1254786t reading this, you likely do, too.  And I will admit, I’m torn.

The research seems too unfinished for me to rely on it as much as I might like.

Consider that over 40 scholars from the UK, USA, Denmark, Italy, Germany, Switzerland and Australia (told you it’s big) will be reviewing  various “pharmacological interventions” to rank how well they work and their “tolerability profiles,” looking at these things for children, teens and adults.  The scholars note that “there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank” with regard to their ability to deliver desired results and to do so with tolerable side effects.  See more here.

But do we keep waiting for what seem to be more definitive answers? At what cost?

Consider this…recent research suggests that school could be a more rewarding experience for children and teens with ADHD who use medication for their symptoms.  Examining about 10, 0000 12-year-old twins, some who’d been followed since 7 years of age, researchers found that medication-free children with ADHD showed lower educational achievement than children with ADHD using methylphenidate (Ritalin, Concerta), who showed lower educational achievement than children without ADHD.  That is, ADHD appeared to lead to lower educational achievement but especially so if it was unmedicated ADHD.  Plus ADHD symptoms also predicted a negative educational trajectory from 14 to 16 years of age.  See study here.

Where does this leave us as parents wanting our children to have the best chance at achieving what deep down really matters to them?

It leaves me leaning toward the test of experience.  I am willing to let my teen, when wishing to do so, swallow a pill as I (figuratively) swallow mine.

Meanwhile, I will keep combing the research….