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.

Second 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 AI 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 studies, primarily focused on college students, seem to look at this, with recommendations for 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 its effectiveness for us.

June 17, 2017 2

Medication Metaphor: Tunnels

Imagine yourself inside a room full of tunnels.

You can look down any of them. Maybe you like this sense of freedom. Maybe you also find it distracting.

But now you have your ADHD medication.

Walls go up over all the tunnels except the one you’re facing.

When you turn your head, the wall for the last tunnel you faced slides up. The wall for the tunnel you now face slides down.

You can switch which tunnel you look down, but you can see only one tunnel at a time.

You can also see the tunnels with obstacles.

On medication, you find it’s easier to enter these previously-avoided tunnels (maybe because the more appealing tunnels have their walls up, keeping their temptations out of sight).

And once you enter one of these “harder” tunnels, the medication helps you stay there.

This is part of the experience of ADHD medication for many of those with ADHD, on the one that’s working for them.

May 21, 2017 0

Something Fishy

ADHD often 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 can mean low levels of both but, overall, higher levels of omega-6 to omega-3.

Now you may say, well, I just need to increase my omega-3 levels then, right? I wish it were so simple. Researchers have tried this with only some success. 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).

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

See here.

April 14, 2017 1

Marijuana + ADHD = ?

My husband read my post below and, essentially, said, “Huh?” He suggested I keep it simple and get right to the answer to the question posed above. Here it is: A big-deal study showed that, contrary to expectations, marijuana (mj) had no effect on ADHD-related brain differences. It had effects on the brain, of course, but these effects were separate from the effects of ADHD. Details and other results, which are the ones of more interest to me, below.

An impressive group of scholars got together to examine the mj + ADHD question using 21- to 25-year-olds followed since elementary school as part of a large multi-site longitudinal study of ADHD known as MTA. Comparing mj users (who used at least once/week) & non-users with & without ADHD, the group expected to find that mj intensifies ADHD-related brain alterations. They, essentially, thought mj would add insult to injury (the injury being the decreased “integrity of functional networks” seen with ADHD).

But they found no one-two punch.

ADHD was associated with decreased integrity of functional networks responsible for executive function and somatomotor control, but mj affected different functional networks.

Interesting to me is that one of the mj-affected networks was the default mode network, which, when you have ADHD, fails to cooperate with the task-positive network (for more on this). It raises the question of whether mj has an indirect effect on ADHD symptoms, even if no direct one. (The other mj-affected network was the lateral visual one.)

Also interesting to me is that ADHD was associated with INCREASED functional network integrity for two networks: 1) “stronger integration of right posterior parietal cortex” within the dorsal attention network & 2) “stronger integration of left inferior premotor region within the cingulo-opercular network.” For 1, think spatial orientation toward what’s relevant and, for 2, think maintaining alertness.

The researchers described the first strengthening (1 above) as “maladaptive” because of its association with slower processing speed for those without ADHD.

But they saw the second (2 above) as helpful and suggest it “may reflect a compensatory adaptation – the strengthening of connections or recruitment of additional brain regions” for the sake of “maintaining normal cognitive performance.”

In almost a side-note kind of way, they note that their data support that ADHD-related differences seen within the somatomotor network “are a good candidate for imaging-based prediction of ADHD diagnosis,” as suggested by earlier research. Wow.

Actual study here.

December 31, 2016 3

Show & Tell or Hide & Seek?

When one has a psychiatric diagnosis, questions about revelation come up. A search for answers around revealing ADHD brings up one: It depends.

What’s the context (work, school, home)? What’s the situation? Who are the parties involved (believers, non-believers, agnostics)? What are the stakes? Ultimately, what are the real pros and cons, short- and long-term? For ADHD, the only time I’ve seen the answer clearly lean toward “yes, tell” is at school for the purpose of working out accommodations.

At work, the answer may largely depend on the work culture. How much and what kind of diversity surrounds you?

How I wish we had more research examining the reality of telling vs. staying quiet.

December 17, 2016 1

Go, Go, Go and Slow, Slow, Slow?

A few years ago, researchers at MIT showed that adults with ADHD have two brain networks that compete for their attention instead of “playing nice,” as they do for adults without ADHD. These networks are essentially a go, go, go one that lights up when we have a task to do (“task-positive network”) and a slow, slow, slow one that activates when we have nothing to do and can daydream or let our minds wander (“default mode network”). Without ADHD, when one network has its turn to be active, the other one turns down…they cooperate. With ADHD, they appear to often be active at the same time. Imagine what that’s like. If you have ADHD, you already know. If only others could experience your brain to know what it’s like….

See for yourself.

December 2, 2016 1

Stuck On Your Carousel?

I have long loved carousels and, for some reason, began to love them even more after reading Ray Bradbury’s Something Wicked This Way Comes. I find them enchanting.

But when I get stuck going round and round riding the same beast (or moving from one to another on the carousel), I know it’s time to get off it.

How does anybody do this? First you have to notice that you’re on your carousel. This means identifying what’s on it.

What thoughts, emotions, etc. are the beasts that call you to it? If you have ADHD, these may include boredom, frustration, the thought “Why bother?” or “I’ll do it later.” Once you jump on one of these beasts, what does going round and round look like for you? Watching movies, playing video games, going online? Nothing wrong with these things.

If you know, though, that one round on the carousel is likely to lead to many others without your even noticing while it’s happening, consider seeing your carousel from a distance.

When you are off it, go ahead and try to create a visual of your carousel, including what thought, emotion, memory, etc. each beast represents and what behavior follows. Then when you jump on your carousel, you have a better chance of noticing this and choosing whether to keep riding or step off. And, unlike the poor souls of Bradbury’s story, you’ll be only minutes or hours older.

November 11, 2016 0

To get things started, add sugar…a spoonful or more

Just the other day, my husband played this song to our daughter, and I said, “Hey, Mary Poppins had it right.” As a mental health therapist running groups for adults diagnosed with ADHD, I encourage members to have fun with their tasks as much as possible. Turn up the pleasure, excitement, interest. Some will work outside or somewhere they find pleasant, some pair a reward with tasks and some work with others, even just as company. Some do all of these.

If you struggle to start something, remember Mary Poppins. And that some of us need a little more sugar than a spoonful.

November 7, 2016 0

“It’s like a room full of puppies and candies.”

Children often say it best.

My child said this as he heard me speaking about ADHD.

I asked him what he meant, and he said it’s what a room seems like to him. I asked him what an empty room seems like, and he described how he will notice the shapes, curves, and corners of the walls; bumps on the ceiling; light seeping under the door; and the texture of the floor, adding that carpet’s like a maze of threads. He concluded, “Even an empty room is filled with so much. It’s insane.”

November 5, 2016 1